If you have a medical condition as a result of your military service, then you likely qualify for VA benefits. With VA benefits, you get access to a monthly stipend and VA healthcare. 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.
Do I need a Medicare Supplement if I have VA benefits?
In short, no, you do not “need” a Medigap plan if you have VA benefits. That said, we do recommend acquiring a Medicare Supplement plan anyway. Why? 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.
Agent TipYou need to keep in mind that you cannot have Medigap and an Advantage plan at the same time. Medigap serves as a supplement to Medicare. Medicare Advantage is a private insurance plan that replaces Original Medicare
Do I Need Medicare if I have VA Benefits?
You can use your VA benefits with a private insurance plan, Medicare, or Medicaid. However, just because you can use them together doesn’t mean that you need both. So, do you need Medicare if you already have VA benefits?
To keep things brief, no, you do not need Medicare if you have VA benefits. You can get all of your care through your VA benefits. That said, the VA will put you into “groups” based on your disability’s severity. Your group can determine the extent of care that you get with your VA healthcare plan.
As a result, we recommend using some form of Medicare with your VA benefits. You can get inpatient and outpatient coverage, in addition to your coverage through Veterans Affairs. Whether you just want Original Medicare, or you want extra coverage with Part D, Medigap, or Medicare Advantage, it is well worth it to enroll when you qualify.
How Do VA Benefits Work with Medicare?
In most cases, the VA will bill any other medical insurance provider you have for non-service-connected care. If you get health benefits that are not related to your disability, your VA healthcare will bill your other provider. However, this only applies if you have a private insurance plan like Medicare Advantage. Veterans Affairs will not bill Medicare.
AGENT TIP:Combining Medicare and VA benefits together can help ensure that you have more options and more coverage.
If you have both Medicare and VA benefits, you have to choose which one to use when you go to the doctor. 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).
Is Part B needed?
Medicare Part B is optional, but there are penalty fees for signing up after the initial enrollment period. It’s important to note that Part B can help pay for care that’s not covered by your VA benefits. So, while it’s not a requirement, it is good to enroll once you qualify.
If you are going to sign up for a Medicare Advantage plan or Medicare Supplement plan you need to have Medicare Part B in place first.
Do I have to pay for Medicare if I have VA benefits?
No, you do not have to pay for Medicare Part A or B. If you qualify for premium-free Part A, you can choose to forego Part B (which requires premiums). Alternatively, you can choose to use your VA benefits and not enroll in Medicare at all. However, this means that you will be limited to VA hospitals and doctors. This is why we recommend enrolling in Medicare so that you have access to non-VA care.
What are the advantages of having a Medicare plan with VA Benefits?
Here are a few reasons why we recommend having some form of Medicare in conjunction with your VA health coverage:
- VA healthcare funding is not guaranteed. Thus, future budget cuts could prevent some veterans from getting benefits through the Department of Veterans Affairs.
- Medicare coverage allows you to receive care at non-VA hospitals. This is vital, as VA hospitals are known for having long lines and poor service.
- If you don’t want Medicare now, you may have to pay a late enrollment penalty for signing up later on.
- Medicare Part D makes it easier to get prescription drugs from local pharmacies, as opposed to the VA’s mail-order system.
In short, Medicare helps give you more options and, in many cases, higher-quality care than the VA health system. By relying on VA healthcare, you could be putting yourself at risk if you need care from a non-VA clinic. Finally, Medicare is well-funded and unlikely to suffer from budget cuts anytime soon.
As an addition to Original Medicare, a Medicare Supplement plan can provide even more benefits. 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.
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. Plus, many policies include vision, dental, hearing, and wellness care.
Combining all of your Medicare plans into one Medicare Advantage plan can also help lower your costs. For example, you will often pay less in premiums and deductibles with a Medicare Advantage plan.
Frequently Asked Questions
When you have both Medicare and VA benefits, you get to choose which is your primary. It will depend on where you go to receive medical care. If you go to VA clinic or hospital, your VA benefits will be your primary. Alternatively, if you go to a non-VA clinic, Medicare will be your primary.
No, you do not need Medicare Part D drug benefits if you have access to VA health care services. VA prescription drug coverage provides “creditable coverage” that does not require any monthly premiums or copayments. As with any VA care, you will need to go through VA clinics or pharmacies.
Medigap gives you even more options when it comes to doctors. With Medicare Advantage, you have options, but you’re still limited to doctors in your network. 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.
So, do veterans need Medicare? No, they don’t. That said, veterans’ benefits only cover your care at VA clinics. Medicare covers you ANYWHERE that accepts Original Medicare. So, adding Medicare is a great way to save on costs and have more choices with your health insurance. For even more coverage, savings, and flexibility, you can add a Medicare Supplement or switch to Medicare Advantage.
If you have more questions or want to learn about cost-sharing Medigap options, call us at 800-208-4974!
- Medicare Eligibility Under 65 Explained
- Silver Sneakers and Medicare
- What Doctors Can I See With My Medicare Plan?
Alex Wender is the founder and CEO of Bluewave Insurance. He has been blogging about Medicare-related topics since 2010. Since then, he and his agency have helped thousands of people across the country choose the right Medicare to fit their needs.