7 Medicare Facts Every Veteran Should Know

Medicare covers veterans in the same way as it covers most other Medicare beneficiaries. But there are a few things that veterans of the armed forces should know about Medicare.

Smiling nurse speaking with a patient

1. Medicare and VA coverage do not coordinate benefits

Medicare and VA (Veterans Affairs) insurance do not coordinate coverage. The only instance in which the two programs might team up to offer dual coverage is when the VA approves qualified care to be received at a non-VA facility.

Medicare coverage for people with VA insurance typically works like this:

If you receive care at a VA facility, it will be covered by your VA insurance. If you have Medicare and receive Medicare-approved care at a non-VA facility, Medicare will provide coverage. Medicare will not provide coverage at a VA facility, and VA benefits will not provide coverage at a non-VA facility.

In other words, you must visit a VA hospital or medical facility in order to use your VA coverage, and you must visit a civilian hospital or medical facility in order to use your Medicare coverage.

VA benefits and Medicare coverage do not overlap.

2. There can be advantages to having both types of coverage

There can be some definite advantages in having VA benefits and Medicare insurance.

  • Having both types of coverage can give you more health care options.

    If you only have VA insurance, you are limited to receiving covered care at only VA facilities. But adding Medicare coverage can open up the range of hospitals, doctor’s offices, pharmacies and other types of health care locations in which you may receive covered care.

  • Having both types of coverage can benefit you in the event that an emergency occurs when you are not in close proximity to a VA hospital.

  • Most people do not have to pay a premium for Part A of Medicare.

3. You might be subject to late enrollment fees if you forego Medicare enrollment

If you do not sign up for Medicare Part B during your Initial Enrollment Period, you may be subject to late enrollment penalties if you decide to sign up later on.

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 did not. 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. Choosing not to enroll in Medicare Part B because you have VA coverage does not qualify you for a Special Enrollment Period.

4. You may not have the same VA coverage forever

Another reason you may consider enrolling in Medicare is the possibility that you may lose your VA benefits at some point, leaving you without health insurance coverage.

VA health benefits depend on an annual appropriation of funds by Congress, and it’s unpredictable if enough funding will be approved in future years to care for all veterans. Those veterans in the lower priority groups are at particular risk to see a reduction or even a complete loss of their veteran’s benefits.

5. Prescription drug coverage can vary

VA coverage includes prescription drug benefits, and for this reason, many VA members may choose not to enroll in Medicare Part D (Medicare prescription drug plans). And because VA drug benefits are considered “creditable coverage” by Medicare, VA members are not required to pay a late enrollment penalty if they choose to sign up for Medicare Part D at a later date.

There are, however, a few instances in which enrolling in a Part D plan or a Medicare Advantage plan with prescription drug coverage may make sense:

  • VA coverage includes its own drug formulary (a list of drugs covered by the plan). If the VA does not cover a specific drug that you need to take, you might consider enrolling in a Medicare Part D plan that covers that drug.

  • A drug prescribed by a doctor at a non-VA facility may not be covered by VA benefits without authorization.

  • A non-VA pharmacy may be a more convenient way to obtain your drugs, especially if you reside in a nursing home or other long-term care facility.

  • If you qualify for Medicare Extra Help, your overall drug costs may be lower with a Part D plan than under VA coverage.

6. 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 in order to keep TRICARE coverage.

You must also be enrolled in both Medicare Part A and Part B (Original Medicare) in order to have TRICARE For Life. The lone exception is when the beneficiary is the spouse of an active duty service member, in which case Medicare Part B enrollment is not necessary.

7. Medicare Advantage plans can be good options for veterans

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

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

Some of these additional benefits can include coverage for:

  • Dental
  • Hearing
  • Vision
  • Prescription drugs

Many Medicare Advantage plans may also come with $0 premiums, though $0 premium plans may not be available in all locations.

Seeking additional Medicare help

If you have additional questions about how veterans can make the most of their health insurance with the help of Medicare, contact a licensed insurance agent at TTY Users: 711.

A licensed agent can help you find the Medicare Advantage plan coverage that fits your unique health care needs.   

 

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