Most U.S. military veterans are aged 65 and over and enrolled in Medicare. But with VA insurance, do veterans even need Medicare? And how does Medicare work with VA benefits?
We tackle those questions and more below in our Medicare guide for veterans. Learn how Medicare works with veteran health insurance benefits and find out how to browse Medicare plans online or with the help of a licensed insurance agent. Find out how pairing a Medicare plan with your VA benefits could help you save on health care costs.
Medicare can offer an additional layer of protection against out-of-pocket medical costs, especially when you need specialized care. Having Medicare can give beneficiaries additional choices of doctors and health care facilities, and Medicare may sometimes cover certain services or items that VA insurance and TRICARE do not.
Most beneficiaries qualify for premium-free Medicare Part A. While Medicare Part B requires a monthly premium ($164.90 per month in 2023), Part B is optional. You can disenroll from Part B if you’re automatically enrolled. Learn more about Medicare Part A and Part B below.
Many military veterans and family members are eligible for TRICARE, including Medal of Honor recipients, retired service members and surviving family members of veterans. TRICARE is separate from VA coverage but offers similar types of health coverage.
Medicare acts as the primary payer and TRICARE serves as a secondary payer in most cases for those who are enrolled in both types of coverage. TRICARE offers prescription drug coverage, so you may not need a Medicare Part D plan for your medications. Learn more about Medicare Part D plans below. To have Medicare and TRICARE for Life, you must be enrolled in Medicare Part A and Part B. For TRICARE Prime, you may have Medicare Part B without Part A.
You can’t use both Medicare and VA benefits at the same time to boost your coverage. But Medicare and VA insurance do work together in another sense:
- VA insurance provides coverage at VA hospitals and medical centers, while Medicare does not.
- Medicare provides coverage at non-VA hospitals and medical facilities, while VA insurance does not.
In other words, if you receive care at a VA facility, your VA insurance benefits will apply. And if you receive care at a non-VA facility, your Medicare insurance may provide coverage, depending on which type of Medicare plan you have. Veterans who have VA insurance can give themselves more health care options by enrolling in Medicare.
Medicare is made up of several parts. Part A and Part B make up what is typically called Original Medicare, which is administered by the federal government. Medicare beneficiaries may also be able to consider different types of private Medicare plan options that can either replace or supplement their Original Medicare coverage.
| Type of Medicare Coverage | What It Covers | What It Costs | How to Find Plans |
|---|---|---|---|
| Part A |
Part A covers hospital stays and other inpatient treatment. VA insurance does not cover inpatient stays at non-VA facilities, so veterans are encouraged to enroll in Medicare Part A in the event they are admitted to a non-VA hospital for Medicare-covered care. |
Most people do not pay a monthly premium for Part A. If you or your spouse haven’t worked and paid Medicare taxes for at least 40 quarters (10 years), you’ll likely pay $278 or $506 each month for Medicare Part A. |
You can visit Medicare.gov to learn more about signing up for Medicare Part A. You can also enroll online with the Social Security Administration or by calling 1-800-772-1213. TTY users can call 1-800-325-0778. |
| Part B |
Part B covers doctor’s appointments and other outpatient care. It also covers durable medical equipment and supplies like walkers and wheelchairs. Some veterans may consider Part B enrollment because VA insurance does not cover outpatient care or medical equipment received from a non-VA facility or provider. Medicare Part B is optional. |
The standard monthly Part B premium is $164.90 in 2023. Some beneficiaries may have to pay a higher monthly Part B premium due to what’s called the Medicare income-related monthly adjustment amount (IRMAA). |
As with Part A, you can visit Medicare.gov to learn more about signing up for Medicare Part B. You can also enroll online with the Social Security Administration or by calling 1-800-772-1213. TTY users can call 1-800-325-0778. |
| Part C (Medicare Advantage) |
Part C plans, also called Medicare Advantage plans, cover all Part A and Part B benefits, replacing your Original Medicare coverage. Most Medicare Advantage plans cover prescription drugs, and many plans cover extra benefits that may include things dental, vision, hearing care, fitness benefits, flex cards and more.2 Medicare Advantage plans are sold by private insurance companies. Once again, the coverage found in Medicare Advantage plans will not cover your care at a VA medical center. It may be used at non-VA facilities, though plans may have network restrictions or preferred providers. |
