Medicare Blog

how does using the va health system affect my medicare

by Rahul Rempel Published 2 years ago Updated 1 year ago
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Having VA benefits does not affect Medicare costs. You can qualify for premium-free Medicare Part A coverage, but you'll likely have to pay premiums or a monthly fee for your other Medicare coverage depending on your plan.

Full Answer

Do you need Medicare if you have VA benefits?

You might think that you don’t need Medicare if you qualify for VA medical benefits. However, Medicare can pick up the slack when the VA won’t cover the bill for certain services or at specific facilities. For instance, maybe you live around the block from a VA hospital, but you get sick or injured while traveling. You’ll enjoy more flexibility if you have both Medicare and VA benefits.

How veterans can make sense of Medicare and VA benefits?

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) insurance do not coordinate coverage. The only instance in which the two programs might team up to offer dual coverage is when the VA approves qualified care to be received at a non-VA facility.

Do veterans with VA benefits need Medicare?

You can use your Veterans Affairs (VA) health care benefits along with Medicare. Enrolling in Medicare will not affect your VA benefits. If you have VA benefits, you are not required to enroll in Medicare when you turn 65, but the VA recommends Medicare enrollment to cover non-VA medical expenses.

Is VA considered creditable coverage for Medicare?

That's because enrollment in the VA health care system is not considered creditable coverage. Creditable coverage for Medicare Part B (meaning health insurance that can take the place of Part B) can only be provided by certain employer group health plans.

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Do VA benefits interfere with Medicare?

You can have both Medicare and Veterans Affairs (VA) benefits, but Medicare and VA benefits do not work together. Medicare does not pay for any care that you receive at a VA facility. In order for your VA coverage to cover your care, you must generally receive health care services at a VA facility.

Is VA coverage creditable for Medicare?

Enrollment in the VA health care system is considered creditable coverage for Medicare Part D purposes. This means VA prescription drug coverage is at least as good as the Medicare Part D coverage.

Is VA health care the same as Medicare?

The Medicare and VA systems are entirely separate, with no coordination of benefits between them. You would use your VA identity card at VA facilities and your Medicare card anywhere else. You'll find more information at the VA website on how VA care works with other insurance.

Do veterans pay for Medicare Part 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.”

Do I need Medicare Part D if I have VA benefits?

No. Drug coverage from the VA (Veterans Affairs) is considered creditable prescription drug coverage, which means the coverage is at least as good as what Medicare drug plans provide, so you do not need to enroll in a Medicare Part D plan.

Do veterans get free healthcare for life?

You can get free VA health care for any illness or injury that we determine is related to your military service (called “service connected”). We also provide certain other services for free.

Why do military retirees have to pay for Medicare?

By law, TRICARE Prime and TRICARE Select end at age 65. This requires service retirees to enroll in Medicare at age 65 to maintain a major health care plan and our TRICARE benefits. TRICARE For Life (TFL) acts as our Medicare supplement, and TFL allows us to continue using the TRICARE pharmacy.

How can you lose your VA benefits?

VA disability compensation payments are reduced if a Veteran is convicted of a felony and imprisoned for more than 60 days. Veterans rated 20 percent or more are limited to the 10 percent disability rate. For a Veteran whose disability rating is 10 percent, the payment is reduced by one-half.

Is VA insurance primary over Medicare?

For veterans approaching Medicare eligibility, it is common to have questions about whether it is necessary to enroll in Medicare alongside Veterans Affairs (VA) benefits. The short answer is that Medicare does not coordinate with VA benefits.

What Medicare plan is best for veterans?

Medicare Advantage plans can be good options for veterans. A Medicare Advantage plan may be worth considering if you are a veteran. A Medicare Advantage plan will provide all the same coverage as Original Medicare, and some Medicare Advantage plans may cover some additional benefits that Original Medicare doesn't.

Will I lose my VA disability if I go to a nursing home?

The VA may pay all or part of the nursing home costs for disabled and elderly veterans. The Department of Veterans Affairs (VA) provides both short-term and long-term care in nursing homes to veterans who aren't sick enough to be in the hospital but are too disabled or elderly to take care of themselves.

