Va Benefits And Medicare
It is important to note that the US Department of Veterans Affairs plans and Medicare are completely separate. VA plans only cover care at VA facilities and Medicare only covers care at Medicare-assigned facilities. VA coverage and Medicare coverage usually do not overlap.
To confirm your VA benefits and options, please call the VA directly 1-877-222-VETS , since we are not authorized to answer specific questions.
Learn More About The Value An Ma Plan May Offer Veterans
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Or simply enter your ZIP code below to see plans available in your area.
Va Health Care Eligibility
According to the Department of Veterans Affairs, You may be eligible for VA health care benefits if you served in the active military, naval, or air service and didnt receive a dishonorable discharge.
Those who enrolled in uniform services after September 7, 1980, or started active duty after October 16, 1981, must have served for two years or completed their active-duty period unless they meet certain exceptions, such as:
- Discharge due to an active duty-related disability
- Early discharge
- Serving before September 7, 1980
If you were or still are in the military reserves or National Guard, you can qualify for VA benefits if you completed your active-duty period as required by a federal order.
Eligible veterans can apply for VA benefits in one of five ways.
After submitting your application, youll receive a letter in less than a week stating whether your application was approved or not.
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Recent Changes To Va Health Care Eligibility
In September 2021, Veterans Affairs Secretary Denis McDonough implemented a policy to reassess dishonorably discharged veterans for VA benefit eligibility. Under this new policy, those who received other-than-honorable discharges due to sexual orientation, gender identity, or HIV status during Dont Ask, Dont Tell are eligible for all benefits available to honorably discharged veterans. LGBTQ+ veterans who havent applied for a discharge upgrade should do so to determine their eligibility for health and senior care services.
Are Veterans Required To Enroll In Medicare
Nobody is required to enroll in Medicare, but if you do so outside of your Initial Enrollment Period without from an employer, you could face late enrollment penalties. Its important to note that neither VA benefits nor TRICARE will qualify you to delay Medicare enrollment without financial penalty.
Q: Do I need Medicare if Im a veteran whos planning to work past 65?
A: If you have creditable drug coverage from an employer and plan to work past 65, you may be able to delay Medicare enrollment without penalty. .
Q: Is Medicare mandatory for veterans with VA benefits?
A: Medicare is not mandatory for anyone, but if you enroll outside of your Initial Enrollment Period and dont qualify to delay, you could face late enrollment penalties. If you have VA benefits, you do not have to enroll in Medicare in order to keep your VA benefits.
That being said, the Veterans Administration actually recommends veterans enroll in Medicare when they become eligible. Enrolling offers veterans more coverage choices and options for medical and hospital care, as well as for prescription drug services if they also enroll in a Part D plan. Finally, the VA has also cautioned veterans that its uncertain whether or not theyll be able to continue to cover all veterans in the future. Please click here to read the important statement from the VA about why you should sign up for Medicare at 65.
Q: Do you need to get Medicare when you have TRICARE?
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More About Your Medical Benefits Package
We cover preventive care services, like:
- Health education
- Immunization against infectious diseases
- Counseling on genetic diseases
We cover inpatient hospital services, like:
- Kidney dialysis
- Specialized care
We cover urgent and emergency care services, like:
- Urgent or emergency care at some VA health facilities.
- Urgent care for injuries and illnesses that need attention right away, but arent life threatening, at urgent care locations that are part of our contracted network. This may include care at a VA-approved:
- Walk-in retail health clinic for minor illnesses like a sore throat or earache
- Urgent care facility for more pressing illnesses or injuries that require treatment like splinting, casting, or wound care
We cover other services and needs, like:
- Mental health services to treat certain issues like posttraumatic stress disorder , military sexual trauma , depression, and substance use problems.
We may cover services that your VA primary care provider concludes you need to support your treatment , like:
- Tests used to diagnose health conditions, including blood work, X-rays, and ultrasounds
- Therapy and rehabilitation services, including physical therapy, vision rehab, and therapy for traumatic brain injury
- Additional services, including prosthetic items, audiology , and radiation oncology
You may be able to get help with some non-medical services, like:
All of these must be true:
Veterans With Disabilities And Medicare
Since veterans with disabilities may qualify for Supplemental Security Income or Social Security Disability Insurance , you may also be eligible for Medicare based on disabilities under SSDI.
