Serving in the American armed forces provides our nation’s heroes with various benefits from the U.S. Department of Veteran Affairs (VA). Rightfully so, as those who don the American uniform sacrifice their time, health, and lives to defend our country. But when it comes to Medicare and VA benefits, for veterans becoming eligible for both benefits, it’s common to have questions about whether it is necessary to enroll in both.
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The short answer is that Medicare does not coordinate with VA benefits. However, you can have both types of insurance simultaneously and benefit from doing so. Medicare and veterans benefits can be tricky as everyone has their own healthcare factors to consider. Luckily, we’re here to help. Below, we answer the most frequently asked questions about Medicare for veterans.
Do Veterans Have to Sign Up for Medicare?
Yes, if you are a veteran, you’ll need to sign up for Medicare to enjoy these benefits. Both Medicare and VA benefits are available to those eligible, and for many, you can sign up for Medicare three months before turning 65. This is known as your Medicare Initial Enrollment Period, and you can avoid paying late enrollment penalties by enrolling during this time frame.
It’s also important to note that for military members and veterans enrolled in TRICARE, you must sign up for Medicare Part A and Part B to keep your TRICARE benefits. A common concern for veterans is losing VA benefits when enrolling in Medicare, but this is not the case. However, you must enroll in both parts of Original Medicare to keep TRICARE.
Furthermore, it’s also worth noting that those eligible for both Medicare and veterans benefits may have their VA benefits change over their lifetime.
For example, if you are receiving VA benefits but have your health improve and receive a different disability rating, how you are covered can be reduced in some cases. This is another reason veterans are encouraged to enroll in Medicare benefits when eligible to ensure that they maximize the benefits they receive.
So, while nobody has to sign up for Medicare, it is highly advised. Medicare and VA coverage can work together to better protect you from costly healthcare expenses.
Several insurance programs are available to those eligible for both Medicare and VA coverage. The most popular programs include Federal Employee Retirement Health Benefits (FEHB), which is available for federal employees, and TRICARE for those serving in the military and their families.
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When it comes to Medicare and VA benefits, understanding who pays for the services you receive is simple. You use VA benefits when receiving care at a VA hospital or facility. Yet, Medicare will pay when the facility where your services take place is Medicare-certified.
So long as the healthcare services you receive are deemed medically necessary by your healthcare provider. In some instances, non-VA facilities may authorize VA coverage. In this case, Medicare would pay for any Medicare-covered services that VA benefits do not pay for.
Remember that Medicare does not pay for care received at a VA facility. Likewise, VA benefits do not pay secondary to Medicare. This means VA benefits will not cover any Medicare cost-sharing expenses. You can, however, receive supplemental coverage through Medicare Supplement (Medigap) or coverage from Medicare Advantage (Part C) plans to help you avoid paying for leftover costs out of pocket.
It’s also important to remember that Medicare and VA benefits can vary in what they cover. Specifically when it comes to healthcare involving dental, vision, and hearing. Medicare covers approved healthcare procedures for patients deemed medically necessary by their doctors.
For this reason, services such as dental, hearing, and vision are not covered by Medicare benefits and require additional coverage or out-of-pocket payments on your behalf. But together, Medicare and VA coverage help benefit a broad range of healthcare needs. This a highly desirable feature for those who have sacrificed their well-being to keep our country free.
VA Benefits vs. Medicare
No, Medicare is not mandatory for Veterans or anyone else. However, there is significant value to signing up for your benefits when you become eligible.
If you only have coverage through VA benefits, your healthcare may be limited. Veterans may only receive care at a VA facility unless otherwise approved and use their benefits. However, even with approvals, there are hurdles to jump. Often, such approvals can take weeks or months to process.
On the other hand, Medicare offers coverage in nearly every healthcare facility and from almost every provider throughout the nation. Thus, you will have many more options when it comes to receiving medical care.
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Furthermore, if you don’t sign up for Medicare when you first become eligible, there are various late penalties that you may incur once you do. This applies to Medicare Part A and Part B and can result in higher premiums.
