Important Information: Share with your clients
Veterans who receive health care benefits through the U.S. Department of Veterans Affairs (VA) can also enroll in Medicare Parts A and B when they turn 65. The VA encourages veterans to consider enrolling in Medicare as soon as they are eligible to avoid paying late enrollment penalties.
For veterans enrolled in TRICARE (the military’s government-funded health insurance), there may be specific Medicare enrollment requirements to maintain TRICARE coverage.
What Are the Benefits of Having Medicare?
Medicare and VA benefits do not work together to coordinate benefits. When veterans have both, they use their VA coverage at VA facilities and their Medicare coverage at Medicare-approved providers who accept assignment. With a Medicare Advantage plan, they must use a provider in the insurer’s network of doctors and facilities.
Having coverage through both the VA health program and Medicare provides wider coverage and more choices for treatment. For those who don’t live near a VA facility, or whose local facility has long wait times, Medicare coverage may be particularly important. Furthermore, having both types of coverage can be beneficial in an emergency when there is not a VA hospital nearby.
Another reason to consider enrolling in Medicare is the possibility of losing VA benefits at some point, which could leave some veterans without health insurance coverage. VA health benefits depend on an annual appropriation of funds by Congress, and it’s unknown if enough funding will be approved in future years to care for all veterans. Veterans in lower priority groups are at greater risk of a reduction or even a complete loss of their VA benefits.
Medicare Plan Options
Original Medicare, which consists of Part A (hospital) and Part B (medical), only pays 80 percent of the approved costs for hospitals, doctors, and medical procedures. There is no cap on out-of-pocket costs spent in a year. In addition, Original Medicare does not cover prescription drugs. A Medicare Supplement plan (Medigap) or a Medicare Advantage plan (Part C) can fill these gaps in coverage. The plans vary in the type of coverage they offer and cost of premiums.
Prescription Drug Coverage
Veterans can have both VA prescription drug benefits and a Medicare Part D drug plan; however, this may not be necessary. With VA benefits, veterans typically receive premium-free drug coverage. In some cases, veterans may benefit from additional coverage from a Part D or Medicare Advantage plan, if the VA-approved pharmacy locations or Consolidated Mail Outpatient Pharmacy Program (CMOP) are not the best options for them.
VA benefits have their own drug formulary. If a specific drug is not covered, a veteran may consider enrolling in a Medicare Part D plan that covers that drug. In addition, VA benefits may only cover a drug prescribed at a non-VA facility with prior authorization.
Part D coverage may also benefit some veterans if they qualify for Extra Help: the federal Low Income Subsidy (LIS) program that helps people with Medicare afford their Part D drug costs. It can also be useful for veterans in nursing homes outside of the VA health system who need medications from the nursing home pharmacy. If veterans choose to enroll in Part D at a later date, they can do so without paying a penalty.
Medicare Savings Programs
Veterans who enroll in a Medicare plan and have limited income and resources may be eligible for one of the four Medicare Savings Programs. These programs can help offset the out-of-pocket expenses associated with Medicare Parts A, B, and D premiums, deductibles, coinsurance, and copayments.
Whether VA benefits alone provide enough coverage will depend on the individual and their specific medical needs.