Qualifying disabilities differ between the VA and Medicare. In order to receive disability benefits through the VA, applicants must have a disabling condition that was caused by or worsened because of active duty. Veterans who were discharged may not be eligible for disability benefits.
On the other hand, to qualify for SSI and SSDI, the disability doesnt have to be service-related, but it must render you unable to do substantial work and must last or be expected to last at least a year. Additionally, your discharge status isnt taken into account.
There are two cases in which you can get expedited processing for your SSI or SSDI applications.
Once approved for SSDI, veterans automatically get Medicare coverage after theyve been receiving disability benefits for two years.
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Va Benefits And Medicare Part B
Medicare Part B covers preventive and medically necessary services, including ambulance services, doctors services, durable medical equipment, clinical research, and mental health treatment. You should enroll in Medicare Part B to ensure you have adequate coverage for your health care needs, whether theyre service-connected or otherwise. Should you ever lose some of your VA benefits, or your VA benefits dont cover everything you need, youll be able to use Medicare Part B instead of paying 100% of the expenses out of your own pocket. Although Medicare Part B has a monthly premium and an annual deductible , its well worth it if it helps you avoid high out-of-pocket costs. Its wise to enroll in Part B during your initial enrollment period unless you have other employer-sponsored coverage. You may incur late penalties if you wait to enroll. You must be enrolled in Parts A and B if you want TRICARE for Life.
Why Some Worry About Social Security Benefit Cuts
As House Republicans plan to focus on curbing government spending, some worry that could entail cuts to Social Security benefits and Medicare in exchange for votes to increase or suspend the debt limit.
Among the ideas Republicans have pitched include raising Social Security’s full retirement age to 70, changing the way benefits’ annual cost-of-living adjustments are measured to make them less generous, or making it so benefits are means tested through the middle class, Adcock said.
Moreover, they could raise the Medicare eligibility age to 67 from 65, he said.
To make those changes, there would need to be enough support in the Senate, with 60 votes.
“That’s a pretty high threshold,” Adcock said. “I don’t think there would be 60 votes in the Senate to do benefit cuts.”
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Can A Veteran With Va Benefits Safely Quit Paying For Medicare Part B
Q: I served in Vietnam from 1969 to 1970 and I am just now starting to get Veterans Affairs benefits. I am paying $104 for Medicare Part B. Can I stop using Part B and paying for it because I have VA? I am 68. Lanny Smith, Cody, Wyo.
A: First and foremost, thank you for your service. I appreciate your sacrifice and the sacrifice all of our active service men and women make, to keep my family and me safe here in the U.S., says Diane Daniels, author of The Medicare Survival Guide.
You are entitled to Tricare for Life if you are a retired service or reserve member, or if you are a Medal of Honor recipient, says Daniels. Tricare for Life is Medicare jacket coverage for Tricare-eligible beneficiaries who have Medicare Part A and B.
You must continue to pay Medicare Part B premiums to remain enrolled in Tricare, says Daniels. Tricare pays after Medicare in the U.S. and the U.S. territories, she says. Tricare also pays Medicare deductibles and co-insurance.
If, however, youre enrolled in VA Health Care, consider this: You can have both Medicare and Veterans Affairs benefits, according to MedicareInteractive.org. However, Medicare and VA benefits do not work together. Medicare does not pay for any care that you receive at a VA facility. According to MedicareInteractive:
Using Medigap Or Medicare Advantage And Va Benefits
Medigap plans can cover out of pocket expenses if you have Original Medicare.
When Veterans Should Consider a Medigap Plan
- You are enrolled in Original Medicare and have out-of-pocket expenses.
- You are enrolled in a lower priority VA group and could lose benefits in the future.
- You dont live near a VA hospital or other VA facility.
- You want to use local, non-VA hospitals.
Medicare Part A covers hospital costs and Part B covers doctor visits and other medical costs. Medicare Advantage plans cover everything Original Medicare covers, but may have extra benefits such as vision, hearing and dental coverage.
Its important to remember that you cannot have both a Medigap and Medicare Advantage plan. You have to choose one or the other.
