How to get the most out of Medicare as a veteran with VA benefits

Veterans who receive benefits from the VA are often unsure whether they need Medicare or not. Navigating healthcare can be complicated, but luckily, veterans can benefit from both systems. VA benefits and Medicare are separate systems that can work together to provide more comprehensive coverage. Understanding each system will help you make the best decisions for your healthcare possible.

Should I get Medicare if I have coverage from the VA?

Enrolling in Medicare when you are eligible is often the recommended route. Coverage and benefits between the VA and Medicare are different.

Medicare and its parts cover services from hospitals, doctors, and other general medical services. For your routine and regular doctor visits and health care, Medicare will provide coverage. VA benefits will not cover Medicare costs.

VA benefits cover services that are unique to veterans. Common services from the VA include mental and physical therapies for conditions suffered due to military service. These services are often provided in VA facilities and are not covered by Medicare.

Individuals eligible for both VA Benefits and Medicare are encouraged to apply for both. Benefits from both systems will provide the most coverage for an individual.

VA Benefits: When to apply and what to know?

To determine when you can apply, that depends on your eligibility. Veterans who meet basic service and discharge requirements are eligible for VA benefits. Eligibility depends largely on time and length of service, disability status, character of discharge, and more. To verify eligibility, you can see qualifying factors on va.gov. For best results, you should apply within one year of leaving active duty or retirement.

To determine if you should apply, that depends mostly on your needs and wants. Strictly speaking, if you are eligible, you should apply. VA healthcare generally has no enrollment premiums, deductibles, or cost shares. Certain services may charge a co-pay depending on factors such as disability, service history, or income.

Upon enrollment, you are assigned to a priority group. This will determine your coverage and costs. Your coverage and costs can change over time, as can your priority group assignment.

After enrolling, specialized care is available to you, often aimed at treating health issues and other issues common with elderly veterans. Examples of these services include care for post-traumatic stress disorder (PTSD), traumatic brain injuries (TBI), and military sexual trauma (MST).

If you have VA coverage, you are not required to enroll in Medicare. However, you are able to, and it is encouraged.

Medicare coverage: When to apply and what to know?

Individuals qualify for Medicare once they reach the age of 65, except in certain cases that qualify them earlier. There are also other periods in which you may enroll instead, however these are more circumstantial. Typically, you initially enroll in Medicare Parts A and B, though some may defer part B if they still work. You also have the choice to add Part D prescription drug coverage, or get a Medicare Advantage plan. What you enroll for largely depends on the coverage you need.

Most Medicare beneficiaries are enrolled in Parts A and B, either on Original Medicare or through a Medicare Advantage plan. This covers your regular doctor visits, inpatient hospital and nursing facilities, preventative services, and more. Where VA benefits cover your specialized care, Medicare will cover your standard care.

The best time to apply is during your initial enrollment period. This period begins 3 months before you turn 65 and lasts until 3 months afterwards. Enrolling later could subject you to late enrollment fees. Even with VA benefits, Medicare works alongside to offer more complete health care coverage.

Primary Coverage, Coordination of Benefits, and How Medicare and VA Benefits Work Together

Individuals covered by Medicare and the VA have a Coordination of Benefits (CoB) that determines who is responsible for a service. If a medical claim is covered by both parties, the COB establishes priority of payment. The primary plan is first responsible for processing the claim and paying its share of the amount. The secondary plan would then review the claim and pay the remaining balance within its coverage limits.

Coordination of Benefits can vary between VA coverage and Medicare plans. You can typically expect VA to cover services and treatments in VA facilities and/or related to military services. For non-service-related care, Medicare will often be the responsible party for coverage.

Should I buy Medicare Part D if I have VA drug coverage?

If your prescription drugs are covered by VA benefits, you do not need Medicare Part D. Additionally, VA coverage for drugs is considered “creditable coverage” by CMS. This means you won’t have to pay a penalty if you decide to sign up for Part D later. You will have 63 days after losing VA drug benefits to enroll in Part D.

However, VA health care is limited to VA pharmacies, facilities and providers. You may consider signing up for Part D if:

• If your drugs are not covered by the VA
• You need your prescription filled at a nearby pharmacy, as opposed to a VA pharmacy
• Co-payments for the drugs are lower on a Part D plan than from VA. VA copays for prescription drugs can vary by priority level.

How do I know what is right for me?

Everyone has different health needs, so your coverage should be unique to your needs. As a general rule, we recommend you enroll in VA coverage and Medicare when eligible. However, your situation may not require it.

Your personal and family needs should be considered first and foremost. Each program should be considered for its costs and coverage. VA representatives and Medicare Advocates are available to answer questions and make recommendations for those unsure how to navigate the landscape.

See here also how a local licensed agent can help, and thank you for your service!

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