If funding for VA health care is reduced, those in lower priority groups may be at risk of losing their VA health care benefits. You should also enroll in Medicare Part B when you become eligible. Delaying enrollment might result in a permanent late enrollment penalty, which increases the longer you delay signing up.
Can you get Medicare Part B and VA benefits?
Medicare Part B (Medical Insurance) and VA Benefits Medicare Part B can provide you with medical coverage and services outside of the VA health system. Therefore, it is recommended that you enroll in Medicare Part B in addition to your VA benefits.
Should veterans enroll in Medicare or VA health care?
This could leave Veterans, especially those enrolled in one of the lower-priority groups, with no access to VA health care coverage. For this reason, having a secondary source of coverage may be in Veterans’ best interest. Enrolling in both VA and Medicare can provide Veterans flexibility.
What should veterans of the Armed Forces know about Medicare?
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.
Should you consider a Medicare Advantage plan for VA benefits?
If you need additional services or coverage not offered to you through your VA benefits, you may consider a Medicare Advantage plan. Most Medicare Advantage plans offer additional coverage, like vision, hearing, dental, prescription drug coverage, and/or health and wellness programs.
What happens if you delay Medicare Part B?
What does Medicare mean?
Do we bill Medicare or Medicaid?
Can HRAs reimburse you for non service connected conditions?
Does VA pay deductible?
Do you have to bill your spouse's health insurance?
Can you request a restriction on VA health information?
See more
About this website
Can you have VA insurance and Medicare at the same time?
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.
Can you use VA instead of Medicare?
If you have other forms of health care coverage (like a private insurance plan, Medicare, Medicaid, or TRICARE), you can use VA health care benefits along with these plans.
Do I need Medicare and VA insurance?
A: Medicare is not mandatory for anyone, but if you enroll outside of your Initial Enrollment Period and don't qualify to delay, you could face late enrollment penalties. If you have VA benefits, you do not have to enroll in Medicare in order to keep your VA benefits.
Are VA benefits better 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.
VA and Other Health Insurance - Health Benefits
Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more.
Military vets can use both Medicare and VA health care
Experts say that ex-service members who rely on health care through the Veterans Health Administration should evaluate whether to sign up for Medicare when they are first eligible.
Do You Need Medicare if You Have VA Benefits?
Are you a veteran with medical coverage through the U.S. Department of Veterans Affairs (VA) who is eligible, or nearing eligibility for Medicare coverage? If you already have medical coverage through the VA health program, you may be wondering if you also need to enroll in Medicare. The answer is...
Billing Guidelines for Health Care Provided to Veterans and Beneficiaries
18 U.S.C §1031 Major fraud against the United States 18 U.S.C §1035 False statements relating to health care matters 18 U.S.C §1342 Fictitious name or address 18 U.S.C §1346 Definition of “scheme or artifice to defraud 18 U.S.C §1347 Health care fraud 31 U.S.C.§3729 False Claims Act 42 U.S.C. §1320a-7b Health Care Programs
Questions regarding Medicare billing secondary to VA (for inpatient ...
Hello, all! I've been tasked with researching four questions related to Inpatient Part A claims where patient has either VA & traditional Medicare Part A, or VA and Medicare HMO/Medicare Advantage. I have limited experience with VA, so any input you can offer is appreciated. Thank you! 1)...
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.
Do I Need to Pay for Medicare if I Have VA Benefits?
For individuals who have worked enough quarters, Part A is premium-free. Therefore, it’s beneficial to take this hospital insurance through Medicare.
Can a Veteran Get a Medicare Advantage Plan?
Those who have both VA benefits and Parts A and B of Medicare have the option to replace the latter two with a Medicare Advantage plan. Private insurance companies offer these plans, and when you have one, the carrier pays instead of Medicare.
Is VA insurance creditable?
VA benefits include prescription drug coverage. Additionally, this coverage is creditable for Medicare Part D. Meaning, it’s comparable to the level of prescription drug coverage Medicare requires companies offering Part D policies to provide.
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.
Does Medicare cover VA care?