Signing up for Medicare Supplement or Medicare Advantage plans can also cost you more by waiting through either late enrollment penalties or higher premiums due to your increase in age at the time of your enrollment. There can also be a denial of coverage due to the inability to pass Medicare Supplement underwriting outside your Initial Enrollment Period.
Thus, having both Medicare and Veterans Administration medical benefits allows individuals to access well-rounded healthcare coverage with various eligible doctors and hospitals.
If I Have VA Benefits, Do I Need Medicare?
Everyone has different healthcare and budget needs, but there are many cases in which veterans receiving VA benefits can benefit from Medicare coverage. For individuals who have worked at least ten years or 40 quarters paying Medicare tax, Medicare Part A is premium-free. Therefore, enrolling in the hospital insurance you’ve earned through Medicare is beneficial.
However, like other beneficiaries, veterans with VA benefits will need to pay a standard Medicare Part B premium for Medicare’s outpatient coverage. Remember, you will want to enroll in Medicare Part B as soon as you are eligible because delaying Part B coverage can result in a lifelong late penalty. The penalty occurs because, unlike group health insurance through a large employer, VA benefits are not creditable coverage for Medicare.
As a result, you save money long-term when you enroll during your Initial Enrollment Period. You may qualify for a Medicare Savings Program if you want to enroll in Medicare Part B but need financial assistance with your Medicare Part B premium, you may be eligible for a Medicare Savings Program.
Who Pays First, VA or Medicare?
In most cases, Medicare and VA benefits are used at different healthcare facilities. VA benefits pay when you receive healthcare at VA facilities, and Medicare benefits are for Medicare-approved services at civilian healthcare providers participating in the federal plan.
But, like any rule, there is an exception to be aware of. The only case in which both Medicare and VA coverage will pay is when the VA partially authorizes care you receive from a non-VA hospital. So, if the balance of services is Medicare-eligible, Medicare will pay for what the VA doesn’t.
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Therefore, VA benefits aren’t secondary insurance to Medicare, as they cover care at different facilities, but Medicare can become secondary in this instance. Furthermore, if you have a Medigap plan and there are additional expenses, your supplemental coverage will help cover additional costs that may remain.
It may be rare to use both Medicare and VA coverage simultaneously. However, having both coverages in such situations can be helpful. Regardless, if you are eligible for both, enrolling in both can round out your healthcare and provide you with better coverage and more options when receiving care under more ordinary circumstances.
Medicare Part D and VA Benefits
VA benefits include prescription drug coverage. Unlike VA health coverage, your VA drug coverage is creditable for Medicare Part D. If you delay Medicare Part D coverage due to VA drug coverage, you will not be responsible for the Medicare Part D penalty in the future.
Because the VA benefits include prescription drug coverage, most beneficiaries with both Medicare and VA benefits do not need to enroll in a Medicare Part D plan. However, if there comes a time when you choose to cancel your VA coverage, you will want to pick up a Medicare Part D plan as soon as possible to avoid the expensive costs of your prescriptions.
As you know, healthcare can be complex, and enrolling in the right plans is crucial. There are some situations in which an individual with Medicare and VA benefits could benefit from signing up for Medicare Part D. For example, if you are residing in an area where VA facilities are inaccessible or if you want more options for pharmacies at which to pick up prescriptions.
A Medicare Part D plan could also be a good option for individuals who struggle to pay for their prescriptions. There is also Medicare Part D Extra Help, a subsidy for those with low incomes that can help with your prescription costs. Those who qualify can enjoy lower copays in many cases than they would through VA benefits.
Can You Have a Medicare Advantage Plan and VA Benefits?
Yes, if you have VA benefits, you can also have a Medicare Advantage plan. Anyone with VA benefits and Medicare Part A and B can enroll in a Medicare Advantage plan. Unlike Original Medicare, private insurance companies offer various plans with benefits that may be helpful for your healthcare. When you enroll in these plans, the private carrier providing your coverage pays for the healthcare rather than Medicare.
