Medicare and Veterans Affair Benefits

There are roughly 19 million veterans living in the U.S., according to data from the Department of Veterans Affairs, and about 283, 000 of these, live in Oregon. Veterans receive several benefits from the state, including health care benefits. Aside from VA healthcare benefits, veterans can also receive Medicare when eligible. Veterans can benefit from VA health care coverage and Medicare if they meet the eligibility requirements. About half of veterans with VA benefits also have Medicare coverage, which expands their options for where and how they receive care.

The government has several health insurance programs available such as VA benefits, Medicare, and Tricare for life, to aid the health care needs of the veterans.

VA benefits and Medicare

The Veterans Affairs department recommends veterans enroll in Medicare when they turn 65, even if they have VA coverage. Aside from your VA Benefits, enrolling in a Medicare plan will give you access to additional coverage options when looking for care outside VA facilities. This could be beneficial, especially to those veterans living far from VA facilities.

It is recommended to enroll in Medicare Part B when you become eligible. Thus, delayed enrollment might result in a late enrollment penalty, increasing the longer the delay with signing up.

Medicare Coverage and Eligibility

Medicare is available to veterans over 65 or under 65 if they have specific disabilities. Eligibility requirements apply to veterans the same way as other enrollees. Veterans will automatically be enrolled in Medicare Parts A and B if they receive Social Security or Railroad Retirement Board (RRB) benefits for at least four months before their 65th birthday.

In the case of those veterans who are not automatically enrolled in Medicare and delay signing up for Part B, you may have to pay higher monthly premiums. So, it would be best to sign up for Medicare upon eligibility.

As a veteran, you can have both Medicare and Veterans Affairs benefits, but it is important to note that Medicare and VA benefits do not work together. Medicare does not cover any care that you receive at a VA facility.

You must generally receive health care services at a VA facility for your VA coverage to cover your care. With Medicare, you must receive care at a Medicare-certified facility that works with your medicare plan for Medicare to cover your care. It is essential to know that VA benefits will not cover Medicare cost-sharing (deductibles, copayments, coinsurances).

Medicare may pay for Medicare-covered services the VA does not pay for, given that the VA authorizes services in a non-VA hospital but does not cover all the services you get during your hospital stay.

If you opt not to enroll in Medicare and to keep your VA coverage, you will not have health insurance for facilities outside the VA health system.

Medicare Part A and B for VA benefits recipients

Some VA benefits recipients enroll in Medicare Part A because it’s premium-free. They sometimes turn down Part B because of the additional monthly premium. It is essential to know that if you want to enroll in Medicare in the future and if you delay, there will be penalties, and you would likely have to wait to enroll during the General Enrollment Period (GEP). Eligibility for the Part B Special Enrollment Period (SEP) is not Applicable. If you delay Medicare enrollment and decide to enroll in Part B, you should do so during your Initial Enrollment Period (IEP).

Enrolling in Part B gives you the flexibility of getting health care outside the VA system. You may also qualify for programs to help pay the Part B premium and Medicare cost-sharing. Your VA benefits to getting coverage for health care services and items not covered by Medicare, such as over-the-counter medications, annual physical exams, and hearing aids, can be kept. It is also good to be sure to consider your drug coverage options when you decide whether or not to delay Medicare enrollment.

An important reminder is that if you cancel Medicare Part B after getting it, you won’t be able to reinstate your coverage until January of the following year.

Medicare coverage for Parts A and B includes Inpatient care, outpatient health care, home health care, medically necessary services, and Preventative services. Medicare generally does not cover routine dental, vision, or hearing care, so better to speak with a reliable resource to know how these will be covered.

Additional Medicare Coverage Options for VA Benefits Recipient

  • Medigap
    Medigap plans can be added to Original Medicare to help cover some out-of-pocket costs not covered under Original Medicare.
  • Medicare Advantage
    Medicare Advantage plans ( Known as Part C) offer the same coverage as Original Medicare and may include additional benefits such as drug coverage.
  • Medicare Part D
    Enrolling in a drug prescription plan allows veterans to get covered with prescriptions at local pharmacies instead of through the VA mail-order service. There’s no penalty for delaying enrollment in Medicare Part D.

How do Medicare and VA Benefits Work Together?

Medicare and VA benefits are separate plans. They don’t overlap in coverage. When you enroll for Medicare, your VA benefits will not be affected and vice versa. Having both Medicare and VA Benefits expands your coverage where you can access services. Medicare helps cover services at non-VA facilities, whereas VA benefits cover services at VA-authorized or non-VA facilities with pre-authorization. Consider factors such as budget, convenience, and the type of care you need when deciding whether to go to a VA or non-VA facility. If the VA pre-authorizes services at a non-VA area, then Medicare may pay for other services you accessed at the facility.

Medicare and Veterans with Disabilities

Veterans approved for Social Security Disability Insurance automatically get Medicare after receiving disability benefits for two years. As long as you meet the eligibility requirements for both Medicare and VA benefits programs, you can receive Social Security disability benefits and veteran disability compensation.

Qualifying factors differ between the VA and Medicare. For you to receive disability benefits through the VA, you must have a disabling condition caused by or worsened by and during active duty. Veterans who were discharged may not be eligible for disability benefits. To qualify for SSI and SSDI, your disability doesn’t have to be service-related. Given that it must render you unable to do substantial work and must last or at least be expected to last a year. In addition, your discharge status isn’t taken into account.

Two cases in which you can get expedited processing for your SSI or SSDI applications: (1.) If you receive a 100 percent permanent and total disability rating from the VA and (2) If you became disabled during active duty on or after October 1, 2001. Once you get approved for SSDI, you will automatically get Medicare Coverage after you’ve been receiving disability benefits for two years.

If you want more information and learn more about how Medicare and VA benefits work, our team of Insurance Experts can help you. Give Health Plans in Oregon a call at 503-928-6918 today!




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