If you’re a military retiree or veteran turning 65, you’ve probably got some health coverage questions. After all, 65 is when most people become eligible for Medicare. But do you need Medicare if you have your VA health coverage?
The United States Department of Veterans Affairs (VA) strongly encourages veterans to sign up for Medicare Parts A and B after becoming eligible. This is because Medicare coverage, in addition to your VA benefits, can help you get the care you need – even from non-VA hospitals.
Let’s take a look at how Medicare and your VA health coverage does and doesn’t work together, when you qualify for Medicare, how to enroll and much more.
How veterans can qualify for Medicare
Veterans qualify for Medicare the same way as everyone else. United States citizens and permanent legal residents become eligible for Medicare after turning 65. Some people are eligible for Medicare before age 65 if they have a qualifying disability, like end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Veterans who qualify for Medicare can enroll in VA and Medicare benefits, receiving coverage from both programs at the same time.
Do veterans need Medicare?
The VA recommends enrolling in Medicare, because having both Medicare and VA health coverage can give you more options for care. Typically, VA health benefits only cover services that are provided by VA clinics, facilities and hospitals. With Medicare, you can access providers outside of these facilities, so you can see doctors closer to your home or get a second opinion from a non-VA doctor.
For military retirees with TRICARE, Medicare is mandatory to keep your benefits. Once you start receiving Medicare coverage, you will automatically begin receiving TRICARE for Life. This program is offered by the federal government and combines Medicare and TRICARE coverage.
Do veterans pay for Medicare?
Veterans pay for Medicare just like other beneficiaries. Typically, with Original Medicare, you don’t have to pay for Part A (hospital) coverage. This is because most people have contributed to Medicare taxes for the minimum requirement of 10 years.
You still pay a premium for Part B’s (medical) more robust coverage, which includes doctor visits, outpatient care and more. All Medicare beneficiaries are expected to pay cost-sharing amounts, including deductibles, coinsurance and copays.
Veterans with VA benefits can opt out of Medicare – but it’s not recommended
It’s not technically mandatory for anyone to enroll in Medicare, and veterans can opt out of benefits. However, having Medicare ensures that you get access to services that VA benefits might not cover. And if you choose to defer coverage, you may even have to pay penalties for enrolling in Medicare late.
For instance, many veterans choose to accept Medicare Part A but opt out of Part B to avoid monthly payments. But deferring Part B can get tricky – penalties kick in, and the longer you defer coverage, the higher they can become. Part D prescription drug coverage works the same way.
The good news is that you have options. If you’re worried about paying monthly Part B premium payments, some Medicare Advantage (Part C) plans offered by private insurance providers help cover or reduce Part B premium expenses.
Part C plans are an alternative to Original Medicare, covering Parts A and B and Part D prescription drug coverage. Medicare Advantage plans vary, but most offer additional benefits. Many of these plans may even offer a Part B giveback benefit, making your monthly payment low- or no-cost.
For those with TRICARE for Life, you must be enrolled in both Parts A and B to receive benefits.
When veterans can enroll in Medicare
Veterans can enroll in a Medicare plan during the same windows of time offered to others who are eligible. These windows include:
- The Medicare Initial Enrollment Period (IEP): This period is triggered when you first become eligible to enroll in Medicare at age 65. During this time, you can enroll in Original Medicare Parts A and B or sign up for a Medicare Advantage plan. The IEP is typically 7 months long and begins three months before your 65th birthday.
- The Medicare General Enrollment Period (GEP): If you don’t sign up for Medicare Part A and Part B during your IEP, you can apply during the General Enrollment Period. This window lasts from Jan. 1 through March 31 every year, and coverage begins July 1. But remember, you may have to pay higher premiums due to late enrollment.
- The Medicare Annual Enrollment Period (AEP): After you sign up for Medicare, you’re covered and don’t need to renew it. But every year during the Medicare Annual Enrollment Period, you have an opportunity to change your Medicare health or prescription drug plan. AEP happens annually from Oct. 15 through Dec. 7. If you make a change during this enrollment period, your new plan benefits are effective Jan. 1 of the following year.
Special Enrollment Periods (SEPs) that apply to veterans
Sometimes, unexpected life situations arise that give you the chance to sign up for or change your Medicare plan outside of your IEP or AEP. This window, triggered by a qualifying life event (QLE), is known as a Special Enrollment Period (SEP).
There are many QLEs that make you eligible for an SEP. Many of these are more general, like moving or getting married. But some are unique to veterans, such as when those with TRICARE retire or separate from active duty. An SEP is also triggered when a veteran’s employer or union coverage ends for any reason.