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Does My Current Health Insurance Status Affect Whether I Can Get Va Health Care Benefits
No. Whether or not you have health insurance coverage doesnt affect the VA health care benefits you can get.
Note: Its always a good idea to let your VA doctor know if youre receiving care outside VA. This helps your provider coordinate your care to help keep you safe and make sure youre getting care thats proven to work and that meets your specific needs.
Should You Enroll In A Medicare Part D Plan If You Have Va Benefits
Medicare Part D covers prescription drugs at the pharmacy and these plans cost on average around $35 a month. Most Vets do not select a Medicare Prescription Drug Plan as they have RX coverage from the VA. If you choose not to enroll in Part D when you are first eligible you can even still enroll in Part D later without paying a penalty.
Please note: We are only able to give general information about Medicare-related issues. If you have specific questions about your VA coverage, please contact Veterans Affairs directly.
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If You Have Tricare You May Have To Enroll In Original Medicare
If you are not on active duty and are entitled to premium-free Medicare Part A, then you must also enroll in Part B in order to keep TRICARE coverage.
You must also be enrolled in both Medicare Part A and Part B in order to have TRICARE For Life. The lone exception is when the beneficiary is the spouse of an active duty service member, in which case Medicare Part B enrollment is not necessary.
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Do You Need Medicare Advantage If You Have Va Benefits
Medicare Part C, more commonly known as Medicare Advantage, provides the same coverage as Original Medicare. However, most Advantage plans provide additional benefits, like prescription drug coverage and routine dental care.
If you’re covered by a VA health plan, you may decide you don’t need an Advantage plan, since you already have prescription benefits. The main “advantage” to a Medicare Advantage plan is that most of them include prescription drug coverage. However, if any of your prescriptions are not covered by your VA RX plan, you may want to consider Medicare Advantage. Or, if you prefer to stay with Original Medicare, since it doesn’t have any restrictions like provider networks, you may prefer to sign up for a Medicare Part D plan .
Part C insurance plans are provided by private insurers. Costs and coverage vary according to the plan you choose. Around 40 percent of Medicare Advantage plans have no premium. Most will have yearly deductibles and copayments, though. You may also find that you have a separate deductible for your Part D coverage if your Advantage plan includes prescriptions.
Please note that you still have to pay the Medicare Part B premium, even if your Advantage plan has a monthly premium. Also, you cannot have both an Advantage plan and a Medigap plan.
Should You Get Medigap If You Have Va Benefits
Perhaps. A Medicare Supplement Plan will fill in the unpaid gaps in coverage such as deductibles, copays, and coinsurance. Medicare also includes benefits when traveling outside of the U.S. and its territories.
Make sure to speak with your VA, Tricare, or CHAMPVA representative before enrolling in any supplemental plan to ensure that it is your best course of action. Here are two reasons why you may want to enroll in a Medigap plan:
It is important to enroll in Medigap when it is first available. If you apply outside of your Medigap initial enrollment period you will be asked medical questions. You could also be denied coverage or charged more.
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Do I Need Part D If I Have Va Benefits
VA benefits include prescription drug coverage. Unlike VA health coverage, VA drug coverage is creditable for Medicare Part D. This means 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.
However, most beneficiaries with both Medicare and VA benefits do not need to enroll in prescription drug coverage through a Medicare Part D plan. 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.
Additionally, there are some situations in which an individual with Medicare and VA benefits could benefit from signing up for Medicare 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 Medicare Part D plan could also be a good option. If you qualify for Medicare Part D Extra Help, your prescriptions may have lower copays than they would through VA benefits.
Are Veterans Eligible For Medicare
Yes, veterans are eligible for Medicare as long as they meet the Medicare eligibility criteria. To qualify for Medicare, older adults must be at least 65 years old and have worked and paid Medicare taxes for at least 10 years. If youre under age 65, you may qualify for Medicare if you have end-stage renal disease or a qualifying Social Security disability. Once you meet the eligibility requirements, youll be able to enroll in Original Medicare Parts A and B. After youre enrolled in both Parts A and B, you will be eligible to enroll in a Medicare Advantage or Medigap plan. You can enroll in Part D if you are enrolled in Medicare Part A and/or Part B.
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