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Veterans with VA Benefits

If you are a veteran or family member of a veteran, you may have health care coverage either through VA benefits (administered through the Department of Veterans Affairs) or TRICARE (administered through the Department of Defense). Medicare coordinates with these two programs in different ways.

The following are common questions about how VA benefits work with Medicare.

I have VA benefits. Do I need to enroll in Medicare?

Generally, if you have VA benefits, you should also enroll in Medicare Parts A and B to guarantee coverage outside the Veterans Affairs system. In almost all cases, Medicare and VA benefits work separately.

Although you should probably enroll in Medicare Parts A and B, you may not wish to enroll in a Medicare private drug plan (Part D) if you have VA benefits. Veterans’ prescription drug coverage is more comprehensive than Medicare drug coverage and charges no premiums and no or limited copayments for prescriptions. In addition, if you ever do want to enroll in Part D later on, VA drug coverage is considered as good as the Medicare drug benefit (“creditable coverage”) so you will not have to pay a penalty as long as you enroll in the Medicare drug benefit within 63 days of losing veterans’ benefits. However, if you live very far away from a VA medical facility and the Medicare private drug plan includes nearby pharmacies in its network, you may want to enroll in a Medicare drug plan sooner.

It is important that before you do anything, you should talk to your VA or benefits administrator to learn how Medicare enrollment affects your coverage.

To learn more about your VA benefits and Medicare enrollment, contact the Department of Veterans Affairs online or at 1-877-222-8387.

Aon Hewitt Navigators® is a Medicare insurance brokerage service recommended by NCOA because it meets rigorous Standards of Excellence established by NCOA. You may be eligible for personal one-on-one assistance in selecting and enrolling in health coverage. All of the services are provided at no cost to consumers. Check to see if you are eligible.

I have both Medicare and VA coverage. Who pays first?

If you have or can get both Medicare and VA benefits, you can get treatment under either program. But you must choose which benefits to use each time you see a doctor or get health care. Medicare can't pay for the same services covered by Veterans' benefits, and your Veterans' benefits can't pay for the same services covered by Medicare.

To get the U.S. Department of Veterans Affairs (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 the Medicare-covered part of the services the VA doesn't pay for. Medicare may also be able to pay all or part of your copayment if you're billed for VA-authorized care by a doctor or hospital who isn't part of the VA.

You can learn more about this in the official Medicare publication, Who Pays First?

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