How Medicare and VA benefits can work together
The first thing to note is that while you may have both types of coverage at the same time, these two programs aren’t tied together. Basically, you get to decide which to use based on when and where you receive a health care service.
As mentioned, VA benefits usually apply only to VA providers. Some VA benefits might cover care at non-VA facilities, though typically only with preauthorization. Original Medicare will be accepted at all offices and clinics that provide Medicare-authorized services. This offers you more flexibility, so you can receive care from many different types of clinics and providers with some measure of coverage.
How Medicare and TRICARE for Life can work together
Unlike Medicare and VA benefits, which function separately, Medicare and TRICARE for Life work together. Their benefits are coordinated between both programs as a wraparound. This means that if you have TRICARE for Life, you’re able to see any participating or non-participating Medicare health care provider. With TRICARE for Life, you can also receive health services at military hospitals and clinics.
But who pays for what? Generally, Medicare will contribute toward your health care service costs first, then TRICARE coverage kicks in. You typically won’t have much to pay for services that are covered by both plans. However, if you receive services that aren’t covered by Medicare or TRICARE for Life, you may have out-of-pocket costs.
Can you have both a D-SNP and VA coverage?
One common question is whether VA benefits will pay for Medicare costs like deductibles, copays and coinsurance. Unfortunately, they won’t. But if you’re worried about these expenses, you have options.
For instance, you might be eligible for Medicaid in addition to your Medicare coverage. These two programs can work together alongside your VA benefits to give you the support you need. When you receive a Medicare-authorized health care service, Medicare will pay first. If you have any cost-sharing amounts left over, Medicaid will typically kick in to help.
If you’re eligible for both Medicare and Medicaid, you are considered “dual eligible,” and you may qualify to enroll in a Dual Eligible Special Needs Plan (D-SNP). A D-SNP is a type of Medicare Advantage plan that contracts with your state Medicaid program to help coordinate your Medicare and Medicaid benefits.
Veterans benefits and Medicare Part C (Medicare Advantage)
As an alternative to Original Medicare, a Medicare Advantage plan can work well alongside your VA benefits. These all-in-one plans include the benefits of Original Medicare, extra coverage and many plans include Part D prescription drug benefits.
This means your Medicare coverage is all in one place. And there are many Medicare Advantage plans on the market, so you can choose one that works best for your health and financial needs.
Some Part C plans also provide coverage for additional services, like hearing, vision and dental that your VA benefits may not. This helps bridge the gaps in your care, ensuring you have access to all the health services you need.
When it comes to prescriptions, VA drug coverage is pretty comprehensive. You don’t pay a monthly premium, and copays are often low- or no-cost. The biggest downside is that a VA provider must authorize your prescriptions, and you must get your medicines from a VA pharmacy or its mail-order system.
Enrolling in Medicare Part D, whether through a Medicare Advantage plan or standalone coverage, can offer you a bit more flexibility. If you want to get your prescription drugs from a local pharmacy or non-VA doctor, Part D will allow you to do so.
Part D coverage is typically a good idea for people living farther away from a VA pharmacy or facility, those who want more options for different prescription drugs or those who live in a non-VA nursing home and want to get medicines from their facility’s pharmacy partner.
Medicare and 100% VA disability
VA health care coverage is designed to give priority to veterans who need immediate access to health care services. When veterans apply for VA benefits, they’re assigned to a “priority group.” The priority group determines coverage and out-of-pocket costs within the VA system.
Veterans within a lower priority group might not have access to specific services like dental or vision care. They may also be required to cost share, paying out of pocket for copays or coinsurance.
If you are 100% disabled, meaning you’ve been assigned the highest disability rating by the Department of Veterans Affairs, you are most likely in priority group one. This means all inpatient and outpatient care, medication and health care services provided by VA facilities are covered. On top of that, your VA disability benefits will never expire.
If you’re a disabled veteran, Medicare coverage can be a critical resource to add to your VA health benefits. Disability care can be complex. With Medicare, you can receive covered care from non-VA hospitals and providers, giving you more choices for care.
Medicare and your VA benefits: Things to keep in mind
If your Medicare eligibility period is coming up and you’re undecided about next steps, the best thing you can do is look at your VA benefits. What priority group are you? Are those benefits covering all your needs? And even if you’re satisfied with your coverage, life can change quickly. While you may not expect certain health care needs in the next year, you never really know! It’s best to be prepared.
Having Medicare and VA benefits can offer you flexibility and access to more health care options. This way, you can get the care you need, when you need it, and know for certain your coverage will be there to help support you.
