VA Health Care and Medicare

Are you a Veteran about to turn, or just turning, 65? Wondering how VA coverage and Medicare will work together, or if you even need Medicare coverage if you have Veterans Affairs health benefits? We put together the following expert answers and valuable information to help you transition to Medicare as a veteran.

VA Health Coverage

With your Veterans Affairs (VA) Health Care benefits, you are covered for regular checkups and appointments with specialists, but you are limited to only VA-approved hospitals, doctors and networks. This can be an issue when you traveling, or if you live in an area where VA services are not readily available.

Also, VA Benefits vary from person to person. According to VA.gov, “Each Veteran’s medical benefits package is unique.”¹ Essentially all Veterans will receive basic health coverage, but not all will qualify for additional services like eyeglasses and dental care.

Medicare benefits are fairly standard within each part of Original Medicare, and could cover more services than your existing VA medical benefits. You can also opt in to more cohesive coverage and wider health care network options with Medicare Part C, or Medicare Advantage Plans. 

VA Surgical Coverage

VA Health Care covers most surgeries, but at their discrepancy. This means that they will determine if the surgery you need is suitable for coverage. This can depend on your priority group, the advice of your VA Primary Care Physician (PCP), and current medical standards for treating the health condition requiring the surgery.

For example, reconstructive surgery as a result of an incident that happened during your active duty could be covered. However, the same surgery for an incident not related to your time in service could not be covered.

Medicare coverage for surgeries does not depend on your military service or VA doctor recommendations, so when you have Medicare on top of your VA benefits, you could be covered better for surgeries and other specialist health care.

VA Prescription Drug Coverage

The VA will only cover prescriptions written or approved by a VA doctor, and requires that medications only be filled at VA facilities. You can submit prescriptions written by non-VA doctors for approval, but the process can be lengthy or not successful in getting approval for the same prescription.

Medicare requires that all enrollees have prescription coverage, either through Medicare Part D or as part of their Medicare Advantage Plan. This coverage can help give you access to more medications in more places, with the ability to use non-VA doctors, hospitals and pharmacies. Many Medicare Part D plans also include vision and dental benefits, which might not be included in your VA health benefits.

Penalty for Losing Benefits

If for any reason you lose your VA Health Care benefits after turning 65, or VA facilities are no longer available in your area, and you are not enrolled in Medicare, you could face penalties and a lack of access to basic healthcare. The VA hospital network has been threatened many times, and federal funding cuts have already limited facilities and services in certain areas.

Enrolling in Medicare as a Veteran is one of the best ways to help ensure you have the health care coverage you need throughout your senior years. Even if you have a VA Health Care benefits package, having Medicare coverage along with your VA benefits have help you have access to more services and possibly reduce out-of-pocket expenses.

Medicare & Your VA Benefits

It is important that you understand your VA Health Care benefits and what they will, and will not, cover for you as you turn 65. Talk to your local Veterans Affairs office and review your unique VA Health Care coverage.

Then, meet with a licensed Medicare specialist in your area to get help enrolling in the best Medicare plan for you. Contact an agent today for a complimentary consultation and Medicare benefit review.