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How Medicare Works With VA Benefits

If you’re a US military veteran 65 and older, you may receive both Veteran Affairs (VA) healthcare and Medicare. VA benefits include:

  • Inpatient hospital services
  • Home health care
  • Mental health services
  • Preventative care
  • Emergency care services

Those who qualify for VA benefits consist of veterans who have served actively in the US military. However, if you had an early discharge, you may not be eligible for VA benefits.

Even if you have VA benefits, enrolling in Medicare may provide you with more health coverage if you were to receive care in a non-VA health clinic.

VA Benefits and Medicare

VA Benefits
If you actively served in the US military
Must be 65 and older, disabled, or diagnosed with End Stage Renal Disease.
Premium(s), coinsurance, deductibles
Facility coverage
VA facilities only
Any facility or practitioner that accepts Medicare
Health coverage
Covered for regular check-ups, appointments with a specialist, home health care, and medical equipment.
Original Medicare covers hospital and medical services; Medicare Advantage and Part D plans may offer more coverages.

How Does VA Health Care Work with VA Benefits?

If you are a veteran, you may seek care at any VA medical center. VA health care includes inpatient and outpatient care, long-term care, and prescription drugs. When you’re enrolled in Medicare, you may have to enroll in Part A (Hospital insurance), Part B (Medical insurance), and Part D (Drug prescriptions). However, if you receive drug coverage through the VA, you may not have to enroll in Part D of Medicare.

You may receive free VA health care that the U.S. Department of Veterans Affairs determines was from your military service for any illness or injury. There are certain services that are offered for free, such as mental health care. Other free services provided by the VA may be found here.

Copays may vary depending on your disability rating, military service record, and income level. When you enroll in VA healthcare, you may be assigned to different priority groups of 8. For example, if you have an illness that made you unable to work, you could be assigned into priority group 1. In this group, you may not have to pay for any tests, care, or medications.

There are no monthly premiums or deductibles with VA benefits. However, your VA health coverage may change over time, as the income limits may change each year.

How Does VA Health Care Work with Medicare?

Medicare is a federal health program for seniors and young people receiving social security benefits. Note that VA benefits and Medicare do not work together. Medicare does not cover care from a VA facility. To have your Medicare plan cover you, you must be in a Medicare-certified facility, and your VA benefits may not pay for your Medicare cost-sharing such as deductibles, copays, and coinsurance.

When it comes to Medicare eligibility, you must be:

  • 65 and older
  • Disabled
  • Diagnosed with End-Stage Renal Disease

There are different Medicare parts that cover different services. These include:

  • Original Medicare: Compromised of Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers inpatient services and is free for those who have paid their Medicare taxes for 10 years or more. Part B covers outpatient services such as lab tests, medical equipment, and home health care.
  • Part D: Part D is a separate plan for drug coverage. Oftentimes, Medigap plans do not cover prescriptions. Bear in mind that if you do not enroll in Part D, you may be penalized 1% each month that you do not have Part D.
  • Medicare Advantage: Sometimes called Part C of Medicare, Medicare Advantage is a mixture of Part A, Part B, and Part D all in one. Most plans range from $0 to $100, which may be helpful for those who are on a tight budget.
  • Medigap: Also known as Medicare supplement help cover deductibles, coinsurance, and copays that Medicare does not cover. Plans may range from $40 to $300 each month.

If you have a Medicare Advantage plan, you may be limited to certain networks of healthcare providers. On the other hand, you may visit any healthcare facility with a Medigap plan.

Combine Your VA Benefits with Medicare For Better Coverage

As stated above, VA benefits and Medicare do not work together, but it may be beneficial to have both. The VA and Medicare both provide coverage for inpatient services, preventative care, and home health care. However, there are scenarios where you may choose to go to a VA facility versus a non-VA facility.

For example, if you experience a medical emergency, it may be best to seek care in a VA facility. You do not have to check in with the VA prior to calling an ambulance and it’s recommended to go to a VA facility without delay. However, it’s important to notify the VA within 72 hours of receiving care.

You may seek care at a VA facility for routine eye exams and for drug prescriptions, as Medigap plans do not cover eye exams or prescriptions.

In the case that VA funding is reduced, having Medicare as a backup health plan may be beneficial for those in lower priority groups. If you need medical equipment or screenings done, you may seek care at a non-VA facility. Medicare may cover medical equipment such as wheelchairs, patient monitors, and hospital beds.

When it comes to choosing which facility to seek care from, make sure to read testimonials and reviews of the facility. Reading reviews may provide insight into how efficiently their healthcare providers treat and interact with their patients. Visiting the facility in person may be helpful as well, as you may see how clean and maintained the facility is. Being in a clean environment is important, as you know you won’t get contaminated with other diseases.

How Medicare Works with TRICARE

TRICARE is a military health service program that provides health coverage to retired veterans, active duty members, and their families. Health coverage includes inpatient care, outpatient care, and preventative care. With TRICARE, you may seek care in TRICARE-certified facilities or in military hospitals and clinics where the Department of Defense (DoD) operates.

There are a number of TRICARE plans available and eligibility may depend on who you and your dependents are. To see which TRICARE plan you may be eligible for, you may use the TRICARE Plan Finder tool.

TRICARE benefits include coverage for coinsurance and deductibles from Medicare. When a TRICARE individual and their dependents turn 65 and are eligible for Medicare, their current TRICARE plan may automatically change to TRICARE For Life. This means that Medicare is your primary payer and TRICARE pays second to Medicare.

If you have a dependent that’s under the age of 65 and becomes Medicare-eligible, they may enroll in a different TRICARE plan. However, it’s important to request enrollment changes 90 days before your dependent’s effective date of Medicare.

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