The monthly costs for Medicare Advantage plans are relatively low, and there are times when Medicare Advantage plans even come without premiums. Thus, Medicare Advantage plans are a good option for extra coverage when you already have VA benefits. In an emergency scenario where you need care at a civilian facility, Medicare Advantage plans can help with costs, as VA benefits are only helpful at VA facilities.
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When enrolling in a Medicare Advantage plan, speaking with a licensed Medicare agent is essential as there is a lot to consider. First and foremost is to determine whether a Medicare Advantage or Medicare Supplement plan will work best for your budget and healthcare needs.
You can’t have both at the same time, and while Medicare Advantage plans are helpful, Medigap plans can offer attractive benefits at a lower premium for many beneficiaries. Again, you can’t use VA benefits outside of VA facilities, and supplemental coverage for your Medicare benefits can help you cover out-of-pocket costs. Reviewing your healthcare needs and comparing your options is the best route to ensuring which coverage option works best for you.
Do Disabled Veterans Need Medicare?
Disabled veterans under 65 eligible for Medicare due to collecting SSDI for at least two years should enroll in Medicare. Regardless of disability status, everyone qualifying for Medicare should enroll in at least Medicare Part A if they can get it premium-free. You may also be able to enroll in Medicare Part B, but you may have to pay premiums to receive benefits.
Additionally, supplemental benefits, such as Medigap or coverage from Medicare Advantage plans, may help you cover additional costs. But there are premiums to consider, and for those on disability under the age of 65, these costs are often higher.
On top of the increased costs, availability can be an issue. While many states require Medicare Supplement carriers to provide at least one plan, several others do not. Therefore, you may also find that Medigap plans are not always available.
In many cases, Medicare Advantage plans can also provide great coverage, but everyone has different healthcare needs. So, while Medicare can help many disabled Veterans, it’s essential to understand your personal circumstances before enrolling in benefits.
Disabled veterans and Medicare coverage needs can vary. By speaking with a licensed insurance agent, you can identify your healthcare concerns, the benefits that can help cover them, and premiums that fit your budget. You can compare the available plan options and enroll in the benefits that best suit your needs.
Do Veterans Need Medicare Supplement?
A Medicare Supplement plan can benefit anyone who has Original Medicare, regardless of what other coverage they may have. Medicare Part A and Part B do not cover 100% of your care. However, when you have a Medigap plan, it covers the costs Original Medicare leaves behind, leaving you responsible for few-to-no out-of-pocket costs.
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When you enroll in a Medicare Supplement plan in addition to your Original Medicare and VA coverage, your visits to civilian facilities and hospitals that accept Medicare will receive full coverage after you meet your Medigap plan’s deductible. Although the VA doesn’t bill Medicare, they may bill your Medicare Supplement plan for services the plan covers (which are the same as those Medicare covers).
Together, Medicare and VA coverage offer a more comprehensive approach to covering the healthcare costs of veterans.
How To Get Help With Medicare and VA Benefits
Getting helps navigating Medicare and veterans benefits is easy. Here at MedicareFAQ, our team of licensed Medicare agents is an expert resource in finding you the right benefits for your healthcare needs. Not only are we here to help with any questions you have about how to get the most out of your coverage, but we can help you cut costs in the process.
Medicare and VA benefits work together to help you avoid costly healthcare expenses regardless of receiving healthcare in civilian or VA facilities. Call the phone number above to receive quotes and compare your options. If you are unable to call at this time, fill out our online rate form to view the options available in your area.
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Can 100% rated total and permanent disabled veterans opt out of Medicare ? I have been paying it for 3 years but I rarely use it. Waste of my money. What happens if disenroll in Medicare? and am I entitled to a refund of my premiums?.
Hi Jeffrey! Medicare is not mandatory, so disenrolling at any time is an option. However, if you disenroll and reenroll in the future, you may face a penalty for the time you were not covered.
