Medicare vs. VA Benefits for Veterans

As a veteran, you’re entitled to medical coverage through the Veterans Affairs (VA) health program. If you’re approaching the age of 65, you’re also eligible for Medicare benefits. VA benefits cover treatments received for service-connected conditions at a VA facility. However, there are times where you may need to visit a non-VA facility for care, or receive treatment at a VA facility for non-service-connected conditions. In these cases, enrolling in a Medicare plan can significantly reduce or even eliminate your out-of-pocket costs.

Here’s what you need to know about how enrolling in both these programs might provide you with greater coverage and better options when it comes to the types of healthcare services you can receive and where you can receive them.

VA benefits

You may be eligible for VA health care benefits if you served in the active military, naval, or air service and didn’t receive a dishonorable discharge.

With recent eligibility expansion, all Veterans who meet basic service and discharge requirements at home or abroad — are now eligible for VA health care.

With VA health care benefits, most medical care and services are covered, but things like dental or vision services may not be. Services are covered according to the following criteria:

• Your priority group: You’re assigned to 1 of 8 priority groups based on military service history, disability rating, income level, Medicaid eligibility and other benefits you receive, like VA pension benefits
• The advice of your primary care provider regarding your specific conditions
• Accepted medical standards for treating your specific conditions

Keep in mind that VA benefits cover medical services received at a VA facility only. This may not be a convenient option for you in terms of travel to the VA facility, or even if you want to receive care from a specific doctor outside of the VA system.

Many veterans find that enrolling in a Medicare plan in addition to their VA plan can provide convenience and savings when it comes to receiving and paying for healthcare services.

Medicare benefits

While VA benefits and Medicare are completely separate, enrolling in both programs greatly expands your ability to receive coverage for medical services. It is recommended that you enroll in Medicare when you become eligible. here’s why:

• Having Medicare means you’re covered if you need to go to a non-VA hospital or doctor—so you have more options to choose from. If you live far from a VA facility, it can be more convenient to visit a nearby doctor who accepts Medicare.
• Funding for VA health care could change in the future. We encourage you to sign up for every health care benefit that you’re eligible for, so you have options if you need them.
• If you delay signing up for Medicare Part B (coverage for doctors and outpatient services) and then need to sign up later because you lose your VA health care benefits or need more choice in care options, you may have to pay a penalty. This penalty gets bigger each year you delay signing up—and you’ll pay it every year for the rest of your life.
• If you sign up for Medicare Part D (coverage for prescription drugs), you’ll be able to use it to get medicine from non-VA doctors and fill your prescriptions at your local pharmacy instead of through the VA mail-order service. There’s no penalty for delaying Medicare Part D as long as you enroll when you’re first eligible or within 63 days of when you no longer have VA health care or other creditable prescription drug coverage.

Enrolling in Medicare provides greater flexibility and convenience for senior veterans. Here’s how Medicare plans can supplement your VA benefits.

Medicare Part A

All senior veterans are highly encouraged to enroll in Medicare Part A in addition to VA participation. In most cases, you won’t pay a monthly premium for Part A coverage as long as you meet certain eligibility requirements.

In general, Part A covers:

• Inpatient care in a hospital
• Temporary nursing home care following an illness or injury
• Skilled nursing facility care
• Hospice care
• Home healthcare

Medicare Part B

It’s highly recommended that veterans enroll in Medicare Part B as well. Part B coverage provides you with a variety of outpatient services outside the VA system. Be sure to enroll in this option as soon as it becomes available to you, since you may experience a gap in coverage or face a penalty for each 12-month period you lack Part B coverage.

Medicare Part B covers medically necessary services. If you have a medical condition that requires diagnosis or treatment, Part B covers the necessary services and supplies as long as they meet accepted medical practice standards.

Specifically, Part B can cover:

• Doctors’ services
• Clinical research
• Durable medical equipment
• Ambulance services
• Inpatient and outpatient mental health services
• Some outpatient prescription drugs
• Preventive care: If you need preventive services, such as those that prevent or mitigate the effects of the flu, Part B covers them as long as you get treatment from a healthcare provider who accepts the assignment.

Medicare Part C

Medicare Part C is also known as a Medicare Advantage plan. You might consider this coverage if you need health services in addition to those provided through your VA benefits and/or Original Medicare. Providers include Medicare-contracted private companies, and they have to follow all standards and rules set by Medicare.

While some of the services covered by Part C may overlap with those of the VA, a Medicare Advantage plan might be a better choice for your needs depending on the locations of your healthcare providers and the time, expense and effort it takes to travel to their facilities.

Be sure to check with the plan before you schedule service to find out exactly what’s covered and the out-of-pocket costs you’ll have to pay.

Medicare Part D

Veterans can take advantage of VA prescription drug benefits as well as a Medicare Part D drug plan. You might not always need one, though. VA benefits typically provide premium-free drug coverage. However, if the approved pharmacy locations or the Consolidated Mail Outpatient Pharmacy Program (CMOP) is not convenient for your healthcare needs, it may be wise to enroll in a Part D or a Part C plan that includes prescription drug coverage.

The enrollment requirements for Part D are more flexible than those for other Medicare plans, and you can enroll without a penalty at a later time as long as you’ve maintained another form of prescription drug coverage.

While all Part D plans must cover enrollees in certain protected classes, including HIV/AIDS and cancer patients, you’ll have to choose a plan that covers drugs related to your healthcare needs. Generally, Part D plans place drugs into tiered levels on their list of covered drugs, and drugs in each tier may require you to pay different out-of-pocket costs. Put simply, drugs in lower tiers cost less than those in higher tiers.

Starting in the 2025 coverage year, Part D has a new maximum out-of-pocket of $2,000 for prescription drug costs per year, and an option to spread your medication costs across the year for simpler budgeting.

Medicare Supplemental Insurance (Medigap)

If you sign up for Medicare during the initial six-month enrollment period, you’ll have the option to select a Medigap policy without going through medical underwriting. These policies cover portions of your healthcare costs that Medicare doesn’t pay, including deductibles, coinsurance and copays.

Medigap plans are ideal for veterans who live far from a VA facility or those who are in a lower-priority VA group. If you plan to use Medicare Part B medical insurance to visit non-VA healthcare providers, a Medigap policy can be helpful in covering your out-of-pocket Part B costs.

Medigap policies can also help senior veterans who frequently travel outside the U.S. Some plans will cover international care services that Medicare won’t. Medicare will pay its share, then the Medigap policy will pay its share, significantly reducing your out-of-pocket costs should you require medical care during your travels.

Conclusion

Navigating both VA and Medicare benefits can be a tedious and confusing process, even if you’re familiar with the various levels of coverage. If you have any questions or need help understanding how Medicare works with your VA benefits, contact us. We can help you identify the right coverage to protect your health for years. Call us today so one of our licensed insurance agents can assist you.

Ede’m Now Health Marketplace is a brand operated by Integrity Marketing Group, LLC, and used by its affiliated licensed insurance agencies that are certified to sell Medicare products. Medicare Enroll is not endorsed by the Center for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency.