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do i need medicare if i have veterans benefits

by Amy Wilkinson Published 3 years ago Updated 2 years ago
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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.

Does the VA encourage veterans to enroll in Medicare?

The VA usually encourages veterans to enroll in both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). You typically don't have to pay a premium for Part A, while the standard Part B premium for 2022 is $170.10 or higher, depending on your income.

Will a veteran benefit from Medicare?

Veterans who utilize benefits from TRICARE or the Veterans Affairs can still obtain Medicare coverage. Having secondary insurance could prove very useful and save members a lot of money. Let’s talk about how the two plans work together. Veterans who would like to enroll in a Medicare Advantage plan do so like everyone else.

How does Medicare work with coverage for veterans?

Here’s why:

  • VA health coverage isn’t set in stone and isn’t the same for everyone. ...
  • Having both Medicare and VA benefits greatly widens your coverage. VA coverage pays for medical services if you go to a VA hospital or doctor. ...
  • You may be subject to penalties in the future. ...

Do I need Medicare if I have veterans 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 disability’s severity.

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What is Medicare Advantage for veterans?

Many veterans are going to find Medicare Advantage a practical solution to coverage. Most plans boast a $0 premium and extra benefits beyond Medicare. Some plans may include prescription drug coverage. Depending on the service area, an Advantage plan could include telehealth, dental, vision, and a gym membership.

How long do disabled veterans have to be on 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 Administration?

Who Pays First, Medicare, or the Veterans Administration? The simple answer to the question of who pays first is both. When you go to the Veterans facilities, the only coverage you have is Veterans Administration coverage. Then, when you go to civilian facilities, you only have Medicare coverage.

Can you have both types of Medicare and VA?

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.

Is Medicare mandatory?

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

Does Medicare cover heart attacks?

Further, Medicare is only going to cover doctors that accept Medicare. So, if you have a heart attack while grocery shopping and the nearest hospital isn’t a Veterans facility, you’re going to want Medicare coverage.

Does the VA bill Medicare?

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).

What should veterans know about Medicare?

Here are seven things every veteran should know about Medicare. Medicare covers veterans in the same way as it covers most other Medicare beneficiaries. But there are a few things that veterans of the armed forces should know about Medicare. 1. Medicare and VA coverage do not coordinate benefits. Medicare and VA (Veterans Affairs) ...

What if VA does not cover a specific drug?

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.

How to enroll in Medicare Advantage?

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: 1 VA coverage includes its own drug formulary (a list of drugs covered by the plan). 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. 2 A drug prescribed by a doctor at a non-VA facility may not be covered by VA benefits without authorization. 3 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. 4 If you qualify for Medicare Extra Help, your overall drug costs may be lower with a Part D plan than under VA coverage.

What can an agent do for Medicare?

An agent can help you find the Medicare Advantage plan coverage that fits your unique health care needs.

What happens if you don't sign up for Medicare Part B?

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.

Does Medicare Advantage have its own formulary?

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 (a list of drugs covered by the plan).

Do you have to enroll in Medicare if you are not on active duty?

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.

Why do you need a Medicare Supplement Plan?

Because both of these plans provide you with more coverage than Original Medicare ( Part A and B ). A Medicare Supplement plan helps fill in the gaps (deductibles, copayments, out-of-pocket expenses, etc.) left by Medicare.

What happens if you don't want Medicare?

If you don’t want Medicare now, you may have to pay a late enrollment penalty for signing up later on.

Is Medicare Advantage the same as VA?

Medicare Advantage. Combining Medicare Advantage and VA benefits is a great way to have more options with your coverage. There are many Medicare Advantage plans to choose from. Most plans include the same benefits as Medicare Part A, Part B, and a Part D prescription drug plan.

Does Medicare Supplement cover out of pocket expenses?

A Medigap policy helps pay for certain out-of-pocket expenses that Parts A and B do not cover. For example, Medigap can provide extra help with deductibles, copayments, coinsurances, and even medical emergencies that occur while traveling abroad.

Do veterans need medicare?

So, do veterans need Medicare? No, they don’t. That said, veterans’ benefits only cover your care at VA clinics. Medicare covers you ANYWHERE that accepts Original Medicare. So, adding Medicare is a great way to save on costs and have more choices with your health insurance. For even more coverage, savings, and flexibility, you can add a Medicare Supplement or switch to Medicare Advantage.

Does Medicare cover VA hospital?

For example, when you go to a VA hospital, your VA benefits will cover it (Medicare will not). When you go to a non-VA hospital in your network, your Medicare plan will cover it (VA benefits usually won’t).

Do VA benefits work together?

This leaves many veterans wondering how (or if) Medicare and VA benefits can work together to provide them with the healthcare they need. Moreover, if you already get VA health benefits, you may want to know if you should buy a Medicare Supplement (Medigap) plan.

How much would you be on the hook for a heart attack if you didn't have a Medicare Supplement?

Using our example of a heart attack, which costs around $1 million, you’d be on the hook for $200,000 if you didn’t have a Medicare Supplement.

What is Medicare Part B?

Medicare Part B is coverage for doctors and outpatient services. Generally, most care you need that’s not inpatient care is covered under Medicare Part B.

How much is a generic prescription for VA?

For a lot of people, it’s just a handful of generic prescriptions, and they’re only $4 anyways, so that VA prescription benefit isn’t really worth the hassle.

Does Medicare Advantage have a low premium?

While Medicare Advantage plans do come with some perks, like really low or even $0 premium and extra benefits like free dental and eye exams, you’re still stuck with the network issue.

Can you see doctors in Medicare Advantage?

If you choose a Medicare Advantage plan instead, you can only see doctors in that particular plan’s network. That’s a whole other set of issues, especially for those who live in Decatur. MA networks in Decatur can be quite limiting.

