Veterans who qualify for VA benefits also qualify for Medicare when they turn 65. There are several reasons why having dual coverage is a good idea.
Understanding Veteran’s Benefits
Eligibility for Veterans Affairs benefits depends on several factors. The veteran:
- Must have served in the active military, naval, or air service and have not been dishonorably discharged.
- Usually must have served 24 continuous months or the full period for which he or she was called to active duty. This rule may not apply if there was an early discharge due to a service-related disability or hardship.
- Must have suffered a service-related disability.
Active duty members who qualify for Tricare benefits will transition to Tricare for Life (TFL) when they retire. They can keep TFL benefits if they enroll in Medicare Parts A and B when they turn 65. Some veterans have coverage from both VA benefits and TFL.
VA benefits vary based on the priority level assigned to the veteran. There are eight levels, based on service history, disability, income, and eligibility for Medicaid. Priority 1 is the highest, assigned to veterans with serious service-related disabilities. This group receives the most comprehensive benefits.
Veterans must receive all care (including emergency care) at a VA-approved location. VA benefits cover prescriptions if they are prescribed by a VA physician and filled at a VA facility or participating community pharmacy. Vets do not need to enroll in Part D but can choose to do so at anytime without facing a late penalty.
Medicare Eligibility
While it is not necessary for veterans to enroll in Medicare if they are covered by VA or TFL benefits, the Department of Veterans Affairs encourages all veterans to enroll when they turn 65 during their Initial Enrollment Period. Individuals who decide to enroll at a later time will face late enrollment penalties.
Why Having Dual Coverage Is a Good Idea
Vets who choose to enroll in Medicare and have dual coverage will gain several benefits:
- Access to more locations where they can receive care. Vets can choose to receive care from both VA and non-VA facilities.
- Medicare offers some benefits not covered by the VA, including the many supplemental benefits offered by Medicare Advantage plans.
- Funding for VA benefits could be reduced in the future, meaning vets in lower priority groups may see their benefits reduced or eliminated completely. Vets already enrolled in Medicare will not have to worry about late penalties.
Vets with Part D coverage:
- Can receive assistance from Extra Help, if they qualify.
- May have access to additional drugs not covered by the VA.
- Will have coverage for prescriptions if they are admitted to a non-VA nursing home.
Coordination of Benefits
The VA and Medicare do not coordinate benefits. Veterans must choose which benefits they will use before they receive any healthcare services. They will use their VA benefits when accessing care at VA facilities and their Medicare benefits when at non-VA facilities.
TFL does coordinate benefits with Medicare, with Medicare acting as the primary payer. Any amount Medicare does not cover will be sent to TFL for payment.
Need help finding Medicare plans that work in conjunction with your VA benefits? Healthcare Educators is dedicated to helping you. Our goal is your success. Contact us today.