Veterans often ask us whether they need both Medicare and VA Benefits. More specifically, they want to know if they need Medicare Part B. Part B has a monthly premium, after all, and they aren’t sure they really need it.
My personal opinion is a resounding “Yes, you should enroll in both Medicare Parts A and B. (You should consider a supplement too, but I’ll get to that later.)
People can and often do have both Medicare and VA benefits. The two coverages do not work together, but are important separately, as we’ll explain below.
The VA website itself makes it clear that VA benefits are not considered health insurance. The website encourages veterans to enroll in Medicare. This is because Medicare may provide healthcare benefits that you’ll need down the road. Each program has certain benefits that the other program does not.
For instance, many veterans use their VA health benefits to obtain coverage for medical services not covered by Original Medicare. This can include certain over-the-counter medications and hearing benefits including hearing aids. It also includes more generous prescription drug coverage than Medicare Part D.
On the flip side, enrolling in Medicare Part B will allow Medicare to cover elective services that you receive outside of the VA healthcare system. For me, this is the most important thing. You see, my father is a Vietnam veteran. I enrolled him in both Medicare Parts A and B as well as a Medigap plan. for several reasons.
Let’s take a look at some of those reasons:
Freedom to Seek Treatment from Civilian Doctors and Hospitals
Veterans relying on only VA coverage will often find that non-emergency medical treatment is generally only given at a VA facility. While your VA doctor may be able to coordinate outside referrals in some circumstances, there are never any guarantees.
Many Veterans enjoy using their Medicare to seeing a local civilian doctor for minor ailments and illnesses. Sometimes the VA clinic isn’t nearby, or there are significant wait times to see a doctor.
Medicare, on the other hand, has hundreds of thousands of providers. Some of the very best doctors in their fields accept Medicare. If diagnosed with a serious condition, you’ll have choices for specialists outside the VA to receive the best care.
The same goes for VA drug benefits. The VA drug formulary (list of covered drugs) has only about 60% of what a Medicare Part D plan has. It’s best for veterans to use the VA for their maintenance drugs. They would be wise to also have a Part D drug plan that they can use for short term meds or specialty meds that are not covered by the VA.
You also cannot take a prescription from a civilian doctor and fill it at the VA. You must make an appointment to consult with a VA doctor to get a prescription before you can fill it at the VA.
All VA Benefits are Not the Same
Another reason why veterans often enroll in Medicare is that VA benefits are not equal for everyone. There are 8 levels to qualify for benefits. Certain veterans have higher priority levels based on health conditions that are service-related and also based on income. Full medical benefits are limited to Veterans with a military-related disability who also has low income.
VA benefits can vary by region. They are also subject to changes based on funding from our federal government.
There is always a chance that your current benefits could be reduced in the future. If this were to happen, having alternate coverage like Medicare is helpful. While you could add Medicare later on down the road, it will cost you.
Avoiding Medicare Penalties
Enrolling in Medicare when you first become eligible will help you to avoid costly penalties. You are only eligible to join Medicare Part B for a short window of time after you become eligible. This is usually at age 65. If you wait, your VA coverage does NOT exempt you from paying the Medicare Part B late enrollment penalty. The penalty is 10% per year for every year that you waited to enroll. Even just a few years delay can be very costly.
What’s worse is that you have to wait until the General Enrollment Period in January to apply for Part B. Then those benefits won’t begin until the following July. If you are adding the Part B to see a civilian healthcare provider, waiting for this period to come around can be agonizing. It’s not worth risking.
Eligibility for Medigap
Once you have enrolled in both Medicare Parts A & B, you are eligible for supplemental insurance such as a Medigap policy or Medicare Advantage program. Having Medigap gives you further protection against catastrophic medical expenses should you seek treatment at a specialty facility. Also interesting is that while the VA cannot bill Medicare for services, we have read that in some circumstances they may be willing to bill your supplemental policy. So if there are certain VA treatments or which you owe a significant copay, your Medigap policy may help you to reduce some that cost-sharing.
Do your homework and find out ahead of time what the VA will bill. Then contact your Medigap company to see if they will honor that bill and pay some or all of it. This is one area where your agent can’t predict how the billing will go. A Medigap plan will certainly help you outside of the VA, and it might help with some charges by the VA.
In other words, it can’t hurt to have it. Read more about Medicare Supplemental coverage for Veterans here.
Eligibility for Medicare Advantage
Likewise, enrolling in a Medicare Advantage program is quite popular with Veterans. Many of these plans have a $0 premium but serve up great extra benefits like gym membership and vision coverage. Without enrollment into Medicare A & B, you can’t be considered for a Medicare Advantage plan. Having Medicare widens your choices for this additional coverage. Most Medicare Advantage plans also include Part D. If a doctor prescribes a medication that the VA won’t cover, your Medicare Part D inside of your Medicare Advantage plan may cover it.
Remember, Medicare cannot pay for any care that you receive at a VA facility. Likewise, the VA, with few exceptions, cannot pay for any coverage that you receive at a Medicare-certified facility . The two programs are mutually exclusive, so it’s important for VA members to carefully consider how to set up your coverage. A Boomer Benefits friendly licensed agent can help you decide what supplemental coverage might best suit your individual needs.
Do you need help deciding whether to enroll in a Medicare and VA coverage? We can help. Reach out to us today to learn more about Medicare and VA benefits.