Medicare and VA Benefits
Veterans frequently ask if they need both Medicare and VA benefits, with a particular focus on whether Medicare Part B is necessary. Since Part B comes with a monthly premium, many veterans are unsure if it’s worth the cost.
It’s common for individuals to have both Medicare and VA benefits. Although these two types of coverage don’t work together, each is valuable on its own, as I’ll explain further.In my view, the answer is a strong "Yes, you should sign up for both Medicare Parts A and B." (I also recommend looking into supplemental coverage, but I’ll address that later.)
The VA’s website clearly states that VA benefits are not considered health insurance, and it encourages veterans to enroll in Medicare. This is because Medicare can offer healthcare benefits that might be necessary in the future. Each program offers unique advantages that the other does not.
For example, many veterans rely on their VA health benefits for services that Original Medicare doesn’t cover, such as certain over-the-counter medications and hearing aids.
Conversely, having Medicare Part B ensures that Medicare can cover elective services outside of the VA healthcare system. This is particularly important to me, as my father is a Vietnam veteran. I made sure he enrolled in both Medicare Parts A and B, along with a Medigap plan, for several important reasons.
Let’s explore some of those reasons:
Freedom to see non-VA Doctors and Hospitals
Veterans who rely solely on VA coverage often find that non-emergency treatment is typically only available at VA facilities, with outside referrals not always guaranteed.
Many veterans prefer using Medicare to visit local civilian doctors for minor issues, especially if VA clinics are far away or have long wait times.
Medicare offers access to hundreds of thousands of providers, including top specialists. If you’re diagnosed with a serious condition, Medicare allows you to seek care from experts outside the VA system.
Regarding medications, the VA drug formulary covers only about 60% of what Medicare Part D offers. While veterans should use VA benefits for maintenance drugs, having a Part D plan for short-term or specialty medications not covered by the VA is advisable. Here are 7 Things you should know about Part D coverage.
Additionally, prescriptions from civilian doctors cannot be filled at the VA without first consulting a VA doctor and obtaining a new prescription.
Not all VA Benefits are the Same
Another common reason veterans opt for Medicare is the variability of VA benefits. Eligibility is divided into eight priority levels, with some veterans receiving higher priority due to service-related health conditions or income levels. Comprehensive medical benefits are generally reserved for those with service-connected disabilities and low income.
VA benefits can differ by region and are subject to change depending on federal government funding.
There's always a risk that your benefits could be reduced in the future. In such a case, having Medicare as an alternative would be advantageous. While you can enroll in Medicare later, doing so may come with additional costs.
Avoid Medicare Penalties
Enrolling in Medicare as soon as you're eligible is crucial to avoiding significant penalties. You have a limited window to sign up for Medicare Part B, usually starting at age 65. It's important to note that VA coverage does not exempt you from the Medicare Part B late enrollment penalty if you delay enrollment. This penalty is 10% of the standard premium for each year you delay, and even a few years of waiting can result in substantial costs.
Adding to the challenge, if you miss your initial enrollment period, you must wait until the General Enrollment Period in January to apply for Part B. Coverage then won’t begin until the 1st of the month following your application. This delay can be frustrating if you’re trying to access civilian healthcare providers through Medicare, making it a risky gamble to postpone enrollment.
Eligibility for Medigap
Once you're enrolled in both Medicare Parts A and B, you become eligible for supplemental insurance options, such as a Medigap policy or Medicare Advantage plan. Medigap provides additional protection against high medical expenses, particularly if you need specialized treatment.
Eligibility for Medicare Advantage
Enrolling in a Medicare Advantage plan is also a popular choice among veterans. Many of these plans come with a $0 premium and offer valuable extra benefits, such as gym memberships and vision coverage. However, you must be enrolled in both Medicare Parts A and B to qualify for a Medicare Advantage plan. This option expands your coverage choices and often includes Part D prescription drug coverage. If a civilian doctor prescribes a medication that the VA doesn't cover, your Medicare Part D, included in many Medicare Advantage plans, may cover it.
It's important to remember that Medicare and VA benefits are mutually exclusive—Medicare cannot cover care received at a VA facility, and the VA generally won't pay for services at a Medicare-certified facility. Therefore, veterans should carefully evaluate their coverage options. A knowledgeable Strive Medicare licensed agent can assist you in finding the supplemental coverage that best meets your needs.
If you're unsure whether to enroll in Medicare alongside your VA benefits, we're here to help. Contact us today to learn more about how Medicare and VA coverage can work together for you.