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Do I Need Medicare if I Have Veterans Benefits?


For veterans approaching Medicare eligibility, it’s common to have questions about whether Veterans Affairs (VA) benefits will work with this new health care coverage. The short answer is that Medicare doesn’t coordinate with VA benefits. However, you can have both types of insurance at the same time and benefit from doing so. Below, we’ll answer the most frequently asked questions about Medicare for veterans.

Medicare and VA Benefits

Many people who qualify for Medicare are also eligible for other health insurance through the government. These programs include FEHB for federal employees and TRICARE for those serving in the military and their families.

When it comes to VA benefits and Medicare, knowing who pays for the services you receive is straightforward. Simply, you’ll use your VA benefits if you’re receiving care at a VA hospital or facility. Likewise, when the facility where your services take place is Medicare-certified, Medicare will pay.

Do Veterans Have to Sign Up for Medicare?

Medicare isn’t mandatory. However, there is significant value to signing up for this coverage when you become eligible.

If your only health insurance is through VA benefits, you’ll only have coverage within the VA health system. On the other hand, Medicare offers coverage in nearly every facility and from nearly all providers throughout the nation. Thus, having both Medicare and VA benefits allows individuals to access well-rounded health care coverage. Keep in mind that once you enroll in Medicare, you’ll want to update your health information with the VA.

Do I Need to Pay for Medicare if I Have VA Benefits?

For individuals who have worked enough quarters, Part A is premium-free. Therefore, it’s beneficial to take this hospital insurance through Medicare.

However, like other beneficiaries, veterans with VA benefits will need to pay a standard Part B premium for outpatient coverage through Medicare. The premium is subject to increase the longer you go without Part B coverage after you’re eligible, via a lifelong late penalty. The penalty occurs because, unlike group health insurance through a large employer, VA benefits aren’t creditable for Medicare.

As a result, you’ll save money long-term when you sign up as soon as you’re eligible. If you need financial assistance with your Part B premium, you might qualify for a Medicare Savings Program (MSP).

Do I Need Part D if I Have VA benefits?

VA benefits include prescription drug coverage. Additionally, this coverage is creditable for Medicare Part D. Meaning, it’s comparable to the level of prescription drug coverage Medicare requires companies offering Part D policies to provide.

Consequently, those with Medicare and VA benefits don’t need to worry about getting prescription drug coverage through a Part D plan. Although, if there comes a time when you choose to cancel your VA coverage, you’ll want to pick up a Part D plan as soon as possible. Otherwise, you’ll face a different type of late penalty on top of your premium, for lacking creditable coverage. This amount will be higher the longer you go without creditable coverage.

Additionally, there are some situations in which an individual with Medicare and VA benefits could benefit from signing up for Part D. These circumstances include residing in an area where VA facilities are inaccessible or wanting more options for pharmacies at which to pick up prescriptions.

For individuals who struggle to pay for their prescriptions, a Part D plan could also be a good option. If you qualify for Extra Help, your prescriptions may have lower copays than they would through VA benefits.

Can a Veteran Get a Medicare Advantage Plan?

Those who have both VA benefits and Parts A and B of Medicare have the option to replace the latter two with a Medicare Advantage plan. Private insurance companies offer these plans, and when you have one, the carrier pays instead of Medicare.

The monthly costs for Advantage plans are relatively low. Sometimes, Advantage plans come without premiums. So these plans aren’t a bad option for extra coverage when you already have VA benefits. In an emergency scenario where you’d need care at a civilian facility, Advantage plans can help with costs, as they involve maximum out-of-pocket limits that Original Medicare (Parts A and B) doesn’t include.

Do I Need a Medicare Supplement if I Have VA benefits?

A Medicare Supplement (Medigap) plan can benefit anyone who has Original Medicare, regardless of what other coverage they might have. Part A and Part B don’t cover 100% of your care, but when you have a Medigap plan, it pays for the balance you’re responsible for after Medicare pays.

When you have this type of policy in addition to your Medicare and VA coverage, your visits to civilian facilities and hospitals that accept Medicare will receive full coverage. Although the VA doesn’t bill Medicare, they may bill your Medigap plan for services the plan covers (which are the same as those Medicare covers).

FAQs

Do veterans lose their VA when they sign up for Medicare?
No, you won’t lose your VA benefits when you enroll in Medicare.
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 Part A if they can get it premium-free.
Who pays first, Medicare or Veterans benefits?
The only case in which both the VA and Medicare pay is if 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.
Can the VA be secondary insurance to Medicare?
VA benefits aren’t secondary insurance to Medicare, as they cover care at different types of facilities. Yet, if you’re eligible for both, enrolling in both can round out your health care.
Does Medicare pay for care at a VA facility?
No, Medicare doesn’t cover the care you receive at a VA facility; this is where you will use your VA benefits.
Will my VA benefits cover cost-sharing for Medicare?
Your VA benefits will not pay for cost-sharing – including coinsurance, copayments, and deductibles – that come with Medicare. However, a Medigap plan can help with these costs.
Is VA drug coverage creditable for Part D?
Medicare considers prescription drug coverage through the VA creditable for Part D.

How to Get Help with Medicare for Veterans

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

37 thoughts on “Do I Need Medicare if I Have Veterans Benefits?

  1. 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.

    1. 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.

  2. 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.

    1. 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.

  3. 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?

    1. 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.

      1. 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?

  4. 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.

    1. 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.

  5. 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?

      1. Hi Dor, once you enroll in Medicare Parts A and B, you automatically get TRICARE For Life (TFL).

      2. 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

      3. Hi Jackson – if you receive Social Security Disability Income for 24 months or more, you will be eligible for Medicare under 65.

  6. 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.

  7. NEED HELP! I will be receiving Medicare on May 1st this year. When should I enroll in Medicare and apply for Medicare Advantage?

  8. 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?

    1. 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.

  9. 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.

    1. 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.

  10. 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).

  11. 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.

    1. 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.

    1. 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.

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