Is there a coordination between Medicare and VA?

In short, there is no coordination of benefits between Medicare and VA benefits. They’re two completely separate entities.

Does Medicare cover travel outside the country?

Medicare Supplements also boast other benefits, such as coverage if you travel outside of the country.

Why do veterans use VA benefits?

Some use VA benefits as to avoid the gaps in Medicare and the costs they would incur. On the flip side, there are also many Veterans who recognize that those gaps can be covered through Medicare Supplement insurance.

Why do people buy Medicare Supplement?

Often times, Medicare Beneficiaries will opt to purchase Medicare Supplement (Medigap) insurance to help fill in the gaps that Original Medicare doesn’t pay. This helps broaden their ability to have more control over their own health care needs.

What is Medicare Supplement?

Medicare Supplement insurance is designed to fill those gaps. It provides peace of mind knowing that your medical needs are being attended to and your bills are being paid by the insurance company.

How to contact VA insurance?

This is often best done through an independent insurance agent who has access to multiple insurance companies and their rates. Please call me (1-888-411-1329) if you have any questions about your VA benefits and Medicare Supplement. I look forward to speaking with you.

Does Medicare Supplement pay after Medicare pays?

Medicare Supplement ( Medigap) insurance pays after Medicare pays. There are many types of Medigap Plans; but, they all help to pay for medical expenses not covered by Original Medicare…such as coinsurance and deductibles.

Is Medicare and VA separate?

Medicare and the VA are separate. Quite simply, Medicare and VA are separate entities. VA facilities are not Medicare approved providers. Beneficiaries usually use their VA benefits when they need help with health care items not approved by Medicare ( hearing aids, over-the-counter medications ). Medicare Supplement ( Medigap) ...

Can the VA bill Medicare?

VA cannot bill Original Medicare, but can bill Medicare Supplement insurance for a covered service.

Why is it important to understand VA and Medicare?

Because each offers different benefits, having both at your disposal will broaden your health insurance coverage options. If you’re a veteran, it’s important to understand how VA benefits and Medicare work in tandem before you make the choice.

How long do you have to enroll in Medicare if you lose your VA benefits?

If you lose your VA benefits, you’ll have 63 days to enroll in a Part D plan before that penalty kicks in.

What is Medicare Supplement Insurance?

A veteran may choose to supplement their Medicare coverage with a privately administered Medigap Insurance plan (also called Medicare Supplement Insurance), which helps cover the out-of-pocket costs associated with Medicare, such as deductibles, copayments, coinsurance and other fees.

How much is the VA deductible for 2021?

In addition to the 2021 Medicare Part A deductible of $1,484 per benefit period, coinsurance for hospital stays lasting longer than 60 days starts at $371 per day in 2021. Moreover, after meeting your 2021 Part B deductible ...

What is the priority number for veterans?

All veterans who qualify for VA health benefits are assigned to a priority group numbered 1 through 8, with 1 being the highest and 8 being the lowest. Your priority number, which depends on factors such as your income level and if you have a service-connected disability, determines everything from copayments to out-of-pocket costs to ...

How long do you have to serve in the military to get VA benefits?

The minimum duty requirements for VA benefits call for 24 months of continuous service, which also applies to members of the National Guard and the Reserves. But because there are many exceptions ...

Can veterans get Medicare?

How Veterans Can Make Sense of Medicare and VA Benefits. Veterans who receive health care benefits through the U.S. Department of Veterans Affairs (VA) can also enroll in Medicare upon turning 65. Because each offers different benefits, having both at your disposal will broaden your health insurance coverage options.

Do You Need Medicare If You Have VA Benefits?

Having both VA benefits and Medicare increases your options for where and how you receive health care services.

How Do VA Benefits Work with Medicare?

Medicare and VA benefits seldom work together. This is a major reason the VA recommends that veterans enroll in Original Medicare even if they have VA benefits.

Prescription Drug Coverage Through VA Benefits or Medicare Part D

If you have both VA and Medicare Part D prescription drug coverage, you have the option of using either to pay for your prescriptions.

Using Medigap or Medicare Advantage and VA Benefits

Medicare supplement insurance plans — also called Medigap — and Medicare Advantage plans are sold by private insurers that contract with Medicare.

What does Medicare mean?

Having Medicare means you’re covered if you need to go to a non-VA hospital or doctor—so you have more options to choose from.

What happens if you delay Medicare Part B?

If you delay signing up for Medicare Part B (coverage for doctors and outpatient services) and then need to sign up later because you lose your VA health care benefits or need more choice in care options, you’ll pay a penalty. This penalty gets bigger each year you delay signing up—and you’ll pay it every year for the rest of your life.

Does VA pay deductible?

Your private insurer may apply your VA health care charges toward your annual deductible (the amount of money you pay toward your care each year before your insurance starts paying for care).

Do you have to bill your spouse's health insurance?

We’re required by law to bill your health insurance (including your spouse’s insurance if you’re covered under the policy). The money collected goes back to VA medical centers to support health care costs provided to all Veterans.

Can you request a restriction on VA health information?

You can submit a restriction request asking us not to disclose your health information for billing purposes, but we’re not required to grant your request. To submit a restriction request, please contact your nearest VA health facility and ask to talk with the privacy officer. You can also ask to talk with the billing office for more information.

Does VA health care meet the ACA?

If I’m signed up for the VA health care program, does that mean I meet the requirements to have health care under the Affordable Care Act (ACA)? Yes. Being signed up for VA health care meets your Affordable Care Act health coverage requirement of having “minimum essential health coverage.”.

Do we bill Medicare or Medicaid?

We don’t bill Medicare or Medicaid, but we may bill Medicare supplemental health insurance for covered services.

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