If you are one of more than 8.1 million veterans aged 65 or older, you might have some questions about how Medicare works in conjunction with your military benefits. A local Medicare agent is your best resource for answers to those questions. Your agent will meet with you in person, review your individual circumstances, and give you recommendations of the best healthcare coverage for your situation. Best of all, there is never any cost to you.
This Q&A gives you an overview of how Medicare can complement your military benefits. This can guide you in your conversation with your Medicare agent, who will be able to answer any additional questions you have.
Do I Need Medicare if I Have VA Benefits?
Medicare is not a requirement if you have VA benefits, although the US Department of Veterans Affairs encourages all vets to enroll in Medicare Part A and B during their Initial Enrollment Period when they turn 65. Since you have prescription drug coverage through the VA, you do not need to sign up for a Part D plan.
Even though it’s not a requirement, there are several reasons why enrolling in Medicare is a good idea:
- More access to care and more choices for where you can receive treatment. For those who don’t live near a VA facility or whose local facility has long wait times, this can be important.
- The possibility of losing your VA benefits at some time in the future. Congress funds VA benefits annually. It’s unknown if there will be sufficient funding in the years to come. Vets in a higher Priority Group are at greater risk of a reduction or even complete loss of benefits. If you don’t enroll in Medicare when you turn 65 and you later lose your VA benefits, you will face late enrollment penalties.
- If you enroll in Medicare and have limited income and resources, you might be eligible for one of the four Medicare Savings Programs to help offset some of your out-of-pocket expenses.
- Many Medicare Advantage (MA) plans offer an array of supplemental benefits, such as hearing, dental, and vision. Your Priority Group determines if your VA benefits offer any coverage for these services. Many MA plans also offer wellness and gym benefits, meals after hospital stays, transportation to medical appointments, reward cards for completion of annual preventive services, and an allowance for over-the-counter medications.
Who Pays My Claim if I Have Both Medicare and VA Benefits?
Medicare and VA benefits do not overlap – they are two completely separate coverages. This means you need to decide which program’s benefits to use for your care. You must use a VA facility to use your VA benefits and a civilian non-VA facility for your Medicare coverage. The only exception is when the VA authorizes care at a non-VA facility. This happens in specific circumstances, such as when a VA facility is geographically inaccessible from your home.
What if I Have TRICARE?
If you have TRICARE, your coverage will automatically transition to TRICARE For Life (TFL) when you turn 65. You must enroll in Medicare Part A and B during your Initial Enrollment Period. If you fail to enroll in Medicare, your TRICARE coverage will end. With TFL, you will continue to have prescription coverage through TRICARE’s Pharmacy Program. You do not need to enroll in a Medicare Part D plan.
Who Pays My Claim if I Have TRICARE and Medicare?
Medicare and TFL will coordinate payment on your claims. Medicare is your primary coverage and will therefore pay first. Any unpaid amount will be sent to TFL for processing and payment. TFL will typically cover any deductibles, copays, and coinsurance that Medicare does not cover.
What if I Have TRICARE For Life and VA Benefits?
These two coverages do not coordinate care. You must choose which benefits to use.
Is There Any Reason I Might Want to Enroll in a Part D Drug Plan?
If you have prescription drug coverage through VA benefits or TRICARE For Life, you do not need a Medicare Part D plan, but there are some reasons why this could be beneficial.
- You want access to more pharmacies.
- Neither the VA nor TRICARE covers a specific drug you take, but a Part D plan does cover the drug (every Part D plan has its own drug formulary).
- You qualify for Extra Help, the federal low-income program that can help you afford your drug costs.
- You are in a nursing home outside the VA health system and need medications from the nursing home pharmacy.
- Your VA benefits might not cover drugs prescribed to you at a non-VA facility without authorization. With TFL, you may be able to receive prescriptions from a non-network pharmacy, but you will have to pay upfront and submit a claim for reimbursement.
You can enroll in a Part D plan at any time without paying a late enrollment penalty.
What Else Should I Consider?
When considering Medicare coverage, think about your future needs. If your health changes, you may want the option to see doctors and hospitals outside the VA. If you move, you may no longer be within a convenient distance of a VA facility. Enrolling in Medicare can give you peace of mind.
How Do I Meet with a Medicare Agent?
The experienced team of Medicare Agents at Healthcare Educators represents a variety of health insurance carriers in your state. They are familiar with the plans available in your area. When you meet with an agent, you will review your preferred doctors and hospitals, your prescription drugs, any chronic conditions and ongoing treatments, your lifestyle (including travel), and your budget. Your agent will take the time to consider your specific needs to find the right coverage for you.
Healthcare Educators makes Medicare easy. Call today to schedule an appointment.