VA Benefits and Medicare
I have VA benefits, do I need Medicare?
The decision is yours but the recommendation is clear.
Yes, you do.
In face, the VA says “We encourage you to sign up for Medicare as soon as you can.”
A few reasons to sign up from the VA
- We don’t know if Congress will provide enough funding in future years for us to provide care for all Veterans who are signed up for VA health care. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future.
- Having Medicare means you’re covered if you need to go to a non-VA hospital or doctor—so you have more options to choose from.
- If you delay signing up for Medicare Part B (coverage for doctors and outpatient services) and then need to sign up later because you lose your VA health care benefits or need more choice in care options, you’ll pay a penalty. This penalty gets bigger each year you delay signing up—and you’ll pay it every year for the rest of your life.
- If you sign up for Medicare Part D (coverage for prescription drugs), you’ll be able to use it to get medicine from non-VA doctors and fill your prescriptions at your local pharmacy instead of through the VA mail-order service. There’s no penalty for delaying Medicare Part D.
What if I don’t sign up?
Creditable Coverage
VA benefits do NOT count as creditable coverage for Medicare Part B.
This means that if you decide you want access to other doctors in the future and decide to start Medicare Part B then you could be penalized for all the time you didn’t have coverage.
That penalty is 10% for each year that you didn’t have Medicare Part B but were eligible for it.
So if you go 4 years without Medicare but decide at age 69 to enroll then you will have a 40% penalty. It’s important to note that this isn’t a one-time penalty. You will pay this amount each month that you have Medicare. For as long as you have Medicare coverage.
Emergency Coverage
VA benefits normally only cover you at a VA facility.
This is true even for emergencies.
You may prefer to use only the VA facilities for treatment which is fine. But none of us knows the future. And if you have an accident or some other emergency then you are typically taken to the nearest hospital. Which may or may not be a VA facility.
And if it’s not a VA facility, then you could end up paying the bill on your own.
One of my clients actually had this happen. He was in a car accident where he was rear ended as he was trying to turn left. $30,000+ later in medical bills and he signed up for Medicare Part B as soon as he was able to after that which is how we met.
Prescription Coverage
VA benefits do count as creditable coverage for Medicare Part D. This is the prescription drug coverage program.
Many people get prescriptions from the VA system. It’s important to know that you can only fill prescriptions at the VA that have been prescribed by a VA doctor.
So if you see a non-VA doctor that prescribes you medications then you cannot fill those at the VA system.
I have both Medicare and VA benefits, now what?
Medicare and VA benefits do not coordinate.
That means you can’t use your VA benefits outside of a VA facility. And you can’t use your Medicare benefits at a VA facility.
But you still have access to both types of facilities.
You do NOT have to choose like an “either/or” type situation.
Medicare Supplement or Medicare Advantage?
Many people don’t know that there are Medicare Advantage plans created special for people with VA benefits. Some of the perks of these plans are:
- Extra benefits like vision, dental, and hearing
- Some plans have givebacks where they help you pay your Medicare Part B premium
- Over the counter benefits – you get a lump sum amount credited to your account to purchase over the counter supplies
- And more…
A drawback is these plans do use networks. So you can still use your VA benefits. But if you are going to use your Medicare benefits then you need to see a provider in the network that the insurance company has set up in order to get the full benefits of the plan.
On the hand, if you want to travel and have the flexibility to see any doctor then a Medicare Supplement could be a good fit.
Medicare can be confusing. And having VA benefits is great but adds more questions for most people. I’ve been specializing in Medicare for more than 10 years so I can make this much easier for you.
To see what options are available for you, please call me at 855-712-7316 or email at Mike@askMedicareMike.com so I can get specifics for your unique situation.