medicare options for veterans

Medicare Options for Veterans

If you are a veteran, meaning you served active duty in the U.S. Armed forces, you may be eligible for both Veterans Affairs(VA) benefits and Medicare. 

To be eligible for VA benefits, you must have served your country for a certain period of time, received an honorable discharge, and qualify based on your income status. Note that care for all disabilities related to your military service is free, regardless of your income. The cost of other medical care depends on the priority group the VA assigns you. Administered by the federal government, VA benefits include pensions, educational stipends, health care, and other benefits. While it is essential to know that VA benefits do not work with Medicare, you can be enrolled in both.

VA Benefits Basics

VA health benefits cover care provided mainly in VA medical centers, VA outpatient clinics, and VA nursing homes. Veterans can receive care at any VA facility, and health benefits can include coverage for:

  • Medical and mental health care (including substance abuse treatment)
  • Home health care
  • Nursing home care
  • Durable medical equipment
  • Medicare-excluded items (including over-the-counter medications and supplies, annual physical exams, hearing aids, and eyeglasses under certain circumstances)

Suppose you have VA benefits and become eligible for Medicare. In that case, you should consider the benefits of both types of insurance, whether you should enroll in Medicare now or delay enrollment, and the potential consequences of delayed enrollment.

Medicare Coverage for Veterans With VA Benefits 

Care received at a VA facility will be covered by your VA insurance. Medicare will provide coverage if you have Medicare and receive Medicare-approved care at a non-VA facility. Medicare will not provide coverage at a VA facility, and VA benefits will not provide coverage at a non-VA facility. There can be advantages to having both types of coverage.

For one reason, having both types of coverage can give you more health care options. If you only have VA insurance, covered care is limited to only VA facilities. Adding Medicare coverage can open up a range of hospitals, doctor’s offices, pharmacies, and other types of health care locations in which you can receive covered care.

Think about if you have an emergency that occurs and you aren’t near a VA hospital or clinic. If this should happen, you can visit a civilian hospital or medical facility and use your Medicare coverage. 

Things to Consider when Having Both VA Benefits and Medicare

Most people do not have to pay a premium for Part A of Medicare; however, you may be subject to late enrollment fees if you forgo Medicare enrollment. 

Late enrollment penalties can happen if you do not sign up for Medicare Part B during your Initial Enrollment Period and choose to later on. For example, the Part B late enrollment penalty is 10 percent of the Part B premium for each 12-month period in which you were eligible to enroll but didn’t. You will have to continue to pay the penalty for as long as you remain enrolled in Part B.

You may be able to avoid the Part B late enrollment penalty if you qualify for a Medicare Special Enrollment Period. However, choosing not to enroll in Medicare Part B because you have VA coverage does not qualify you for a Special Enrollment Period.

VA Coverage May Not Last Forever

VA benefits depend on funds provided by Congress, and we can never predict whether enough funding will be approved in future years to care for all veterans. However, according to the Veterans Health Administration, more than nine million Veterans are enrolled in the VA health care program.

Because the future is unpredictable, you may lose your VA benefits at some point, leaving you without health insurance coverage.

Medicare Part A and Part B for Veterans 

Some veterans opt to enroll in Medicare Part A because it’s premium-free; however, turn down Part B because of the additional monthly premium. 

If you decide to enroll in Part B, you should do so during your Initial Enrollment Period. Enrolling in Part B provides you with the flexibility of getting health care outside the VA system. Also, you may qualify for programs to help pay the Part B premium and Medicare cost-sharing. 

Medicare Advantage Plans: A Good Option for Veterans?

A Medicare Advantage plan may be worth considering if you’re a veteran.

A Medicare Advantage plan will provide all the same coverage as original Medicare, and some Advantage plans may cover some additional benefits that original Medicare doesn’t.

Many Medicare Advantage plans may also come with $0 premiums. It’s important to check your location, because $0 premium plans may not be available in your area. I can help determine which Advantage Plans are offered in your location. 

Prescription Drug Coverage can Vary for Veterans Using VA Benefits

VA benefits offer creditable drug coverage. The drug coverage usually has no premiums and no or limited copayments for prescriptions; however, you must use VA pharmacies and facilities. If you are enrolled in VA drug coverage, you can also opt for Medicare Part D. It’s essential to compare both costs to decide which best suits your needs. 

Here are some benefits of adding Part D coverage: 

  • You don’t live close to a VA pharmacy or facility or don’t want to use a VA provider to get prescriptions
  • You want the flexibility of filling prescriptions at retail pharmacies or find the VA formulary too restrictive
  • You live in a non-VA nursing home and want to get prescriptions from the long-term care pharmacy that works with your nursing home

Remember, if you enroll in VA drug coverage and Part D, the two do not work together. VA benefits will only pay at VA pharmacies and facilities, and Part D will only pay at pharmacies in your plan’s network.

What if You Have TRICARE? 

If you have TRICARE, you may have to enroll in Original Medicare. If you are not on active duty and are entitled to premium-free Medicare Part A, then you must also enroll in Part B to keep TRICARE coverage.

To have TRICARE for life, you must also be enrolled in Medicare Part A and Part B (Original Medicare). However, if the beneficiary is the spouse of an active duty service member, Medicare Part B enrollment is unnecessary.

Contact Your Local Medicare Agent 

Contact me today if you have VA benefits and are interested in enrolling in Medicare. We can sit down and discuss what options are available to you and which options make the most sense. You can also contact me online.