VA Benefits and Medicare

How does Medicare work with VA Benefits?

A common misconception is that once a person qualifies for one set/source of benefits, they are ineligible for any others. Many veterans may not think about any additional coverage, including Medicare, once they have VA benefits. For some veterans, having Medicare in addition to VA benefits could be beneficial for helping with expenses not covered by the VA. 

What is Medicare?

It is a federal health insurance plan for people who are:

• Over 65 years of age
• Under 65 years with certain disabilities
• Suffering from End-Stage Renal Disease ESRD, which is permanent kidney failure that requires a transplant or dialysis

How Could It Help Me?

VA benefits and Medicare are totally separate programs with different coverages. Some things to remember and consider:

• Medicare will not cover expenses or services received at a VA center or facility, and vice versa. It’s coverage works for the certified facilities within your coverage and plan.
• VA benefits do not pay for anything Medicare related, including deductibles, cost sharing, coinsurance or copayments.
• At times, the VA may authorize treatment at a non-VA facility. In that case, Medicare may cover some of the amount not covered by the VA.

What Are the Options?

There are different coverage plans, called “parts”-

1. Medicare Part A, referred to as hospital insurance, helps cover inpatient care, such as hospital or nursing home facilities. If you believe there is a chance you’ll need or receive care at a non-VA hospital or facility, there is a good chance you’ll be left with some out-of-pocket expenses that the VA won’t cover. This is where having Plan A could potentially be helpful.
2. Medicare Part B, referred to as medical insurance, covers medically necessary and preventative services. Mental health inpatient, outpatient, and partial hospitalization is a big one that is covered through Plan B, along with ambulatory services, clinical research, durable medical equipment, and more.
3. Medicare Part C, called Medicare Advantage Plan, offers the benefits of A and B with additional resources, such as dental and vision, but is not through the federal government. This plan is offered through approved private companies that follow the guidelines. 

What Is the Cost?

• The different parts have different fees, some of which depend on how long you worked and paid Medicare taxes.
• Part A premiums are $0, no cost, for most people, because they worked for at least 10 or more years paying toward those taxes.
• Find a helpful breakdown of the monthly premiums and out of pocket cost estimations here. 

Conclusion

Additional coverage outside of VA benefits may or may not be the right choice for you. It’s good to know your options, what you qualify for, and the costs and benefits to you. For more information specific for veterans, visit this page.

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