I have Veterans Affairs (VA) health coverage and am turning 65 in late March of this next year. Do I need to enroll in Medicare?
-Chris (Springfield, OH)
For our other readers, let’s start with a quick review of Veterans Affairs benefits, also called VA benefits. VA benefits are administered by the federal government for veterans—people who served on active duty in the U.S. Armed Forces for a required period of time and received an honorable discharge or release. VA benefits include pensions, educational stipends, and health care, among other benefits.
It is important to know that VA benefits do not work with Medicare, though you can be enrolled in both.
- In order for your VA coverage to pay for your care, you must generally receive health care services at a VA facility.
- In order for Medicare to pay for your care, you must receive care at a Medicare-certified facility that works with your Medicare coverage.
- VA benefits will not pay for Medicare cost-sharing like deductibles, copayments, or coinsurances.
This means that if you choose not to enroll in Medicare and to keep only your VA coverage, you will not have health insurance for facilities outside the VA system. Enrolling in Medicare gives you more flexibility in what doctors and facilities you go to, while also having VA benefits to cover things not covered by Medicare, such as hearing aids and dental care.
Some people choose to enroll in Medicare Part A for added hospital insurance because it’s often premium-free, but they turn down Part B because of the monthly premiums. In this scenario, though, you would likely face a premium penalty and coverage gap if you decided to enroll in Part B in the future.
VA benefits do offer creditable drug coverage. This means that if you are enrolled in VA drug coverage, you can delay Medicare Part D enrollment without having a late enrollment penalty. Be sure to compare the costs and benefits of Part D and your VA drug coverage to decide which best suits your needs. Typically, VA drug coverage has no premiums and no or limited copayments for prescriptions—but you must use VA pharmacies and facilities. You may want Part D coverage if you:
- Live far from a VA pharmacy or facility, or do not want to use a VA provider to get prescriptions.
- Want the flexibility of filling prescriptions at retail pharmacies or find the VA formulary too restrictive.
- Reside in a non-VA nursing home and want to get prescriptions from the long-term care pharmacy that works with your nursing home.
- Qualify for full Extra Help, which has lower copays than VA coverage.
If you decide to enroll in Medicare Part B and Part D, you should do so during your Initial Enrollment Period (IEP). Your IEP is the three months before your 65th birthday month, the month of your 65th birthday, and the three months after. Because you are turning 65 in March, your Initial Enrollment Period is from December through June.
How do VA benefits work with Medicare?
November 7, 2022