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Medicare for Veterans: A Comprehensive Overview

Veterans approaching their 65th birthday can obtain Medicare, a government-funded health insurance program with options for inpatient, outpatient, and prescription coverage. While VA benefits from the U.S. Department of Veterans Affairs cover medical treatments, having VA and Medicare is still a good idea. Medicare for veterans is a low-cost way to expand coverage options beyond the limits of VA benefits.

Key takeaways:

Do veterans need Medicare?

Veterans don't "need" Medicare any more than any other health insurance policy. Medicare enrollment isn't a legal requirement nor a prerequisite for receiving medical treatment. However, veterans should consider Medicare for reasons related to the limits of VA benefits and the upsides of Medicare coverage.

The reasons why veterans may need Medicare include:

  • VA benefits are restricted to healthcare facilities that accept VA benefit coverage. Not every hospital will accept VA benefits, and if you're in a situation where you're getting treatment at a facility that doesn't accept VA benefits, all costs will be left up to you if you have no other form of coverage.
  • If you enroll in Original Medicare (Part A and Part B), you can get treatment from any physician or healthcare facility that accepts Medicare.
  • If you get Medicare Advantage (Part C), your coverage will be within a network, which will still expand your options.
  • Delaying enrollment in Medicare can result in late enrollment penalties, which are charges added to your monthly premiums. For Part A, you will pay late enrollment fees for twice the number of years you waited to join, and for Part B, you'll be paying late enrollment penalties for as long as you hold the policy.

Whether you have health benefits or not, Medicare is worth adding since it is commonly accepted by healthcare providers and makes healthcare affordable.

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What is Medicare?

Medicare is a health insurance program from the federal U.S. Government and is funded by taxpayers. There are two ways of getting it: Social Security and private insurance companies.

Medicare consists of four parts, each have its own role in coverage:

  • Part A covers inpatient costs such as hospital and skilled nursing facility stays.
  • Part B covers outpatient services such as walk-in visits, home health services, and screenings. It also covers durable medical equipment like walkers, insulin pumps, and oxygen equipment.
  • Part C (Medicare Advantage) is a private health insurance plan with bundled inpatient and outpatient coverage. Some plans include coverage for prescription medications. It may also cover services that Original Medicare doesn't, such as dental, vision, and hearing treatments. Plans may also feature an annual out-of-pocket maximum. Once you've paid a certain out-of-pocket amount for the year, you won't owe any out-of-pocket costs for the rest of the year.
  • Part D is responsible for covering prescription medications. Like Medicare Advantage, it is a private health insurance plan.

With Parts A, B, and D, you can join one plan without joining the others. With Medicare Advantage, you'll have to enroll in Part A and Part B to get it.

Who is eligible for Medicare?

Regarding VA Medicare eligibility, anyone (veteran or not) 65 or older can get Medicare. Enrollment starts during the Initial Enrollment Period, three months before you turn 65, and lasts until three months after your 65th birthday.

While Medicare is commonly associated with seniors, there are ways to get Medicare before turning 65, including:

  • Being diagnosed with amyotrophic lateral sclerosis (ALS). You will automatically be enrolled in Medicare Parts A and B the month your Social Security benefits begin.
  • Receiving disability benefits from Social Security. You'll automatically be enrolled in Part A and Part B after 24 months of receiving disability benefits.

Overall, Medicare is an inclusive health insurance program that doesn't deny coverage if you have preexisting health conditions, and health issues will not increase your premiums.

Can I enroll in Medicare if I'm receiving VA benefits?

You can enroll in Medicare if you're receiving VA benefits. You won't be forced to drop one policy to favor the other. You are entitled to the same Medicare coverage as anyone who meets Medicare's eligibility requirements.

Since you can have both, the question for having both types of coverage then becomes, "Between VA and Medicare, what is the primary?" Medicare and VA benefits together will not coordinate coverage like Medicare does with other health insurance plans, so there is no primary and secondary payer. Usually, when an individual has Medicare with another health insurance plan, one policy will pay for a particular treatment or service up to the plan's limits, and the other policy will cover what it can of what remains.

With VA benefits and Medicare, you must choose which policy to use to cover your medical treatment. You can use one policy or the other, but not both.

Do I need a Medicare Supplement if I have VA benefits?

