Medicare and VA Benefits
As a veteran, you may be eligible for Veterans Affairs (VA) benefits. A veteran is a person who has served actively in the U.S. Armed Forces (military, naval, air force, or space) for a specified period and we're discharged or released under other than dishonorable conditions.
The federal government provides VA benefits to eligible persons and their families. These benefits include pensions, disability compensations, education, housing, employment, and health care.
If eligible, a veteran can be enrolled in both VA benefits and Medicare. The advantage of being enrolled in both VA benefits and Medicare is that veterans can have better coverage, especially when they seek healthcare services from non-VA healthcare facilities. According to statistics, about fifty percent (50%) of veterans who have VA benefits also have Medicare coverage and enjoy more healthcare coverage options.
However, VA benefits do not work together with Medicare. They are exclusive of each other. The only similarity is that they are both health insurance programs provided by the federal government to support the healthcare needs of veterans in the United States.
This article discusses whether you should enroll in VA benefits and Medicare, how VA benefits work with Medicare, eligibility for VA benefits and Medicare, disability under both insurance programs, as well as Medicare options veterans can enroll in.
Should I Enroll In Medicare If I Have VA Coverage?
As recommended by the U.S. Department of Veterans Affairs, veterans should enroll in Medicare Parts A and B as soon as they become eligible, even if they have VA coverage. The only exception may be if they have creditable employer insurance.
Having Medicare coverage expands your coverage options, especially when seeking care from non-VA providers and facilities. Your VA benefits can cover your medical expenses when you visit a VA doctor or facility, while Medicare will cover other non-VA-related costs. You will benefit largely from this if you live far from VA facilities.
Medicare also serves as a backup against future problems. If VA funding reduces or cannot be sustained for veterans, they will still enjoy health care benefits through Medicare. Moreover, VA health coverage is not the same for everyone, and benefits are based on priority levels. If any issues arise in the future, veterans in low-priority groups may lose their VA benefits.
Once you're eligible, enroll in Medicare Part B to avoid the late enrollment penalty. The penalty increases with every 12-month period you delay signing up and is paid as long as you are enrolled in Medicare Part B.
Am I Eligible For VA Health Benefits?
The Department of Veterans Affairs states that only persons who have served in active military, naval, or air service and didn’t receive a dishonorable discharge are eligible for VA health benefits.
Also, if you enlisted in uniform services after September 7, 1980, or started active duty after October 16, 1981, you must have served continuously for two years or the full active-duty period except for certain conditions.
These conditions include;
● Discharge due to disability caused or made worse by your active duty
● Early discharge
● Serving before September 7, 1980
If you’re a current or former member of the Military Reserves or National Guard, you can qualify for VA health benefits if you have been called to active duty by a federal order and completed your active-duty period.
If you had or have an active-duty status for training purposes only, you don’t qualify for VA health care benefits.
What Does VA Benefits Cover?
VA benefits cover a range of services. These services can only be received from a VA-authorized or pre-authorized non-VA facility. They include:
● Inpatient hospital services
● Emergency care services
● Home health care
● Preventive care
● Mental health services
● In some cases, dental and vision services
As A Veteran, Am I Eligible For Medicare?
There are no special or different Medicare eligibility rules for veterans. Medicare eligibility requirements are the same for veterans as for every other person. Medicare is available to veterans 65 and above or under 65 with certain disabilities.
You’ll automatically be enrolled in Medicare Parts A and B if you meet any of the following requirements:
● You will receive retirement benefits from either Social Security or the Railroad Retirement Board when you turn 65 years old. Usually, your Medicare card will be mailed to you about three months before your 65th birthday.
● You have Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis (ALS).
● You have End-Stage Renal Disease where you require regular dialysis or a kidney transplant.
● You have received Social Security Disability Insurance (SSDI) for at least 24 months. So, you are automatically enrolled in your 25th month.
Delaying enrollment in Medicare Part B attracts a permanent penalty. You will have to pay a higher monthly premium.
How About Medicare And VA Benefits Due To disability?
Disability under VA and Medicare are different. Under Veteran Affairs, the disability must have been caused by or worsened with active duty. This is the reason you can receive disability benefits through VA.
