VA Benefits and Medicare

If you're Medicare-eligible and already receiving health benefits from the VA, you probably have a few questions like:

• Should I sign up for Medicare?
• How does Medicare work with VA benefits?
• Should I get a Medicare prescription drug plan (PDP)?

Here’s what you should know.

The U.S. Department of Veterans Affairs Encourages You to Sign Up for Medicare

If future funding for VA Benefits change, Medicare will give you more options for health care if you need them. In general, VA Benefits do not cover care outside their network. If you have Medicare Parts A and B, you can visit any doctor or hospital outside the VA network that accepts Medicare.

You have a seven-month period to sign up for Medicare called your Initial Enrollment Period (IEP). This period includes:

• The three months before your 65th birthday
• The month of your birthday
• The three months after your birthday

If you do not sign up for Medicare Part B during your IEP, you might have to pay a late enrollment penalty on your annual premium. That could mean your monthly Part B premium may go up 10% for each 12-month period you could have had Part B but didn’t sign up. So if you sign up 12 months after your IEP ends, your Part B premium penalty will be 10%. If you sign up 24 months after your IEP ends, it will be 20%. The penalty will apply for as long as you have Medicare Part B.

If you qualify to sign up for Part B during a Special Enrollment Period, the late enrollment penalty may not apply.

If you didn’t sign up for Part B when you were first eligible because you were covered by group health plan coverage (your own, a spouse’s or a family member’s), you can enroll in Part A and/or Part B:

• anytime you’re still covered by the group health plan.
• during the eight-month period that begins the month after the policyholder’s employment ends or the coverage ends, whichever happens first.

But if you delay enrollment because you only have VA benefits, the Part B penalty may still apply.

Medicare and the VA Do Not Coordinate Benefits

When two plans work together to pay claims for the same person, the process is called "coordination of benefits." But Medicare and VA benefits do not work together. They are entirely separate from each other, even though they're government programs.

According to the VA, you need to choose which benefits to use each time you receive care. You can use your VA benefits:

• at a VA medical center or facility because Medicare does not pay for care received at a VA facility.
• in a non-VA hospital or different health care setting if you get permission first.

If you have permission, you may seek care at a non-VA location. But you may need to pay a VA copayment for care not related to service conditions. Medicare may pay for the other services you need during your stay. You should check with your Medicare plan to know which care locations and services are covered to help determine what your out-of-pocket costs may be.

If you want to only use your Medicare benefits, you can see any doctor, specialist or hospital that accepts Medicare. But remember, VA benefits will not cover any costs Medicare leaves you to pay.

If you have any additional questions about your benefits and Medicare, you should contact the VA.

Advantages to Getting a Medicare Prescription Drug Plan (Part D)

When you have a Medicare prescription drug plan, you have the option to get medicine from non-VA doctors and fill your prescriptions at your local pharmacy. If you delay enrolling in Medicare Part D, there is no penalty if you enroll within 63 days of losing VA health care or other creditable prescription drug coverage.

Creditable prescription drug coverage is considered at least as good as Medicare's standard Part D prescription drug coverage. Enrollment in the VA health care system is considered “creditable coverage” for Medicare Part D. So you should not have a penalty if you delay enrollment.