I’m retired military and disabled who draws social security disability. I am 62 and have Tricare and my wife is younger. Am I required to sign up for parts A and B Medicare?
Hi Marty, you will not need to enroll in Medicare Part A and Part B until you turn 65. Until then, your current coverage will be considered creditable coverage.
can the va order presription to a non va pharmacy if the user has a gap plan?
The Medigap plan does not cover prescription drugs. You would need to enroll in a Medicare Part D plan to receive coverage at pharmacies not covered by your VA coverage.
I have medicare part A and B ,I also have V A coverage I do all my medical work with the V A. I have paid medicare for 17 years and never used it. so why do you say to have both i have spent thousands of dollars on medicare for nothing!
We understand your frustration. Medicare is not mandatory for anyone. However, many clients who receive VA benefits sign up for Medicare because they want the additional coverage in the event they need emergency care and are not near a VA Facility or seek medical care outside of the VA.
I think I messed up; I didn’t enroll in medicare A or B when I turned 65 as I was (still am) receiving my health care at my local VA Hospital.
I just signed up to receive my Soc. Sec. retirement benefits and am worried I’ll be heavily penalized for not signing up earlier for Medicare. I couldn’t afford it at the time, and money is still tight.
Can I opt out of Medicare to avoid the penalties, and just use my current VA medical treatment options?
James, Medicare is not mandatory. If you prefer to stay on your current coverage and they will allow you to continue coverage, you will not have to pay any Medicare penalty. However, in the future if you do decide to enroll in Medicare, you will be penalized based on the number of years you went without creditable coverage. It is best to contact Social Security regarding any penalty you may accrue.
I am a federal annuitant that retained my FEHB which I pay$175/month. In addition, I receive all my Rx and care as a NSC Veteran at my local VA. My FEHB/Blue Cross Standard Option covers most of my copays which would otherwise be approximately 100/month. I will be turning 65 for in May and my Part A will be at no cost. What is my best option?
Patrick, it is always recommended to pick up Part A as it has no premium for most Medicare-eligible individuals. It will not affect your current plan, but work in addition to your plan, reducing your out-of-pocket costs.
I read that I can get $144.00 added to my SSA check each month. How can I do that?
Allan, thank you for reaching out! The Medicare Give Back Benefit is offered on select Medicare Advantage plans to reduce the monthly Part B premium. These plans are not available in all areas and not every plan will give you back the full premium. The details of the plan are determined by the carrier.
Hi Jagger, I’m a veteran deemed by the VA to be 100% Totally and Permanently Disabled, and unemployable. I am paying $170 per month for Medicare currently and need to know if I need Medicare. For instance, if I go to a civilian hospital emergency room or am taken by ambulance from this civilian hospital or taken from my home to a VA facility, will the VA pick up all these expenses. I prefer the VA facility and I would only go to a civilian hospital if it were an emergency.
Rick, it would be best to contact your VA administrator to review the specifics of your plan.
Hello Rick. I am 100 percent service connected disabled. I am paying $170. per month for nothing. My only question is the VA going to allow me to still use my civilian doctor’s outside the VA. Good luck getting a right answer from the VA. Thanks for your service comrade.
Is Community Care by the VA like a Medicare supplement?
Great question! VA Community Care is a type of insurance provided by the VA that allows beneficiaries the option to receive care from doctors outside of the VA health system. Community Care does not work alongside Medicare and there are no stipulations that you must be enrolled in Medicare to obtain Community Care, like a Medicare Supplement. Supplements are available to Medicare beneficiaries only.
OK, so I am retired USMC (1996) and VA30% disabled. My primary care Dr has been VA since eligibility 20 years ago, I signed up for Medicare last year when I turned 65 and paid $148.50 each month. Next year’s standard is $170/month. My retired co-worker say she pays no medicare premium due to her lower-income and retired pay status. Now I receive a bill for $616/month due to the sale of a rented condo. The wife has until Apr 30, 2022, to sign up for Medicare and will have to pay the same. She is not a veteran or Her Tricare Prime was only $25 out of my DFAS retirement check and we suspect hers will also go to $616 like mine every month. I have found no need for part b since the VA has covered my emergency expenses and say they will even transport me to the nearest VA facility covering the entire expense. What can I do to cancel Medicare for me? will it affect her also? Will filing a next tax return with no income lower my premium? I retire in January.