To qualify for Medicare due to disability, you must:
● Have end-stage renal disease (ESRD)
● Have amyotrophic lateral sclerosis (ALS)
● Be qualified for and have received Social Security Disability Insurance (SSDI) for at least 24 months (2 years)
● Be qualified for certain disability benefits from the Railroad Retirement Board for 24 months
Under SSDI, your disability doesn't have to be service-related. However, to qualify for Social Security Disability Insurance (SSDI), you must meet the following conditions:
● You must have worked in jobs covered by Social Security.
● You must have a medical condition that’s expected to last at least one year.
● The medical condition must significantly limit you from engaging in substantial gainful activity.
● You also have to meet earnings requirements based on your work history.
Even if you do not qualify for VA disability benefits but are approved for SSDI, you automatically get enrolled in Medicare after you've received disability benefits for two years.
What Other Medicare Plans Can I Enroll In?
You may enroll in alternative or additional Medicare plans apart from Original Medicare (Parts A and B).
Original Medicare covers inpatient and outpatient healthcare services. The Medicare Part A (hospital insurance) of Original Medicare covers the following services:
● Inpatient care in a hospital setting
● Home health care
● Skilled nursing facility (SNF) care
● Nursing home care
● Hospice care
On the other hand, Medicare Part B (medical insurance) covers:
● Outpatient doctor visits
● Emergency services
● Durable medical equipment (DME)
● Some outpatient prescription drugs
● Medical services such as lab tests, X-rays, and some cancer screening tests
● Preventative care services, including counseling
● Other outpatient treatments
Enrolling in other plans may provide you with more coverage. They include:
Medicare Part C (Medicare Advantage Plans)
Medicare Part C, also known as Medicare Advantage plans, is an alternative way to have Original Medicare. It covers the same services as Original Medicare A and B. Most Medicare Advantage plans also cover prescription drugs (Medicare Part D).
Medicare Advantage Plans have out-of-pocket limits on costs associated with your covered services. Once you reach the limit, you pay nothing for the rest of the year, making it a potential saving option
Medicare advantage plans are administered by private insurance companies that must follow rules set forth by Medicare. Some Medicare Advantage plans are designed specifically to fit the needs of Veterans. People with VA benefits who use Medicare only as a “Backup” option, often find that Advantage plans with a Part B giveback are a good fit.
Medicare Part D
Medicare Part D is a Medicare option that covers prescription drugs. Anyone with Medicare Part A and Part B (including those subscribed to the Medicare Advantage plan) is eligible for Medicare Part D.
Part D plans are provided only through private insurance companies registered with the federal government. You can enroll with a private Medicare prescription drug plan (PDP) or a Medicare Advantage Plan with drug coverage (MADP). With your drug plan, you can get your covered prescriptions at local pharmacies instead of through the VA mail-order service. Its important to note that although VA health coverage is NOT creditable, VA prescription coverage IS creditable. This is why many veterans choose an MA-only plan that has a Part B giveback benefit (if available in their area)
Medicare Supplemental Insurance (Medigap)
Medicare supplement insurance (Medigap) is a Medicare option purchased to fill financial gaps in the traditional "Original Medicare." Medigap policies cover out-of-pocket costs not covered by Original Medicare, including deductibles, copayments, coinsurance, and health care expenses when you travel outside the United States.
Note that as a veteran with VA benefits, you can only sign up for either Medicare Advantage Plan or Medigap plan. You can not be enrolled in both at the same time.
How Do VA Benefits And Medicare Work Together?
As mentioned earlier, you can have both VA benefits and Medicare, but they do not work together or overlap in coverage. Instead, each works differently. VA benefits do not affect Medicare coverage and vice versa.
Each time you access care, you have to choose what coverage option you want to use. Typically, you will use your Veteran Health Identification Card when seeking care at VA-authorized or non-VA facilities with pre-authorization and your Medicare card at other non-VA facilities.
Ensure you consider cost, convenience, and health needs when deciding whether to go to a VA or non-VA facility.
Where Can I Access VA Care In The United States?
There are over 1,200 care locations across the U.S. In each location, you can use your Veteran Health Identification Card to access healthcare.
These locations include:
● VA medical centers
● Vet centers
● VA community-based outpatient clinics
● VA community living centers or other assisted living facilities
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