If you’re a Veteran, it’s important to have all the services you’re eligible for working together to meet your whole health needs.
But the world of Veteran’s benefits can be confusing, and it can be difficult to know how much coverage you really have. Supplementing your Veteran’s healthcare coverage with a Medicare plan may be a good idea, especially because Veteran’s Administration (VA) healthcare coverage can vary drastically from person to person and over time.
Here, we will look at the different Medicare plans, TRICARE, and VA Medical Benefits and how they all work together.
You can have both VA coverage and Medicare if you:
- are age 65 or over and enrolled in Medicare Part B
- are any age and have a qualifying disability, end stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS) and are enrolled in both Medicare Part A and Part B
Medicare is not mandatory, and you may be considering delaying or declining Medicare coverage and relying only on your VA benefits.
If you’re thinking about deferring Medicare, discuss the pros and cons with a VA representative. It’s important to know how or if your current plan will work with Medicare, so you can choose the most comprehensive overage possible.
Declining Medicare completely is also possible, but you will have to withdraw from your Social Security benefits and pay back any Social Security payments you have already received.
If you have another form of healthcare coverage, like a private insurance plan, Medicare, Medicaid, or TRICARE, you can use VA healthcare benefits along with these plans.
However, when enrolling in VA healthcare, you must provide information about your other coverage.
The VA may bill your private insurance company for care, supplies, or medications provided to treat non-service-connected conditions. This can result in significant out-of-pocket costs for you, especially if you haven’t met your private health insurance deductible.
The VA doesn’t bill Medicare or Medicaid, but may bill a Medicare supplemental health insurance plan for covered services.
To learn more about how VA interacts with other health insurances, see the VA website.
So, what if you receive care in a non-VA facility for a condition that’s not service-related and isn’t covered by your VA insurance plan? If you’re over 65, this is where Medicare helps.
By opting into each part of Medicare, you’re building more comprehensive healthcare coverage for yourself. You’ll also be less likely to pay high out-of-pocket costs.
Next, let’s take a look at the different parts of Medicare.
Medicare Part A
Medicare Part A is usually free and doesn’t have a premium. This part covers non-VA hospital care if you have an emergency or if you live far away from a VA facility.
Medicare Part B
Medicare Part B offers more coverage options for non-VA healthcare providers as well as other things that your VA healthcare plan may not cover.
It is important to note that if you do not sign up for Medicare Part B right away and later lose your VA coverage, a late enrollment fee will apply.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, offers healthcare coverage that the VA and basic Medicare do not. This includes dental, vision, hearing, prescription drugs, and more.
However, there are some potential disadvantages to consider as well, including additional plan costs, having to stay within a provider network, and lack of coverage while traveling.
Consider your specific coverage needs and budget when deciding which type of plan will work best for you.
Medicare Part D
Medicare Part D is a prescription drug plan. Although it generally has higher drug prices than the VA plan, it may cover drugs that are not covered by the VA. Part D plans also allow you to go to your preferred retail pharmacy and fill prescriptions from non-VA doctors.
Supplemental plans, such as Medigap, are useful for covering emergency situations or for when you are traveling outside the U.S. They are also helpful if you do not live near a VA-approved provider or medical facility, or if you are in a lower-priority VA benefit group.
How do I enroll in Medicare?
You can easily enroll in Medicare online. There are just a few things to remember:
- If you are approaching age 65, you may enroll during the initial enrollment period. Enrollment in Medicare parts A and B begins 3 months before you turn age 65, the month of your birthday, and 3 months after you turn 65 years old.
- If you are not enrolled, want to make changes to an existing Medicare part A or B, or are over age 65 but still looking to enroll, the open enrollment period is January 1 to March 31 every year.
To get started with enrollment, visit Medicare’s enrollment page and follow the prompts.
When you have VA healthcare coverage, the VA pays for doctor visits, prescriptions from VA providers, and visits to a VA facility. Medicare will pay for any services and prescriptions from non-VA healthcare providers and facilities.
There may be times when both the VA and Medicare will pay. This may happen if you go to a non-VA hospital for a VA-approved service or treatment, but need additional procedures that aren’t covered by the VA healthcare plan. Medicare will pick up some of those additional costs.
Remember though, you are still responsible for your Part B premium and 20 percent copay or coinsurance fees.
When in doubt, you can always contact the VA and Medicare for any specific coverage questions.
Contact Your coverage providers
- For VA healthcare coverage questions, call 844-698-2311
- For Medicare coverage questions, call 800-MEDICARE
TRICARE is the military’s medical insurance provider. It’s broken down into several different plans, based on your military status. These plans include:
- TRICARE Prime
- TRICARE Prime Remote
- TRICARE Prime Overseas
- TRICARE Prime Remote Overseas
- TRICARE Select
- TRICARE Select Overseas
- TRICARE For Life
- TRICARE Reserve Select
- TRICARE Retired Reserve
- TRICARE Young Adult
- US Family Health Plan
After you retire from military service and reach age 65, you will be eligible for TRICARE for Life if you are enrolled in Medicare parts A and B.
Tricare for Life is consider a second payer. This means that your Medicare plan is billed first for any medical services you receive. After Medicare pays, Tricare will pay the rest, if they cover those services.
You go to your annual physical and you are referred to a cardiologist for the first time. At the cardiology visit, you are told you need to have an echocardiogram and a stress test.
Your primary care doctor, cardiologist, and the facility where you receive those tests will all bill your Medicare plan first. Once Medicare pays for everything that is covered under your plan, the remainder of the bill automatically gets sent to TRICARE.
Your TRICARE plan will cover the leftover costs that Medicare did not pay for, as well as any coinsurance and deductibles you may owe.
If you have VA healthcare and TRICARE coverage, you can use the VA for service-connected conditions and TRICARE for everything else.
You can be eligible for both VA healthcare and TRICARE. However, the systems are separate and don’t coordinate services. When comparing VA and TRICARE for a given health procedure, consider costs, access to care, convenience, and whether it’s for a service-connected condition.
You can also have TRICARE and private health insurance. When seeking care, you must submit claims first to your private insurer. TRICARE will pay the remaining billed amount up to an allowable maximum.
You can also combine any TRICARE plan with Medicaid. In this case, TRICARE is the first payer and Medicaid covers the remaining amount.
You may enroll in Tricare for Life during TRICARE’s open enrollment season, which begins in November. You may also enroll outside of the open season if you have a qualifying life event such as retirement from active duty, marriage, or death of a family member. You have 90 days after a qualifying life event to change your coverage or enrollment.
If you are a Veteran with VA healthcare coverage and are over 65, enrolling in a Medicare plan can provide more well-rounded coverage.
VA and TRICARE plans can be supplemented with Medicare plans. Additional supplemental plans are available through Medicare, and you can choose one that meets your specific cost and benefits needs.
There are many options to help you create a more balanced health care program after age 65.