The average Medicare Advantage plan premium is $17.60 per month in 2023. Plan costs and benefits vary by plan and can change depending on where you live. Request a free online plan quote for the plans in your area or call to speak with a licensed insurance agent. They can help you compare the extra benefits that may be available with plans where you live and what they may cost. |
Licensed insurance agents at MedicareAdvantage.com |
| Part D |
Part D plans are Medicare Prescription Drug Plans that provide coverage exclusively for prescription medications. VA insurance also provides prescription drug coverage, but the benefits are exclusive for use at VA pharmacies and other VA facilities. A Medicare Part D plan may be used at your local pharmacy like Walmart, Walgreens or CVS, though plans may have network restrictions or preferred pharmacies. |
Because Medicare Part D plans may have monthly premiums, copays, deductibles and other costs, having a plan may not help a veteran save money. Be sure to consider your prescription drug needs and anticipated costs through the VA and through any Part D plans in your area. |
Licensed insurance agents at MyRxPlans.com |
| Medicare Supplement (Medigap) |
Medicare Supplement plans can cover Medicare Part A and Part B deductibles, copayments, coinsurance and more. A Medigap plan can supplement your Part A and Part B coverage should you ever receive treatment at a non-VA medical facility. |
The average Medicare Supplement plan premium in 2022 was $136.42 per month. A Medicare Supplement plan may not be worth the monthly cost to you if you don’t anticipate using many non-VA health services during the year that would be covered by Medicare. |
Licensed insurance agents at MedicareSupplement.com |
5. Getting Medicare Part B if You Are Up to 100% Service-Connected Disabled
VA insurance uses eight priority groups to determine enrollment dates and costs. Priority group assignments are based on:
- Military service history
- Disability rating
- Income level
- Medicaid eligibility
- Other VA benefits received
Veterans who are 100% service-connected disabled are assigned to the highest priority group. Veterans without a 100% disability but are still disabled enough to be unable to work may also be assigned to priority group 1. Veterans who earn a higher income and do not have any service-connected disability are assigned to the lowest priority group. Veterans who qualify for more than one priority group are assigned to the highest one. It’s still wise to enroll in Medicare Part B even if you are 100% service-connected disabled, as Part B can provide coverage at non-VA medical facilities and is required if you wish to enroll in TRICARE For Life.
Why Does the VA Put Eligible Beneficiaries Into Priority groups?
Priority groups help the VA make sure that the veterans who need care right away get signed up for coverage as quickly as possible. Priority groups also make sure the VA can provide the highest quality of care to all veterans.
Long-term care benefits can be found in VA insurance in the form of nursing home, assisted living and home health care coverage. These benefits can include coverage of:
- 24/7 nursing and medical care
- Physical therapy
- Custodial care (assistance with activities of daily living like bathing, dressing, and eating)
- Comfort care and pain management
- Caregiver support services and respite care
- Nursing home care
- Assisted living center care
- Adult day care
- Caregiver care in private homes
You must be enrolled in VA insurance, require such care, and have the care available near you. Copayments may be required for some services and others may not be covered by your VA benefits. Medicare provides a variety of services related to home health and nursing home care and may be used by veterans to cover services not covered by VA insurance.
The VA contracts with several major hearing aid manufacturers to provide hearing aid coverage to eligible veterans. If an audiologist determines you need hearing aids and your hearing loss is service-connected, the hearing aids, batteries and repairs will typically be covered in full by VA health insurance.
Others who may qualify for full coverage of hearing aids include:
- Former prisoners of war
- Purple Heart recipients
- Beneficiaries with a “permanently housebound” disability
- Beneficiaries with a hearing loss that results from a qualifying condition
- Beneficiaries with a hearing loss that inhibits medical care or daily living
While Medicare Part A and Part B do not provide any coverage for hearing aids, many Medicare Advantage plans do. Veterans who do not qualify for hearing aid coverage through their VA insurance may enroll in a Medicare Advantage plan to obtain such coverage.
VA insurance covers women’s health care services such as:
- General health and wellness checks and screenings
- Reproductive health care
- Management of long-term conditions
- Pain management
- Mental health services
- Treatment for military sexual trauma
- Gynecology and fertility treatment
- Sensory aids and prosthetics
Medicare also provides coverage of women’s health care services. Once again, Medicare can provide coverage of these services at non-VA medical facilities while VA insurance will provide the benefits at a VA facility.