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.”.

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).

How to avoid paying penalties for VA?

To avoid paying penalties, make sure you enroll in a creditable drug plan by the due date. VA medical benefits offer a creditable drug plan that might prove more cost-effective than other options, such as Medicare or TRICARE. Sometimes, paperwork gets lost or buried.

How to file a VA claim?

The process varies depending on the provider’s preferences: 1 The provider can file the claim with the VA, and you only pay any applicable deductibles. You can also choose to use your Medicare benefits. 2 You pay for the fees relating to the services you received, then submit your own claim to the VA. This option takes longer, but it might prove necessary if you can’t get to a VA hospital. 3 Use your Medicare benefits instead of your VA medical benefits. You might prefer this option if you don’t have the money to pay up front for services rendered as described in the second option.

Can you use Medicare and Medicare at the same time?

The government can suspend or lower funding at any time, and you don’t want to find yourself without viable medical coverage. Just remember that you can’t use both benefits at the same time. If you use Medicare to help pay for an MRI scan, for instance, the VA won’t pick up the rest of the cost.

Can disabled veterans live near VA hospitals?

Some disabled veterans don’t live near VA hospitals. In this case, they may receive fee-based identification cards. They can present these for treatment at a health care facility or doctor’s office. Be sure to call ahead before accepting an appointment since not all providers accept these cards.

Does Medicare cover 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 won’t necessarily need the institution to submit any claims to Medicare. However, Medicare can also cover services included with your VA medical benefits.

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 ...

What happens if you don't enroll in Part B?

If you don’t enroll in Part B when you’re first eligible and later change your mind, you will likely have to pay an ongoing late-enrollment Part B premium penalty of 10% for every 12-month period that you didn’t have it.

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 ...

What happens if you don't have Part B insurance?

If you are not already signed up for Part B (and don't have insurance through an employer or other source), you'll likely have to wait a while for coverage, and you could be liable for late penalties that are permanently added to your Part B premiums.

Can Medicare cover non VA?

With Medicare, you're covered if you need to go to a non-VA provider. This is an especially important point to consider if you live some distance from the nearest VA facility. You may be subject to penalties in the future.

Is VA coverage less expensive than Medicare?

VA coverage for prescriptions is typically less expensive than Medicare Part D drug plans, and you won’t be hit with late penalties if you lose VA coverage in the future, provided that you sign up with a Part D plan within two months of that coverage ending.

Is Medicare and VA separate?

The Medicare and VA systems are entirely separate, with no coordination of benefits between them. You would use your VA identity card at VA facilities and your Medicare card anywhere else. You'll find more information at the VA website on how VA care works with other insurance . Return to Medicare Q&A Tool main page >>.

Is VA health coverage the same for everyone?

VA health coverage isn’t set in stone and isn’t the same for everyone. The VA assigns enrollees to different priority levels according to various factors, such as income and whether they have any medical condition that derives from their military service.

Does Medicare cover VA?

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. If you need to go elsehwere, you'll probably end up having to pay the full cost yourself, even in emergencies. With Medicare, you're covered if you need to go to a non-VA provider.

When can veterans enroll in Medicare?

Like other Americans, veterans become eligible for Medicare at age 65. (Those with a qualifying disability may enroll earlier.) The best time to sign up is during your initial enrollment period. That begins 3 months before the first day of your birthday month and lasts for 7 months.

Do you have to enroll in Medicare if you have VA benefits?

You don’t. But without Medicare coverage, you’ll be uninsured for any treatment you get at non-VA facilities or care from providers not authorized in advance by the VA. You’ll be billed for the full cost of those services, at serious risk to your net worth. That’s why the VA recommends that veterans sign up for Medicare as soon as they can.

What are the benefits of combining Medicare and VA benefits?

Enrolling in Medicare could fill in gaps in the coverage you get through the VA benefits. That’s because you’ll be able to go either to VA facilities for treatment (covered under VA benefits) or to Medicare-approved doctors and facilities (covered by Medicare). Also, VA benefits are not guaranteed, so your coverage could change in the future.