Hi Gary – keep in mind that if you cancel Part B and eventually go back on, you will need to pay a penalty in addition to your premium. Additionally, if you are nowhere near a VA facility and require immediate care, you’ll likely need to pay out-of-pocket at a civilian facility.
However, if you want to suspend your Part B coverage, you can fill out Form CMS 1763 and check off Medical Insurance. Waiving your Medicare will not affect your spouse. You may qualify for a Medicare Savings Program due to your reduced income.
Hi, I am guardian for my brother who is 100 % VA connected and receives all care from the VA. He just turned 65 this month, should I enroll him in Medicare?
Hello – we would recommend you enroll your brother in Medicare. VA coverage only works at VA hospitals or facilities, so Medicare would cover care he receives at civilian facilities as well. It is best to enroll him as soon as possible because otherwise, he could incur late enrollment penalties. If he needs help paying his premium and other out-of-pocket costs, you can see if he is eligible for any Medicare Savings Programs.
I have a question: Once he is covered with Medicare coverage and goes to a non VA hospital can the Doctors bill his Part B services to Medicare for his visits?
Hi Anglia – if the facility/practitioner accepts Medicare, they may bill the services to Part B.
IF A VETERAN, ELIGABLE AND ON MEDICARE , PART D OR ADVANTAGE PLANS ARE NOT ACCEPTED BY THE VA.
I am 100% Disabled Veteran and 2 weeks ago was approved for SS disability. I am 64 and I will be 65 in August. SS said they will begin taking $145 from my SSD check from my first check in Dec. That is 8 months before my 65th birthday, does that seem right ? They are taking it 8 month early.
Hi Mark – the Part B premium for 2021 is $148.50. You should not have been automatically enrolled in Medicare yet, because you aren’t eligible for Medicare until you’ve been collecting SSDI for 24 months unless you have ALS or ESRD. Ask Social Security about this if you do not have ALS or ESRD.
I am 100% P &T at VA. Also Retired Military with TriCare Prime. I don’t get SSDI, however I took an Early Retirement. Do I lose my TriCare if I don’t accept Medicare Part B? Or does my TriCare change to TriCare for Life?
Hi Victoria! Yes, you will lose your TRICARE benefits if you don’t enroll in Part B. When you turn 65 and enroll in Part B, you will automatically be enrolled in TRICARE for Life.
What if you are grandfathered to stay with Tricare Prime?
Hi Dor, once you enroll in Medicare Parts A and B, you automatically get TRICARE For Life (TFL).
Jagger, Considering the variables listed below, should I be enrolled in Medicare? Our Tricare covers all our medical insurance requirements with a $3,500 Cap.
– Family of 4 (Wife, Two children)
– Age: 55
– 100% VA Permanent and Total (P and T) Disability
– 20 Years Active Duty Retirement with Tricare Select or Prime Coverage
– Receiving Social Security Disability
– I do not receive SSDI
Hi Jackson – if you receive Social Security Disability Income for 24 months or more, you will be eligible for Medicare under 65.
I’m a veteran and just want to know what a Medigap plan is and where I get one.
Hi Tim! A Medigap plan is a supplemental plan that works with your Original Medicare benefits. You can get one at any time of the year as long as you have Part B. Give us a call or complete our rates form to see what options are available in your area.
Does the VA pay hearing aids?
Hi Douglas! Yes, the VA will pay for hearing aids as long as you meet the requirements.
I have just been awarded 100% T&P from VA. I’m going to need to sign up for CHAMPVA for my dependents and I saw something about needing to have Medicare. Clueless on all of this and have no idea where to start researching.
