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  • Writer's picturemike layden

VA Benefits and Medicare

Updated: May 20

Medicare is a federal health insurance program that provides coverage for individuals who are 65 years or older. In addition, younger individuals are eligible with disabilities, ESRD, or Lou Gehrig's disease. On the other hand, the Department of Veterans Affairs (VA) provides healthcare services exclusively for veterans. However, many veterans may be eligible for both Medicare and VA benefits.


VA Benefits and Medicare


As a veteran, you may be wondering if you are eligible for Medicare and how it works with your VA benefits. The answer is yes, you can have both Medicare and VA benefits. In this article, we will explore the eligibility requirements for Medicare for veterans with VA and how it can benefit you.


Understanding Medicare Eligibility


Before we dive into Medicare for veterans with VA, let's first understand the eligibility requirements for Medicare.


Age Requirements


The most common way to become eligible for Medicare is by turning 65 years old. This is when you become eligible for Medicare Part A, which covers hospital insurance. You can also enroll in Medicare Part B, which covers medical insurance, during this time.


Disability Requirements


You are eligible if you are under 65 years of age and have received Social Security Disability Insurance (SSDI) for at least 24 months or have End-Stage Renal Disease (ESRD) or Lou Gehrig's disease.


Citizenship and Residency Requirements


To be eligible for Medicare, you must be a U.S. citizen or a permanent legal resident who has lived in the U.S. for at least five consecutive years.


Medicare for Veterans with VA Benefits


As a veteran, you may also have VA benefits. The good news is that you can have both Medicare and VA benefits. However, it's important to understand how they work together.

VA Benefits and Medicare Part A


You may not need to enroll in Medicare Part A if you have VA benefits. Hospital stays, skilled nursing facility care and hospice care can be covered by both the VA and Medicare. However, it's still recommended to enroll in Medicare Part A to avoid any potential gaps in coverage. In most cases, Part A has no additional cost to enroll.


VA Benefits and Medicare Part D


Medicare Part D is prescription drug coverage. You may not need to enroll in Medicare Part D if you have VA benefits. You may be able to get lower-cost prescriptions through the VA.


How Medicare Combined with VA Healthcare Can Benefit Veterans


Having both Medicare and VA benefits can provide you with comprehensive coverage for your healthcare needs. Here are some of the benefits of having both:


VA Benefits and Medicare Part B


VA benefits do not cover the same services as Medicare Part B. This includes doctor visits, preventive care, and medical equipment. Therefore, it's important to enroll in Medicare Part B to have these services covered. By enrolling when you are eligible, you will avoid Part B enrollment penalties down the road.


More Coverage Options


Having both Medicare and VA benefits gives you more options for coverage. You may be able to identify better coverage or lower costs by utilizing VA benefits for certain services and Medicare for others.


Lower Out-of-Pocket Costs


With both Medicare and VA benefits, you may be able to lower your out-of-pocket costs for healthcare. You may only have to pay the copayment or coinsurance for a medical service that is covered by both Medicare and VA benefits.


Access to a Wider Network of Providers


Medicare has a larger network of providers than the VA, which means you may have more options for doctors and specialists. This can be especially beneficial if you live in a rural area where there may be limited VA facilities.


Coverage for Services Not Covered by VA Benefits


As mentioned earlier, VA benefits do not cover the same services as Medicare Part B. By enrolling in Medicare Part B, you can have coverage for these services, such as doctor visits and preventive care.


VA Prescription Drug Plans Provide Creditable Coverage


VA prescription drug plans are considered creditable coverage by Medicare. That means that the VA prescription plan is at least as good as Part D Prescription Drug Plans. If you are satisfied with the VA prescription plan, you do not need to enroll in Part D. There are Medicare Advantage Plans that offer Part A and Part B benefits only and not prescription drug plans. These plans tend to offer additional benefits that are described in the next paragraph. However, there might be good reason to enroll in a Medicare Advantage Plan that includes prescriptions. By doing so, a veteran would afford themselves the convenience of having medications prescribed and filled by civilian physicians and pharmacies.


Medicare Advantage Plans are Available with Extra Benefits That Original Medicare Don't Provide


Many Medicare Advantage Plans provide benefits not provided by Medicare Parts A and B like dental, vision, hearing, gym membership, and more. Advantage Plans also provide monthly Part B premium reduction up to $115 depending on location and plan.


