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At HealthPlanOne.com, we understand that the process of selecting the right health care coverage for an individual or family member is a personal one. Our goal is protect your privacy while ensuring that you are offered useful and comprehensive information to help you make your decision.
At HealthPlanOne.com, we also understand that relationships are built on trust. So we want to make sure that we clearly disclose to you the kind of information our website may collect and what we do with that information.
Does It Help Me In Any Way To Give Va My Health Insurance Information
Yes. Giving us your health insurance information helps you because:
- When your private health insurance provider pays us for your non-service-connected care, we may be able to use the funds to offset partor allof your VA copayment.
- Your private insurer may apply your VA health care charges toward your annual deductible .
Risk Of Going Uninsured
VA health care benefits are fragile. Because the VA health care program relies on funding by Congress, no one knows if theyâll cut the funding in the future. Essentially, thereâs no guarantee that you wonât be kicked off at any time.
If youâre in a lower priority group, you could lose your VA health coverage, and if you arenât signed up for Medicare, you could be completely uncovered. With the average cost of a heart attack costing upwards of $1 million, you donât want to go without insurance!
If you donât sign up for Medicare when youâre first eligible , you canât sign up again until January of the following year. Unfortunately, thereâs also a penalty involved. So, be sure to sign up your Medicare coverage.
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You Might Be Subject To Late Enrollment Fees If You Forego Medicare Enrollment
If you do not sign up for Medicare Part B during your Initial Enrollment Period, you may be subject to late enrollment penalties if you decide to sign up later on.
The Part B late enrollment penalty is 10 percent of the Part B premium for each 12-month period in which you were eligible to enroll but did not. You will have to continue to pay the penalty for as long as you remain enrolled in Part B.
You may be able to avoid the Part B late enrollment penalty if you qualify for a Medicare Special Enrollment Period. Choosing not to enroll in Medicare Part B because you have VA coverage does not qualify you for a Special Enrollment Period.
Medicare And Va Coverage Compliment One Another
Medicare coverage for Parts A and B includes:
- Emergency care services
- Mental health services
While Medicare generally doesnt cover routine dental, vision or hearing care, some veterans can qualify for dental and vision coverage through VA benefits. On the other hand, Medicare covers hospice and skilled nursing facility care while VA health care does not.
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Va Benefits And Medicare Part D
Medicare Part D prescription drug coverage, whether as a standalone plan or a Medicare Advantage Plan with drug coverage, covers at least two prescription medications per drug category. Because VA drug coverage applies only to prescriptions filled at a VA pharmacy or other VA facility, enrolling in Medicare Part D is a good idea if you dont live near a VA pharmacy or you want more flexibility in choosing a pharmacy. Depending on the plan you select, Medicare Part D may also cover a wider variety of medications, often with a lower copayment. If you live near a VA pharmacy and dont mind going there to pick up your prescriptions, you may not need to enroll in Medicare Part D.
Your VA drug benefit counts as creditable coverage for Medicare Part D purposes. If you decide to defer enrollment in Part D, you will not incur late penalty charges if you join a Medicare drug plan at a later time.
How Does It Work If You Have Both Medicare And Va
If you have both VA and Medicare benefits, the way it works is fairly simple. To use your VA benefits, choose a VA facility for your healthcare. To take advantage of your Medicare coverage, use a Medicare-approved provider who accepts assignment. If you have a Medicare Advantage plan, the provider must also accept your plan.
Unfortunately, you cannot use your VA benefits to pay your out-of-pocket Medicare costs, such as deductibles and co-insurance. In addition, Medicare will not pay for services received in a VA facility. These two systems do not coordinate coverage.
If you choose Original Medicare, you may want to add a Medicare supplement plan . Cost sharing for Parts A and B includes deductibles and co-insurance. Out-of-pocket costs under Part A in particular can be quite high. An extended hospital stay could leave you owing tens of thousands of dollars. Your Medigap plan helps pay some of these costs.
Veterans may also choose a Medicare Advantage plan instead of Original Medicare. MA plans provide the same benefits as Original Medicare . However, out-of-pocket costs for hospital stays are usually lower. In addition, MA plans have a maximum out-of-pocket limit, which is $6,700 in 2019. Original Medicare has no limit on out-of-pocket costs.
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Enroll In Medicare Part D At Myrxplanscom
There are a few instances in which enrolling in a Part D plan or a Medicare Advantage plan with prescription drug coverage may make sense:
- VA coverage includes its own drug formulary . If the VA does not cover a specific drug that you need to take, you might consider enrolling in a Medicare Part D plan that covers that drug.
