As a veteran, you’ve earned the right to have excellent healthcare, and we thank you for your service!
At the same time, when you approach the age of 65, you’ll also qualify for Medicare. You can carry both VA benefits and Medicare, but they don’t work together. Instead, some of your care will be covered by the VA and other medical needs by Medicare.
This guide will help you understand how to use both VA benefits and Medicare and when each coverage will apply. Let’s get started!
Both VA Benefits and Medicare provide comprehensive medical coverage for a variety of needs. However, they work in different places.
If you go to a VA facility for your medical care, your VA medical benefits will apply. However, outside that system, you have to pay the full cost yourself, even in an emergency.
With Medicare coverage, if you get care outside the VA but at a Medicare-certified provider, you can use your Medicare benefits. As a result, Medicare can be a vital coverage if you don’t live close to a VA facility or if you travel frequently.
It’s important to keep in mind that VA care is based on your priority level. If you have a lower assigned priority level and VA funding drops, you may not be able to get VA medical benefits anymore. That’s why having Medicare if you’re eligible is an important backup.
You might be wondering “Does the VA bill Medicare?” or “Does the VA bill Medicare Advantage plans?” The answer in both cases is no, they do not work together.
Instead, your coverage will depend on what medical facility you go to. If you go to a VA facility, your VA benefits will take care of your needs. Any non-VA but Medicare-certified care will be covered by Medicare.
Sometimes the VA will authorize care at a non-VA facility. This generally means that they will cover the costs of those services, but if they don’t, Medicare may pay for the Medicare-eligible services left over.
Medicare only applies to non-VA doctors. So in the VA, your VA benefits are primary. Everywhere else, Medicare is primary.
In general, you’ll get the same benefits from both Medicare and VA benefits, though your coverage amounts, copays, and other factors may differ. Your access to VA care, along with the out-of-pocket costs you have in the form of copayments, can vary depending on your priority level. If you have a lower priority number, you might have to wait for care at the VA or have to pay more for services or medications.
Medicare gives you another option that isn’t dependent on your VA priority. Instead, you can get non-VA care when you need it. You can also choose a Medicare Advantage plan that brings additional benefits, such as vision, dental, and other care. However, Medicare Advantage plans have a limited network, so you’ll have to see the approved providers.
Instead of thinking about which coverage is better, it’s best to consider the benefits of combining Medicare and VA benefits.
VA eligibility and Medicare eligibility are separate. To qualify for VA care, you need to be a veteran and meet the VA benefit requirements.
For Medicare, you need to be a U.S. resident or citizen who has lived in the country for at least five years, along with being 65 years of age or older, or having specific health conditions. You can qualify for VA but not Medicare, or you might qualify for both.
As we’ve mentioned, VA benefits are only applicable to VA medical centers. That’s why having Medicare as a secondary coverage can help.
You don’t have to, but you may face penalties if you don’t enroll during your initial enrollment period but decide to sign up later.
Most Americans get Part A automatically and it’s free. For Medicare Part B, you might be automatically enrolled or you may have to sign up. There is a monthly fee for Medicare Part B, but it will be higher if you skip enrollment and then change your mind later on. We put a guide together that explains the difference between Medicare Part A and Part B in further detail.
We highly recommend signing up for Medicare when you are initially eligible. It expands your available medical options and can bring peace of mind if you have a lower VA priority level.
Do VA patients need Medicare? It’s a common question. You might think it’s unnecessary to carry two forms of health coverage.
However, those with VA benefits can only go to VA medical centers. Anything else isn’t covered. With Medicare, you have a much wider range of care available, which can be essential if you’re traveling or live far from a VA center.
If you wait to enroll in Medicare Part B because you have VA benefits, you may have to pay a late-enrollment penalty when you do decide to sign up. VA benefits don’t give you a special enrollment period or an exemption from the late-enrollment fees.
Medicare Advantage, or Medicare Part C, is a full replacement for Original Medicare. Often you get additional benefits, such as discounts on health memberships, vision care, or dental coverage.
It does not. Instead, you use the plan that applies to the medical provider you see.
If you are eligible for Medicare, you can sign up for Medicare Advantage, even if you have VA benefits. As we’ve noted, VA benefits only apply at a VA health center. Medicare Advantage can be used anywhere within the plan’s medical network.
Keep in mind that, unlike Original Medicare, a Medicare Advantage plan will have a limited network of providers, generally within a single geographical area. Make sure your non-VA doctors are part of the network and that the plan covers the prescriptions you need.
This guide has covered the most commonly asked questions that veterans have about Medicare coverage, but you might have additional concerns. That’s not a problem! We’re here to make it easy for you to understand your VA and Medicare options.
Often it helps to talk to a licensed insurance agent that can review your specific situation and help you find the coverage that works for you. If this is something you’d like to do, contact us today!
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