When you get medical treatment, your healthcare provider negotiates a fee with Medicare. Medicare covers what it can of the negotiated rate, and you are responsible for the remaining costs. If you have a Medicare Supplement plan, Medicare will cover its costs, and the Medicare Supplement plan will cover what it can of what's left. This greatly reduces your out-of-pocket costs, potentially to the point where you wouldn't owe anything once your Medicare Supplement plan has paid its share.

Whether you need a Medicare Supplement plan is dependent on a few factors:

  • Whether you have Medicare
  • The coverage you use for your medical services
  • Your personal coverage preferences.

You cannot enroll in a Medicare Supplement plan without Original Medicare (Parts A and B). Other health insurance, Medicare Part D coverage, or VA benefits alone won't be enough for you to qualify for a Medicare Supplement. It should also be noted that you cannot have Medicare Advantage and a Medicare Supplement plan simultaneously. If you have Medicare Advantage, you must return to Original Medicare if you want a Medicare Supplement plan.

If you exclusively use your VA benefits, you won't have any use for a Medicare Supplement plan because it strictly offers supplemental coverage for services covered by Medicare. Medicare must provide coverage for a treatment or service for a Medicare Supplement to reduce your out-of-pocket expenses.

The need for a Medicare Supplement plan will ultimately boil down to your coverage preferences. A Medicare Supplement plan is a good idea if you want to minimize or eliminate remaining out-of-pocket expenses after Original Medicare has covered all it can. If you rarely use your Medicare coverage to pay for services, wish to enroll in Medicare Advantage, or are fully satisfied with your coverage, a Medicare Supplement plan won't be necessary.

Can you have a Medicare Advantage plan and VA benefits?

Medicare Advantage is a private insurance plan; veterans can have private health insurance plans with their VA benefits. Medicare Advantage comes in different forms, such as Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee-for-Service (PFFS) plans. Medicare Advantage plans differ in whether they allow you to see a doctor outside of the plan's network, the need for selecting a primary care physician, and the requirement of getting that physician's referral to see specialists.

Medicare Advantage won't pose a problem unless you want a Medicare Supplement plan, but VA benefits aren't a contributing factor to this issue.

What is the best Medicare plan for veterans?

The best Medicare plan for veterans will depend on personal preferences. What is best for one may be different from what is best for someone else. Original Medicare would be best for a veteran who wants nationwide coverage with the option to add a Medicare Supplement plan. On the other hand, a veteran who wants a private Medicare plan with bonus features (e.g. dental, vision, and hearing coverage) may be better suited for a Medicare Advantage plan. The best plan ultimately comes down to priorities.

Do I have to pay for Medicare if I have VA benefits?

You will have to pay for Medicare if you have VA benefits. However, if you join Medicare during your Initial Enrollment Period (from three months before you turn 65 to three months after your 65th birthday), you can get Part A premium-free. But premium-free Part A is available to anyone who signs up during this enrollment period, not only veterans.

Late enrollment penalties also apply if you didn't have other private coverage during the time you delayed. If you delay Medicare enrollment without having other private coverage and join after the Initial Enrollment Period has passed, you'll be subject to late enrollment penalties, which will tack on an extra monthly fee to your premiums based on the time you've gone without Medicare coverage after becoming eligible.

What happens to my VA disability when I turn 65?

VA disability is not a temporary benefit. It is a lifelong benefit, and turning 65 and/or enrolling in Medicare will not cause your VA disability benefits to be revoked. The benefits you receive from the U.S. Department of Veterans Affairs were created to make life easier and not cause complications years down the road.

Attaching a Medicare plan doesn't jeopardize your VA benefits in any way, be it VA disability or medical benefits. Instead of losing coverage, you gain options. Adding a Medicare plan gives you a broader spectrum of healthcare facilities and professionals to seek affordable treatment, which can be extremely useful if you find yourself in a position where you're unable to get to a VA facility while experiencing a medical emergency or if you want a second opinion about a particular diagnosis.

You'll also have the power to add a Medicare Supplement plan to reduce out-of-pocket costs further or pick a Medicare Advantage plan that offers coverage that meets your needs more closely than any other policy on the market. Medicare opens the door to affordable healthcare while also giving veterans autonomy over reducing their costs.

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