- A drug prescribed by a doctor at a non-VA facility may not be covered by VA benefits without authorization.
- A non-VA pharmacy may be a more convenient way to obtain your drugs, especially if you reside in a nursing home or other long-term care facility.
- If you qualify for Medicare Extra Help, your overall drug costs may be lower with a Part D plan than under VA coverage.
When You Use A Va Hospital
If you get medical care at a VA hospital, your VA benefits will generally cover the costs. This is because the VA uses providers who are covered under the plan, so you wont necessarily need the institution to submit any claims to Medicare. However, Medicare can also cover services included with your VA medical benefits. In some cases, you can choose which provider to use.
Its worth noting that you cant use VA benefits and Medicare simultaneously. In other words, if the VA covers a treatment or office visit, Medicare cant cover services rendered at the same time. The only exception occurs when youre sent to a non-VA hospital by the VA. In that case, you can use your Medicare insurance plan to cover services that the VA wont.
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Do I Need Medicare If I Have Va Benefits
You can use your VA benefits with a private insurance plan, Medicare, or Medicaid. However, just because you can use them together doesnt mean that you need both. So, do you need Medicare if you already have VA benefits?
To keep things brief, no, you do not need Medicare if you have VA benefits. You can get all of your care through your VA benefits. That said, the VA will put you into groups based on your disabilitys severity. Your group can determine the extent of care that you get with your VA healthcare plan.
As a result, we recommend using some form of Medicare with your VA benefits. You can get inpatient and outpatient coverage, in addition to your coverage through Veterans Affairs. Whether you just want Original Medicare, or you want extra coverage with Part D, Medigap, or Medicare Advantage, it is well worth it to enroll when you qualify.
Va And Other Health Insurance
If you have other forms of health care coverage, such as a private insurance plan, Medicare, Medicaid or TRICARE, you can continue to use VA along with these plans. Remember, it is always a good idea to inform your doctors if you are receiving care outside of VA so your health care can be coordinated.
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Medicare And Va Benefits
There are several insurance programs available to those who are also eligible for Medicare. The most popular of 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, understanding who pays for the services you receive is simple. You use VA benefits when receiving care at a VA hospital or facility. Yet, when the facility where your services take place is Medicare-certified, Medicare will pay. 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.
Keep in mind, 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.
Medicare Enrollment For Veterans
The world of veterans benefits can be confusing, and it can be difficult to know how much coverage you really have. Supplementing your veterans healthcare coverage with a Medicare plan may be a good idea, especially because Veterans Administration healthcare coverage can vary drastically from person to person and over time.
Here, we will look at the different Medicare plans, TRICARE, and VA Medical Benefits and how they all work together.
You can have both VA coverage and Medicare if you:
- are age 65 or over and enrolled in Medicare Part B
- are any age and have a qualifying disability, end stage renal disease , or amyotrophic lateral sclerosis and are enrolled in both Medicare Part A and Part B
Medicare is not mandatory, and you may be considering delaying or declining Medicare coverage and relying only on your VA benefits.
If youre thinking about deferring Medicare, discuss the pros and cons with a VA representative. Its important to know how or if your current plan will work with Medicare, so you can choose the most comprehensive overage possible.
The healthcare coverage provided by the VA is a different healthcare system than Medicare. Typically, these systems do not interact with each other, so it is often up to the veteran to understand what coverage is provided by each plan.
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Do I Need Medicare If I Have Veterans Benefits
Home / FAQs / General Medicare / Do I Need Medicare if I Have Veterans Benefits?
For veterans approaching Medicare eligibility, it is common to have questions about whether it is necessary to enroll in Medicare alongside Veterans Affairs benefits. The short answer is that Medicare does not coordinate with VA benefits. However, you can have both types of insurance at the same time and benefit from doing so. Below, we answer the most frequently asked questions about Medicare for veterans.
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How Your Va Benefits And Medicare Work Together
If you have both VA and Medicare benefits, how services are covered typically depends on where you get care.
For services to be covered by the VA, you must go to a VA facility. Or, to get coverage for services at a non-VA facility, you must get prior authorization from the VA.
If you go to a non-VA facility, your Medicare coverage applies. Part A and Part B would likely cover the services and supplies you’d need for either inpatient or outpatient care. Or, if you received prior authorization, the VA would pay for some services and Medicare may pay for others.
When you enroll in Medicare, you should inform the VA that you have that coverage. They can help you understand how the benefits work together.
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Do You Need A Medicare Part D Plan If You Have Va
Most veterans choose their VA prescription benefits, because the out-of-pocket costs are lower. In addition, although having VA benefits does not qualify you for an SEP, Medicare considers the VAs prescription coverage creditable. This means veterans dont face late penalties if they decide to add a Part D plan later.
