Medicare & Veterans Benefits: A Complete Guide

If you’re a Veteran approaching 65, you may feel overwhelmed by all the choices: Medicare, VA Benefits, TRICARE… do you need them all? Which ones actually help you see the doctors you need? You’re not alone.

Many Veterans wonder whether they need both Medicare and Veterans’ Benefits, how the two programs work together, and if there are any cost savings or pitfalls to watch out for.

We’re here to assure you that having both is possible, even preferable for many! That being said, there are a few things to consider when thinking about the interaction of Medicare and Veterans’ Benefits. Think of Medicare as filling the gaps VA Benefits don’t cover.

What Do VA Benefits Cover? For those not already familiar with Veterans' Benefits, it’s important to understand what they already include:

Treatment at VA facilities : From hospital care to preventive services to specialty care, Veterans' Benefits cover access to VA medical centers and clinics. Coverage for prescriptions : Medications that are prescribed by a VA provider are filled at a VA pharmacy with lower copays. Access to Veteran-focused care : Services that are specifically designed for Veterans’ needs (mental health, rehabilitation, and other programs). The main thing to note when it comes to VA Benefits is that they are facility and provider-specific. Coverage is generally limited to Veteran-focused hospitals and care centers, as well as providers who work exclusively with Veterans.

That being said, Medicare coverage can still be incredibly useful to Veterans as a means to cover any treatments, providers, procedures, or medications that don’t fall under existing VA Benefits.

What Does Medicare Cover? Medicare provides healthcare coverage for Americans ages 65 and older (as well as some people who qualify earlier due to disability). At its core, Medicare can be broken down into four parts:

Medicare Part A is also known as Hospital Insurance, covering inpatient care, skilled nursing, hospice, and some home care. Medicare Part B is also referred to as Medical Insurance, and covers doctor visits, outpatient care, preventive services, and medical equipment. Medicare Part C is often called Medicare Advantage; unlike Medicare Parts A and B, it is offered by private insurance companies. It bundles the coverage that is provided under Parts A and B (and potentially Part D), plus some additional coverage depending on the provider. Medicare Part D is Prescription Drug Coverage. It is also sold by private insurance carriers and helps cover the costs associated with prescription drugs. Unlike VA Benefits, Medicare plans allow beneficiaries to see providers outside of VA facilities (though the specifics of your plan will vary based on where you live).

Can You Have Medicare & VA Benefits? The short answer is yes! You can have both VA Benefits and Medicare; in fact, many Veterans choose this route as it often offers the most flexibility when it comes to finding and receiving care.

Let’s look at an example of how this works: imagine that you are traveling away from home and require medical care. Original Medicare coverage applies nationwide with any Medicare-approved provider. VA care is limited to VA facilities. For example, if you’re traveling and need urgent care, Original Medicare lets you see a local doctor or hospital, while VA coverage only applies if you’re near a VA facility.

Do Veterans Need Medicare if They Have VA Benefits? Technically, nobody is required to enroll in Medicare, even non-Veterans. That being said, for most Veterans, this is often the smarter choice for a few reasons:

Medicare Part A is usually premium-free if you’ve worked and paid Medicare taxes, so there’s no downside to enrolling. As for Medicare Part B, enrolling is still a good move because it gives you access to non-VA doctors and specialists. This also helps ensure that you don’t face penalties later on if you do end up needing Part B coverage. For those who have TRICARE, you are required to be enrolled in both Medicare Parts A and B to maintain coverage. VA Benefits vs. Medicare: What Each Covers To recap, let’s go over what Medicare covers versus what VA Benefits cover:

Cost Differences: Out-of-Pocket Considerations Another thing to be cognizant of when choosing your healthcare plans (whether it be VA Benefits, Medicare, or both) is the costs associated with both.

As mentioned previously, delaying enrollment in Medicare Part B can incur penalties whenever you do enroll. A few other cost-related things to keep in mind are:

VA Benefits tend to have lower copays for prescriptions and services within VA facilities. Medicare requires a premium (especially Part B), as well as deductibles and coinsurance. The costs associated with Medicare may seem like a deterrent to enrollment, but consider this: if you rely solely on VA care now, but find yourself needing non-VA care in the future, those costs will likely be much higher without Medicare coverage to offset them.

In conclusion, choosing not to enroll in Medicare now can be a short-term money saver, but comes with higher costs and more vulnerability down the road.

Common Scenarios for Veterans Every individual scenario is unique, but there are a few common ones that we wanted to cover. If you find yourself in any of these positions, we recommend considering enrolling in Medicare:

If you live near a VA facility , you may opt to use VA Benefits for the bulk of your care with Medicare as a backup for non-VA doctors, hospitals, or specialists. If you travel frequently or live far from VA facilities , you may consider enrolling in Original Medicare. It can give you access to care anywhere in the U.S., so you’re not limited to VA locations when you’re away from home. For those with chronic conditions , coupling Medicare with VA Benefits ensures that you can see VA specialists and non-VA providers if the need arises. You must be enrolled in both Medicare Part A and Part B to maintain your TRICARE coverage, so combining Medicare with VA care in this case is necessary. Conclusion Medicare and VA Benefits don’t compete; they work best together. While VA Benefits provide necessary, Veteran-specific services and low-cost prescriptions, Medicare expands your options for doctors, hospitals, and preventive care across the country.

For many Veterans, enrolling in both ensures peace of mind, flexibility, and more complete coverage.

If you still feel you need more guidance on selecting the best healthcare plan (or combination of coverages) for you, turn to a tool like Healthpilot. We understand that the healthcare selection process can be overwhelming or daunting; and we’re here to help. Healthpilot provides expert guidance, easy plan comparisons, and personalized recommendations to help your health and well-being needs.

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Medicare & VA Benefits: FAQs Can you have Medicare and VA Benefits? Yes, in fact, it may be the optimal solution for you. Many Veterans have both, and combining the two often provides the best combination of coverage. This way, Veterans can use VA Benefits at VA facilities and Medicare for care outside of the VA system.

Do Veterans get a discount on Medicare? Unfortunately, no. Medicare costs are the same for Veterans and non-Veterans. However, Veterans with limited income may qualify for programs available to all Medicare beneficiaries (such as Medicare Savings Programs) or Veteran-specific programs like VA financial assistance.

Can you bill both Medicare and the VA? No, each program only pays for the care it covers. VA care is billed through the VA system, and Original Medicare pays for services from Medicare-approved providers outside of VA facilities. The coverages don’t have any overlap, and therefore can not be billed in conjunction with each other.

Can a Veteran receive both VA and Social Security benefits? Yes. VA Benefits and Social Security benefits are separate and don’t affect each other. Many Veterans receive VA health care while also collecting Social Security retirement or disability benefits.

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