No, Medicare doesn’t cover the care you receive at a VA facility; this is where you will use your VA benefits.
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.
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.
Do we bill Medicare or Medicaid?
We don’t bill Medicare or Medicaid, but we may bill Medicare supplemental health insurance for covered services.
Can HRAs reimburse you for non service connected conditions?
We may also accept reimbursement from HRAs for care we provide to treat your non-service-connected conditions.
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.
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 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.
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 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.
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.
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 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.
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.
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.
How does Medigap work?
Medigap plans come with a monthly premium that you pay to the insurance company. As a Medicare recipient, you are entitled to find a lower premium for the same Medigap Plan at anytime throughout the year. This is often best done through an independent insurance agent who has access to multiple insurance companies and their rates. ...
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.
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) ...
What is the VA required to do?
VA is required, by law, to bill private health insurance providers for medical care, supplies and prescriptions provided for treatment of Veterans’ nonservice-connected conditions . All Veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Any payment received by VA may be used to offset “dollar for dollar” a Veteran’s VA copay responsibility.
Is VA health care considered health insurance?
Presenting their health insurance card to the clinic clerk during check-in. VA health care is NOT considered a health insurance plan
Do veterans have to provide information on their health insurance?
All Veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Any payment received by VA may be used to offset “dollar for dollar” a Veteran’s VA copay responsibility.
Can veterans use private health insurance?
Veterans with private health insurance may choose to use these sources of coverage as a supplement to their VA health care benefits. Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance.
Is VA coverage good 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. Since only Veterans can enroll in the VA health care system, dependents and family members do not receive credible coverage under the Veteran’s enrollment.
Is VA health insurance creditable?
Under Medica re Part B, VA health care is NOT creditable coverage. Creditable coverage under Medicare Part B can only be provided through an employer. Although a Veteran may avoid the late enrollment penalty for Medicare Part D by citing VA health care enrollment, that enrollment would not help the Veteran avoid the late enrollment penalty for Part B.
Can veterans get prescription drugs from community physicians?
For example, Veterans enrolled in both programs would have access to community physicians (under Medicare Part A or Part B) and can obtain prescription drugs not on the VA formulary if prescribed by community physicians and filled at their local retail pharmacies (under Medicare Part D).
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.
Does Medigap cover Medicare?
With a Medicare Supplement plan, you have access to any doctor who accepts Medicare. Medigap also covers most costs associated with seeing your doctor, including Part B copayments, Part B premiums, and excess charges.
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.
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.
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.
What are the benefits of combining Medicare and VA benefits?
Also, VA benefits are not guaranteed, so your coverage could change in the future. Enrolling in both programs ensures that you’ll always have insurance through Medicare if your VA eligibility status changes.
What do you have to do to manage Medicare and VA benefits?
For VA benefits, there typically aren’t enrollment fees, monthly premiums, or deductibles. But some veterans may have copayments for healthcare or prescription drugs.
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 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 .”.
What to say to a medicare veteran?
A: First and foremost, thank you for your service. “I appreciate your sacrifice and the sacrifice all of our active service men and women make, to keep my family and me safe here in the U.S.,” says Diane Daniels, author of The Medicare Survival Guide.
How much Social Security does my wife get if she gets $1,900?
So, for example, if your benefit is $1,900, your wife would be entitled to 50% of that amount, or $950. Her Social Security benefit would be $950 made up of her $908 benefit plus a spousal benefit of $42, says Clements.
How to contact Veterans Choice?
It’s also a good idea to call 866-606-8198 to make sure you qualify for the Veterans Choice Program and to schedule an appointment to enroll, says Daniels.
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 cover medical care?
In order for Medicare to cover your care, you must receive care at a Medicare-certified facility that works with your Medicare coverage.
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 ...
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.
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.
Do we bill Medicare or Medicaid?
We don’t bill Medicare or Medicaid, but we may bill Medicare supplemental health insurance for covered services.
Can HRAs reimburse you for non service connected conditions?
We may also accept reimbursement from HRAs for care we provide to treat your non-service-connected conditions.
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.