You may decide to sign up for Part D anyway, especially if the VA formulary doesnt cover any of your prescriptions. Some veterans also qualify for Extra Help, a Medicare program that typically has lower co-payments than under VA.
However, if you do not sign up for Part D when you first become eligible, you have to wait for Annual Enrollment, which occurs from October 15 through December 7. In addition, if you have an MA plan and choose to switch back to Original Medicare during Open Enrollment , you can sign up for a Part D plan.
Medicare For Veterans And Va Benefits: A Complete Guide
Its a good idea for veterans to apply for both Veteran Affairs health care benefits and Medicare when they become eligible. While the two programs dont offer dual-coverage, Medicare offers benefits not covered by VA health care and vice versa.
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Lee Williams
Senior Financial Editor
Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine, AskMen.com, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.
Our fact-checking process starts with vetting all sources to ensure they are authoritative and relevant. Then we verify the facts with original reports published by those sources, or we confirm the facts with qualified experts. For full transparency, we clearly identify our sources in a list at the bottom of each page.
Content created by RetireGuide and sponsored by our partners.
Key Principles
Editorial Independence
To support the health care needs of about 19 million U.S. veterans, government health insurance programs such as VA benefits and Medicare.
This guide covers everything you need to know about Medicare for Veterans, VA benefits, Tricare for Life coverage and how these programs work together.
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Tricare Va Benefits & Advantage Plans
Medicare-approved private insurance companies offer Medicare Advantage plans to cover all your Part A and Part B services.
Just like Supplements, Advantage plans help minimize your out-of-pocket expenses on Medicare.
Advantage plans have maximum yearly out-of-pocket amounts that are often very high and restrict you to a network of providers and facilities, making them much different and much less flexible than Supplements.
If you have TRICARE, you will want to use caution if you are considering an Advantage plan.
Advantage plans restrict you to a network of providers.
It may prove not easy to find providers that accept both your Advantage plan and TRICARE.
Original Medicare with a Supplement covers you for services received from any provider or facility nationwide that accepts Medicare.
It is much more likely that you will find providers that accept original Medicare and TRICARE versus trying to find a provider that will take an Advantage Plan.
If you have VA benefits an Advantage Plan may be a good option since Advantage Plans are much more flexible than the VA.
We talked about Advantage plans in more detail in another post, which you can read here.
Can You Have Both Va Healthcare And Medicare
You can have both VA healthcare and Medicare, and in fact, the VA encourages you to sign up for Medicare as soon as you can. There are a few reasons for this:
- VA coverage isn’t always guaranteed: The VA assigns you to different priority levels based on a variety of factors. If there isn’t enough government funding in the future to provide care to all Veterans with VA healthcare and you’re in one of the lower priority groups, you could lose your VA coverage. Having Medicare as well will ensure you always have coverage you’ll need.
- Wider coverage: The VA pays for services if you go to a VA hospital or doctor. If you have Medicare, you’re covered if you go to a non-VA provider. This gives you more options to choose from and prevents you from having to pay the full cost out-of-pocket for medical services outside of Veterans Affairs.
- Penalties: If you don’t enroll in Medicare B when you’re eligible and you lose VA coverage or decide to enroll in Part B later, you may have to pay a late enrollment penalty every month that you have Part B in the future. To avoid those penalties altogether you should enroll in Part B when you’re eligible.
- Drug coverage: If you also enroll in Medicare Part D prescription drug coverage, you can get prescriptions from non-VA doctors and fill them at non-VA pharmacies. Enrolling in Part D is not required if you have VA coverage but doing so may give you more options.
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Va Benefits And Medicare Part C
Medicare Advantage Plans, also known as Medicare Part C, combine the benefits of Medicare Parts A and B, and in most cases, Part D prescription drug coverage, into a single plan offered by a private health insurance company instead of the federal government. As an alternative way to receive your Medicare benefits, all Medicare Advantage Plans must offer the same level of coverage as Original Medicare. Most insurers cover additional services, such as dental, hearing, and vision care.
Enrolling in Medicare Part C can help reduce your out-of-pocket medical expenses by covering services that arent covered by your VA benefits. You must be enrolled in Medicare Parts A and B to join a Medicare Advantage Plan. You are still responsible for your Part B monthly premium but will likely have access to a zero-premium Medicare Advantage Plan that includes drug coverage. Medicare Advantage Plans provide care from in-network providers to keep your costs as low as possible. All plans have an out-of-pocket maximum for Medicare-covered services. With Original Medicare, there is no limit on what you may spend for your portion of expenses.