Hi Jody! The rule of thumb is if you are eligible for Medicare, regardless of age, you must enroll in both Part A & Part B of Medicare to keep your CHAMPVA benefits.
NEED HELP! I will be receiving Medicare on May 1st this year. When should I enroll in Medicare and apply for Medicare Advantage?
Hi Wayne! Your Initial Coverage Election Period is now, you can enroll in an Advantage plan at any time. Just make sure to do so before your Part B becomes effective. Make sure you compare both Medigap & Medicare Advantage before you choose which one to enroll in.
I use the VA and am 100 percent disabled, so I’m in the highest priorty group. L also have medicare A and B. with their now being Vetrans choice for care, do I need supplamental insurance?
Hi John! Since veteran and Medicare benefits do not complement one another, it’s best to have a Medigap plan to supplement your Medicare benefits. That way, when you go to a non-VA facility, you won’t be responsible for the cost-sharing that comes with Medicare, such as the 20% coinsurance. It’s my understanding that Veterans Choice for Care has been discontinued.
I am 40% disabled through the V.A. If I don’t want to enroll in Medicare will I lose my V.A. medical? Social Security automatically is taking $144.00 out of my check for coverage. I want it stopped.
Hi Michael! Medicare is not mandatory, you will not lose your VA benefits if you choose to not enroll. However, VA benefits are not considered creditable under Medicare. The $144 coming out of your social security check is for Part B. If you disenroll, and choose to reenroll later in the future, you will be penalized since you delayed without having creditable coverage. The $144 premium will be increased by 10% for every year you delayed enrolling in Part B. The VA does recommend having both Part A and Part B in addition to your VA benefits.
Thanks Thanks Thanks, for uncomplaining this process. I am probably 1 month away from getting my Medicare cards. I have been totally- totally confused on the issue of Medicare since I have am a veteran and I am currently getting medical care thru the Veterans Administration. Medicare options are confusing to the average person like myself. Can you give me any advise with Medigap (supplemental policy).
Hi Paul! You’re very welcome! I’m happy to hear the information was helpful to you. Medigap plan premiums are dependent on multiple factors. If you give us a call or complete our online comparison form, we can help you compare each plan side by side in your area to see which one is the most affordable.
I enrolled with Part A when required. I have Veteran Medical coverage and advised in addition to qualified annual OBAMACARE and IRS, I received the annual forms proving medical coverage. NOW.. registering at a local SS Office for Part B, I am told that he U.S. Veterans Administration, Medical Treatment Facility Primary Care coverage is NOT good enough for Medicare to qualify – and I will be penalized from 2015. ???? What is the LAW seeing that I have NOT been informed that the Veteran Medical Facility does not qualify. I have NEVER seen nor been told by the SSA that the VA is NOT medically qualifying as Part B Coverage. Reading your FAQ Page, it is (RECOMMENDED) that Medicare eligible veterans apply for Medicare Part B medical coverage…..” and “will give you peace of mind…” which i MY decision. Therefore, WHERE is the LAW that gives the local SSA Office the purpose to tell my I am going to be PENALIZED 30% per MONTH based on MY Life Benefits.
Hi EH, unfortunately your local SSA office is correct. If you search on va.gov, you’ll see on this page that VA healthcare coverage is NOT considered creditable coverage under Medicare Part B. The VA does not recommend Veterans decline Medicare Part B when their first eligible to enroll for this reason. Since you missed your Initial Enrollment Period, your opportunity to enroll in Part B is during the General Enrollment Period, which is now. The GEP runs annually between January 1st – March 31st. If you don’t enroll during this GEP, you’ll face a higher penalty than you have already come next year. That penalty will continue to increase each year you go without Medicare Part B coverage.
I have medicare part A & B & I ‘ am a vet with VA doctors do I need a secondary insurance ?
Hi Ray! Yes, it’s highly recommended that a veteran supplements their VA benefits with a Medigap plan. That way, you’re covered outside a VA hospital.