Which areas of Medicare coverage and VA benefits can you combine?

Medicare and VA benefits do not work together. But they can sometimes complement each other. For example, if the VA pre-authorizes treatment at a non-VA hospital but not certain services you get during the hospital stay, Medicare may pay for those services. For specifics, contact your Medicare plan.

How does VA disability affect Medicare?

VA benefits — including disability payments — don’t affect Medicare. At age 65, you are eligible for Medicare regardless. Before that, you may receive Social Security Disability Insurance (SSDI) while you’re on VA disability. After 2 years of SSDI payments, you can enroll in Medicare. Your VA disability benefits remain in place.

What do you have to do to manage Medicare and VA benefits?

You will have to pay the premiums for Medicare Part B or Medicare Advantage as well as any cost-sharing copayments. For VA benefits, there typically aren’t enrollment fees, monthly premiums, or deductibles. But some veterans may have copayments for healthcare or prescription drugs.

Where can you get help coordinating Medicare and VA benefits?

Various government-supported offices have staffers to help you combine and manage your health plans:

What happens if you lose your VA benefits?

If your VA Benefits are dropped at some point OR if your local VA facility does not cover all health services, you could pay 100% of the out-of-pocket expenses for a serious illness. The VA highly recommends that you enroll in Part B as well. Don’t miss the Part B deadline or you will have to pay a penalty.

What is the phone number for Medicare?

If you have an urgent matter or need enrollment assistance, call us at 800-930-7956. By submitting your question here, you agree that a licensed sales representative may respond to you about Medicare Advantage, Prescription Drug, and Medicare Supplement Insurance plans.

What is a medicare supplement plan?

A Medicare Supplement Plan (AKA Medigap) will fill in the unpaid gaps in coverage such as deductibles, copays, and coinsurance. Medicare also includes benefits when travelling 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 ...

How much does Medicare Part D cost?

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.

Is there an additional cost for Medicare Part A?

Usually there is no additional cost for Medicare Part A. This will allow you to receive hospital coverage should you go to a non-VA facility. According to the VA’s website “ [We] encourage you to keep your private [Medicare] health insurance.”.

Does Medicare Advantage cover out of pocket costs?

Probably. Medicare Advantage (MA) plans can help reduce your out-of-pocket risk should you go to a non -VA facility. Many MA plans have no little or no additional cost. If you go down this path we recommend that you look for a zero premium policy.

Is VA coverage separate from Medicare?

It is important to note that Veteran’s Affair (VA) plans and Medicare are completely separate. VA plans only cover care at VA facilities and Medicare only covers care at Medicare assigned facilities. VA and Medicare coverage do not overlap.

What happens if you don't enroll in Medicare Part B?

In addition, if you do not enroll into Part B when you are first eligible to do so, you will most likely incur a Part B premium penalty for each 12-month period you were without Medicare Part B coverage. In addition, you may also experience gaps in coverage .”.

How long do you have to wait for VA care?

You have been (or will be) waiting more than 30 days for VA medical care. You live more than 40 miles away from a VA medical care facility or face one of several travel burdens. The Choice Program does not affect your existing VA health care nor any other VA benefit.

Does Medicare Part B pay for VA?

Budget proposal could mean no 52% jump in Medicare Part B premiums. If, however, you’re enrolled in VA Health Care, consider this: You can have both Medicare and Veterans Affairs (VA) benefits, according to MedicareInteractive.org. However, Medicare and VA benefits do not work together. Medicare does not pay for any care ...

Can Medicare pay for the same services as the VA?

Medicare cannot pay for the same service that was covered under the VA benefits, and vice versa. It is important to note that Medicare is never the secondary payer after the VA.”. Daniels also notes that in order for the VA to pay for services, you must go to a VA facility or have the VA authorize services in a non-VA facility.

Does Tricare pay Medicare Part 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, you’re enrolled in VA Health Care, consider this: You can have both Medicare and Veterans Affairs (VA) ...

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