Relying on Medicare Part A and B Only Leave Veterans with Significant Financial Exposure


Original Medicare (Parts A and B) does not pay for all medical expenses. Generally, Medicare pays 80% of Medicare allowable expenses leaving the other 20% for the veteran to pay. Depending on the medical services received, this can be financially catastrophic. Many Medicare Advantage plans have a zero-dollar monthly plan premium and cap total expenses the veteran would have to pay. The amount of the cap varies by plan.


How to Enroll in Medicare for Veterans with VA Benefits


If you are eligible for Medicare, follow these steps to enroll in Parts A and B.


Step 1: Determine Your Eligibility


First, you need to determine if you are eligible for Medicare. This includes meeting the age, disability, and citizenship requirements.


Step 2: Enroll in Medicare Part A


If you are eligible for Medicare, you will automatically be enrolled in Medicare Part A when you turn 65. To enroll in Medicare Part A by contacting the Social Security Administration if you are under 65 and have a disability. Generally, there is no charge for Part A.


Step 3: Enroll in Medicare Part B


If you are eligible for Medicare, you will need to enroll in Medicare Part B to have coverage for medical services. Generally, your enrollment period is the seven-month period that begins three months before your 65th birthday and ends three months after your birthday month. Part B monthly premium for 2024 is $174.70.


Step 4: Decide if You Want Medicare Part D


If you have VA benefits, you may not need to enroll in Medicare Part D. However, if you choose to enroll, you can do so during your initial enrollment period or during the annual open enrollment period, which is from October 15th to December 7th.


Real-World Examples of Medicare for Veterans with VA Benefits

Example 1: John


John is 68 years of age and is a veteran receiving VA benefits. He was automatically enrolled in Medicare Part as he turned 65. John chooses to delay enrolling in Medicare Part B because he is still working and has health insurance through his employer. When he retires at 67, he enrolls in Medicare Part B during his special enrollment period. He also enrolls in Medicare Part D during the annual open enrollment period.


Example 2: Sarah


Sarah is a 63-year-old veteran who has VA benefits. Sarah has received Social Security Disability Insurance (SSDI) for the past 24 months. She is automatically enrolled in Medicare Part A at the beginning of the month she received her 25th check. She also enrolled in Medicare Part B during her initial enrollment period. She chooses not to enroll in Medicare Part D because her VA benefits cover her prescription drugs.


Example 3: Tara


Tara is a 68-year-old veteran receiving VA benefits. She is automatically enrolled in Medicare Part A when she turns 65. She chooses to delay enrolling in Medicare Part B because she is still working and has health insurance through her employer. When she retires at 68, she enrolls in Medicare Part B during her special enrollment period. She also enrolls in Medicare Advantage Plan with Part D benefits during the special election period. In addition to receiving prescriptions, she receives additional benefits such as dental, vision, hearing and more.


Example 4: Anthony


Anthony enrolls in Medicare Parts A and Part B as he turns age 65. Anthony determines he will not need additional prescription coverage than what the VA provides. As a result, he purchases a Medicare Advantage Plan without prescriptions. This particular Advantage Plan has a Part B premium reduction benefit. Because of this benefit, he is able to reduce his part B premium by up to $115 per month. He receives other valuable health benefits too.


Where to find Assistance to Understand Medicare for Veterans with VA?


Mike Layden, CPA is a licensed sales agent and provides Medicare services in six states. These states include Arizona, California, Illinois, Michigan, Missouri, and Ohio. Mike is also a veteran having served eight years in the Illinois Army National Guard and served in Operation Desert Shield/Storm. He is a proud member of the Veterans of Foreign Wars (VFW) Post 755 in Springfield, IL. Mike can be reached for assistance on 217-290-1768 or info@HealthandLifeSolutionsInc.com.


Understanding Medicare and VA benefits can be daunting, but there are resources available to help you. Here are some organizations that can assist you:


Social Security Administration


The Social Security Administration can help you understand your eligibility for Medicare and assist you with enrolling in Medicare Part A and Part B.


Department of Veteran Affairs


The Department of Veterans Affairs can help you understand your VA benefits and how they work with Medicare.


Medicare.gov


Medicare.gov is the official U.S. government site for Medicare. It provides information on eligibility, enrollment, and coverage options.


Takeaways


As a veteran, you can have both Medicare and VA benefits. It's important to understand the eligibility requirements for Medicare and how it works with your VA benefits. By having both, you can have comprehensive coverage for your healthcare needs and potentially lower your out-of-pocket costs. If you need assistance understanding Medicare and VA benefits, there are resources available to help you.


VA Priority Groups | Veterans Affairs


Eligibility For VA Health Care

Becoming Medicare-Eligible | TRICARE


VA Benefits with Medicare

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