Can You Combine Medicare and VA Benefits?
Key takeaways:
Medicare and the U.S. Department of Veterans Affairs (VA) both provide healthcare coverage for millions of Americans. The programs’ benefits do not overlap but can complement each other to provide more coverage options.
VA benefits can not be used to pay for Medicare deductibles, copayments, or premiums. Medicare does not cover expenses incurred at VA facilities.
In most cases, veterans should sign up for Medicare around their 65th birthday. This way, they can avoid late-enrollment penalties.
Whether active or retired, U.S. military service members need access to medical care. All eligible veterans can get healthcare through the U.S. Department of Veterans Affairs (VA), which currently provides care to more than 9 million vets. But veterans over 65 can also enroll in Medicare.
Having both kinds of coverage gives veterans more flexibility around their healthcare. Though, sorting out the benefits can be complicated, because the two healthcare programs don’t interact. Continue reading to learn more about the programs and how you can use both programs’ benefits.
How does Medicare work with your VA benefits?
You can use VA benefits along with your Medicare benefits. But you’ll have to choose which benefits to use when you receive services. You are not able to use both benefits for the same service.
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These benefits can sometimes complement each other, however. For example, if the VA pre-authorizes coverage for treatment at a non-VA hospital but does not cover all the services during your stay, Medicare may pick up the additional costs. For specifics, contact your Medicare plan.
VA benefits can not be used to pay for Medicare cost-sharing expenses, such as deductibles and copayments. You can also not use the benefits for medications prescribed by non-VA healthcare providers or filled at non-VA pharmacies.
Medicare does not cover expenses incurred at VA facilities. Medicare also does not cover prescriptions filled at VA pharmacies.
Who is the primary payer?
If you have both Medicare and VA benefits, your primary payer will depend on where you receive care. The VA pays for services at VA facilities, including medical centers, outpatient clinics, and nursing homes. It also covers medications filled at VA pharmacies or via the VA’s mail-order service.
Sometimes, the VA will pre-authorize coverage for treatment at a non-VA facility. This may happen if location is a problem or if a VA facility can’t provide the care you need. If you receive services that don’t qualify for VA coverage, Medicare may pick up those costs.
In general, Medicare covers care received at non-VA facilities. Medicare Part D can be used to pay for prescription medications filled at non-VA pharmacies.
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Do you have to enroll in Medicare if you have VA benefits?
You don’t have to enroll in Medicare if you have VA benefits. But without Medicare coverage, you may be uninsured for any care you receive at non-VA facilities. This is also true for care you receive from providers who have not been pre-authorized by the VA.
If you don’t have coverage for these services, you’ll be billed for the full costs, which can be significant. That’s why the VA recommends that veterans sign up for Medicare as soon as they can. Since there are no premiums for VA coverage, there’s no disadvantage to remaining enrolled in your VA plan, too.
What are the benefits of combining Medicare and VA benefits?
Enrolling in Medicare could fill in gaps in the coverage you get through the VA. In addition to being able to go to VA facilities for treatment (covered under VA benefits), you’ll be able to go to Medicare-approved providers and facilities (covered by Medicare).
Depending on where you’re receiving care, present your Veteran Health Identification Card (VHIC) or your Medicare card as proof of coverage. If you’re being treated by both Medicare and VA healthcare providers, make sure to inform them about each other so that they can coordinate care, if necessary.
Do you need a Medicare Advantage or supplemental Medigap plan if you have VA benefits?
Whether you’ll want a Medicare Advantage (MA) plan — as opposed to original Medicare (Part A and Part B) — or a supplemental Medigap plan with VA benefits depends on your specific situation.
It’s common to use VA benefits to pay for items that original Medicare doesn’t cover, like hearing aids and vision care. But every veterans’ healthcare package is different. Your care and services will be customized to fit your situation. So it may make sense to add an MA or Medigap plan to your VA benefits to fill in the gaps. Below are a few factors to consider.
VA benefits coverage
Through the VA, you may have comprehensive healthcare coverage for hospital stays, prescription medications, and healthcare provider visits. If your VA benefits provide for 100% of your healthcare needs, you may not need coverage beyond original Medicare. Review your benefits and healthcare needs to determine if there are any gaps in your coverage. If so, you may want to consider an MA or Medigap plan.
Medicare Advantage benefits
MA plans, or Medicare Part C, often include extra benefits like dental, vision, and prescription medication coverage. If you want coverage beyond what your VA benefits and original Medicare offer, you may want to review the specific benefits of various MA plans.
Medigap
Medicare supplemental plans, or Medigap, cover deductibles, copayments, and coinsurance costs associated with original Medicare. So enrolling in a Medigap plan can help you reduce your out-of-pocket costs.
You cannot have both an MA plan and a Medigap plan. So you’ll have to choose what works best for you if you are seeking coverage beyond your VA benefits and original Medicare.
How do VA disability benefits affect Medicare?
VA benefits — including disability payments — don’t affect Medicare coverage. At age 65, you are eligible for Medicare regardless of your VA benefits. Before that, you may receive Social Security Disability Insurance (SSDI) payments at the same time as VA disability benefits. After 2 years of receiving SSDI payments, you can enroll in Medicare. Your VA disability benefits remain in place regardless of SSDI payments and Medicare status.
How much do you pay for Medicare and VA benefits?
Whether you have original Medicare or an MA plan, you will have to pay premiums for Medicare Part B, as well as any cost-sharing payments. With VA benefits, there typically aren’t enrollment fees, monthly premiums, or deductibles. But some veterans may have copayments for healthcare services or prescription medications.
Where can you get help coordinating Medicare and VA benefits?
Various government-supported offices have staffers to help you combine and manage your Medicare and VA benefits. Try calling these resources for assistance:
VA Health Benefits Hotline at 1-877-222-8387
Medicare’s Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627)
Your State Health Insurance Assistance Program (SHIP) at 1-877-839-2675
The bottom line
U.S. Department of Veterans Affairs (VA) benefits and Medicare both provide healthcare coverage. People who enroll in both programs have more options when it comes to where and from whom they receive care. You’ll get the most value out of having multiple plans by examining each one’s treatment, hospitalization, and prescription medication benefits. Then, when a situation arises, you can decide which coverage option you should use.
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References
U.S. Department of Veterans Affairs. (2020). Hearing aids.
U.S. Department of Veterans Affairs. (2022). Get a Veteran Health Identification Card (VHIC).
U.S. Department of Veterans Affairs. (2022). The Affordable Care Act (ACA) and your VA health care coverage.
U.S. Department of Veterans Affairs. (2022). VA health care and other insurance.
U.S. Department of Veterans Affairs. (2022). VA vision care.
U.S. Department of Veterans Affairs. (2023). Eligibility for VA health care.
U.S. Department of Veterans Affairs. (2023). Veterans Health Administration.
U.S. Social Security Administration. (n.d.). Information for military and veterans.
