Posted on August 22, 2023 by Austin Lang
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Posted on August 22, 2023 by Austin Lang
If you’ve served in the U.S. Armed Forces, you are entitled to health coverage through the Department of Veterans’ Affairs (VA). As such, you may assume you don’t need to enroll in Medicare. This is technically true: VA benefits count as qualifying health insurance and are an acceptable substitute for Medicare. However, Medicare for veterans is far from a redundant concept. Having access to VA benefits and Medicare can be a powerful tool in your healthcare arsenal. Here are some Medicare enrollment tips for veterans looking to take advantage of this surprising synergy.
If you’re being treated at a non-VA facility for a non-service-related condition, there is a chance the VA won’t cover it. There’s leeway in case of an emergency: the VA will cover emergency care regardless of where it is received, but even that requires filing a claim within 72 hours. To help with this, it’s recommended that veterans enroll in Medicare Part A, especially if they are eligible for No-Premium Part A. It’s a safety net that comes at no additional cost and widens your available options when choosing hospitals. Many veterans choose to enroll in only Part A and rely on their VA benefits for things Part B would normally cover.
Medicare Part B is a bit more redundant when it comes to veterans. VA benefits are often more comprehensive than what Part B offers, covering doctors visits and outpatient care, as well as things like vision, dental, and even long-term care. There are some benefits, like 24/7 nursing care, that not even Medicare Advantage normally covers. However, you usually need to be at a VA facility to receive these benefits. You can be approved for treatment at a non-VA facility, but that usually only applies to service-related conditions and can delay treatment.
If you don’t live near a VA facility and can’t easily make the trip, Medicare Part B might be worth considering. Even if you do live near a VA facility, it can still be worth enrolling in Part B if you want to see a non-VA provider, though it will come with an additional cost. However, there’s another reason why considering Part B coverage is important.
VA health benefits use an eight-tier priority group system to determine how soon you’re signed up for benefits, as well as how much you pay for Medicare. Veterans with service-connected disabilities, as well as those who meet certain special criteria, have the highest priority. Veterans without disabilities who do not meet any of the exceptional criteria are assigned to lower-priority groups depending on their income and geographic location.
Criteria that may qualify you for a higher priority tier include:
What does this have to do with veterans and Medicare? Well, unfortunately, the state of VA benefits is in continual flux. While Medicare is funded by a trust which all Americans pay into as part of their taxes, VA benefits are specifically budgeted by Congress, which means the amount of available funds can vary from year to year, or even be delayed in the event of a deadlock. In the event of budget cuts, veterans in lower-priority groups are at a higher risk of losing VA coverage.
It’s this risk that makes enrolling in Part B such a tempting proposition. While you don’t necessarily need to enroll in Part B, waiting too long will result in a late enrollment penalty if you do end up needing it. It’s up to you to determine if that added security is worth the cost.
If you are eligible for TRICARE and enroll in Medicare Part B, you’re automatically enrolled in TRICARE For Life: a wraparound service in which both services provide coordinated care. In other words, Medicare will pay the majority of your medical costs, while TRICARE covers the rest. This also applies to military family members enrolled in TRICARE who are eligible for Medicare.
A lot of the core benefits of Medicare Advantage and Medicare Part D are baked into your VA benefits, including vision care and prescription medications. If you’re considering enrolling in such a plan, we recommend checking your VA benefits to see if the service you’re looking for is already covered. However, enrolling in Medicare Advantage has many of the same benefits as enrolling in Original Medicare, and may include additional benefits the VA doesn’t offer. For instance, having both VA and Part D coverage means you have access to two formularies, which makes it more likely that your medications will be covered. There are also benefits Medicare Advantage plans offer that aren’t strictly medical, like grocery stipends or gym memberships. It’s ultimately up to your discretion if enrolling in a Medicare Advantage plan is worth it, though we recommend looking for one specifically designed for veterans to avoid any additional hassle.
If you have questions about your VA coverage, contact your local Department of Veterans’ Affairs. You can also call one of our licensed agents about any Medicare-related questions you might have at (800) 950-0608.
Austin Lang