Are you eligible for both Veterans Affairs Benefits and Medicare? You can be covered under both Medicare and VA Benefits. You should understand what each benefit covers and how they can work together first. We summarize up the main points below to help you make an informed decision.
Veterans Benefits versus Medicare Benefits?
You can have veterans benefits and Medicare, but they will each pay under different circumstances. VA Medical Benefits will only cover medical services at a VA hospital or doctor. Medicare, on the other hand, will cover hospital and doctor visits, but only outside the VA hospital or doctor. You can choose to sign up for Medicare while you have VA benefits. If you do receive both, then you’ll need to choose which benefits to use each time you receive care. When you use VA benefits, you’ll need to get care at a VA medical center or other VA location. It can cover you outside of the VA hospital or care center if they give pre-authorization. Keep in mind that you may need to pay a VA copayment for non-service-connected care.
Medicare will kick in if you need to go to a non-VA hospital or doctor out of the VA network. If this happens, your Medicare Part A and Medicare Part B will cover you. If you do not have Medicare in these circumstances, then you’d likely end up paying the cost yourself. Medicare will give you more options if you prefer a doctor out outside the VA or have an emergency. Just remember, the Medicare and VA systems are entirely separate, with no coordination of benefits between them. When you get care at a VA facility, you must use your veteran benefits. If you need medical care outside of VA, then you use your Medicare benefits.
Can I delay Medicare?
Having VA benefits doesn’t always mean you can delay enrolling in Medicare. In order to delay Medicare without penalty, you must maintain credible coverage. Medicare considers coverage as creditable if it is at least equal to the same coverage you would receive through Medicare. There are different levels of VA Benefits and not all benefits considered creditable coverage. What does this mean? If your level of VA benefits is not creditable, then you need to enroll in Medicare when you are eligible. If you do not enroll when you are eligible, then you may have to pay a lifetime penalty.
What does the VA say?
Per the va.gov website, they encourage you to sign up for Medicare as soon as you are eligible. The VA lists the following reason on why they make this suggestion:
- It is unknown if Congress will provide enough funding in the future to provide care for all Veterans. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future.
- If you enroll in Medicare, you are covered to go to a hospital or doctor outside of the VA.
- If you delay signing up for Medicare Part B and need to sign up later, you may pay a penalty. This penalty gets bigger each year you delay enrollment.
- If you sign up for Medicare Part D (prescription drug coverage), you’ll be able to get prescriptions from non-VA doctors. You can also fill your prescriptions at your local pharmacy instead of through the VA mail-order service.
Do I need to enroll in a Part D Prescription Drug Plan?
If you get prescription drug coverage through the Veterans Affairs (VA) program, it should qualify as credible coverage. If you have credible VA Prescription drug coverage, then you will not be subject to a Part D penalty. However, you may also join a Medicare Prescription Drug Plan on top of your VA Prescription benefits. This will let you get prescriptions from non-VA doctors, as well as fill them at the local pharmacy. If you do get both Part D and VA drug coverage, you can’t use both for the same prescription.
What if I have TRICARE for Life? Find out if you can have TRICARE for LIfe and Medicare Advantage together in our recent blog.
