How Does Medicare Benefits Work If I Already Have VA Benefits?

How does Medicare benefits work if I also already have VA benefits?

  • Well first of all, Medicare generally does not coordinate with VA benefits. 
  • However you can have both Medicare and VA benefits. Many people choose to use both VA & Medicare benefits in order to have access to more providers and services.
  • Medicare and VA benefits do not work together though. (Medicare generally does not pay for care that you would receive in a VA facility.)
  • For Medicare to cover your care, you generally have to receive care at a Medicare certified facility that works with your Medicare plan coverage.
  • For VA to cover your care, you generally must receive your health care service at a VA facility. However exceptions can be made, for example if you receive prior authorization from the VA to receive VA covered services at a Medicare approved facility. Also if an emergency occurs that requires you to receive care, the VA may cover some of the costs until you can be moved to a VA facility for continued care.
  • Many veterans receive their VA health benefits to get coverage for health care services and items not covered by Medicare. Examples could be: over the counter medications, annual physical exams, and hearing aids, all depending on what current Medicare plan they have.

You may want to consider enrolling in Medicare Part B even if you have VA coverage, since
Part B may cover services you receive from Medicare certified providers and provide you with medical coverage outside the VA health system. Note: Without Part B, you will not have Medicare coverage for physician, outpatient, and ambulance services. Also, if you do not enroll into Part B when you are first eligible to do so, but then later decide to enroll in Part B, you will likely face a Part B premium penalty for each 12 month period you were without Medicare Part B coverage. Lastly, you may also experience gaps in coverage.

Drug coverage offered by the VA is creditable. Which means, it is as good as or better than Medicare Part D prescription drug coverage. So as long as you remain enrolled in drug coverage through the VA, you can delay enrolling in Medicare Part D without penalty. If you are interested in enrolling in a Part D plan in addition to your VA coverage, then compare your options first. Some things to consider are the costs of a plan’s premiums, deductibles, and copays, the drugs that are available on a plan’s formulary (the list of covered drugs), and the pharmacies that you can go to.

Note: Medicare Insurance information can be overwhelming and confusing to many people. As an independent licensed agent I can explain things to you in simple terms so you feel comfortable making a decision. Then I can help you choose and enroll in a plan that you feel fits your needs.

By the way, it doesn’t cost you any more if you enroll in a Medicare Insurance plan through me as an independent agent versus directly with an insurance company either over the phone or via the Internet, since I get paid by the insurance companies for your enrollment. Plus you will have personalized service by a local agent. If you would like my assistance, please call me at 941-404-5334.

By calling this number, I understand I will be directed to a licensed insurance sales agent.

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