By: The My Medicare Matters Team
While most people 65 and older get their health care through Medicare, if you are a veteran (or family member of a veteran) you are eligible for additional healthcare options that can provide coverage in addition to Medicare. You may already have healthcare coverage either through VA benefits (administered through the Department of Veterans Affairs), TRICARE (administered through the Department of Defense) or CHAMPVA (administered by the Department of Veterans Affairs Chief Business Office Purchased Care), so Medicare can coordinate with these programs in different ways.
This post will help guide you through using your Medicare in conjunction with your existing veteran healthcare options.
I have VA benefits. Do I need to enroll in Medicare Part A and Part B?
It’s often advisable to join Part A and Part B if you’re eligible for it at age 65 since it covers inpatient hospitalizations, hospice, skilled nursing care, and outpatient care from non-VA providers. Enrolling can prevent gaps in coverage and help you avoid Medicare late enrollment penalties if you decide to join later. Part A is typically free for most people and Part B has a monthly premium.
However, if you are enrolling in TRICARE For Life you must be enrolled in Orginal Medicare (Parts A & B).
How do Medicare and VA benefits work together?
Medicare and VA benefits rarely coordinate benefits which is why Veterans with VA benefits are encouraged to enroll in Medicare Parts A & B. Medicare does not cover services received at VA facilities and the VA will not pay for services obtained from non-VA providers (doctors and hospitals). Veterans who want treatment or care from non-VA providers should join Medicare Parts A & B.
Keep in mind, not all veterans are eligible for the same level of VA services. VA priorities may shift based on congressional appropriations, and veterans in lower-level priorities could see changes (possibly decreases) in their benefits over the years. If a veteran were to lose their VA coverage and join Medicare Parts A & B, then the 10% late enrollment penalties would apply for Parts A & B for each year of delayed enrollment.
I have both Medicare and VA coverage. Who pays first?
If you have both Medicare and VA benefits, your eligible for treatment under either program. You must select which system to use each time you receive any form of healthcare. Medicare only pays for care delivered by Medicare-certified facilities. To get the VA to pay for services, you must go to a VA facility or have the VA authorize services in a non-VA facility. If the VA authorizes services in a non-VA hospital but doesn’t pay for all of the services you get during your hospital stay, then Medicare may pay for a portion of Medicare-covered services.
I get my prescriptions from the VA. Do I need Medicare Part D prescription drug coverage?
Typically, veterans use the VA prescription drug benefits instead of Medicare Part D because it has lower out-of-pocket costs than Medicare Part D. However, anyone who is enrolled in Medicare Part A and/or B can join Medicare Part D. You may want to consider joining if any of these situations apply to you:
- Your prescriptions are not listed on the VA’s covered drugs list, also called a “formulary”
- You take prescription drugs prescribed by non-VA physicians and fill the prescriptions at a local retail pharmacy
- You qualify for Medicare’s Extra Help program, and therefore Part D offers drug copayments lower than VA copayments
VA and TRICARE coverage is creditable coverage, meaning there are no late enrollment penalties for joining Part D later.
To learn more about your VA benefits and Medicare enrollment choices you should contact the Department of Veterans Affairs. If you need help selecting a Medicare plan that works with your Veterans benefits try taking our Medicare Questionnaire assessment, which can connect you to free professional advice about Medicare from a licensed benefits advisor. You can also call your local State Health Insurance Assistance Program (SHIP) for federally-funded Medicare counseling.