A Veteran’s Guide to Medicare Coverage and Enrollment

Medicare eligibility for Veterans

It’s a good idea to check whether you’re eligible for a Medicare plan in addition to your VA healthcare coverage, since the VA’s health benefits may not cover everything you need.

For Veterans to be eligible for Medicare, they must be 65 years or older and enrolled in Medicare Part B or have end stage renal disease (ESRD), a qualifying disability, or amyotrophic lateral sclerosis (ALS) and be enrolled in both Medicare Part A and Part B.

Consider speaking with a VA representative to help you figure out how Medicare can work alongside your VA benefits.

VA healthcare eligibility

If you’re a Veteran, you automatically qualify for some VA healthcare benefits.

All Veterans can get most types of healthcare services through VA health benefits, and some can qualify for extra benefits, including dental care.

Your coverage will vary depending on:

• the priority group you are assigned based on your income, military service history, disability, and other factors
• the advice of your main doctor, nurse, or other primary care professional
• your medical needs for particular health conditions you have

Medicare coverage for Veterans

• Medicare Part A covers non-VA emergency hospital care or hospital care for Veterans who live far from a VA facility. It’s usually free with no premium.
• Medicare Part B provides coverage for other non-VA healthcare providers, plus other care and services not covered by VA healthcare plans.

Remember that, if you apply for Medicare Part B after losing VA coverage, a late enrollment fee may apply, so it’s better to apply earlier.

Some Veterans may choose to enroll in a Medicare Advantage plan, Medigap, Part D plan, and TRICARE:

• The Medicare Advantage plan, also known as Medicare Part C, covers care and services that aren’t covered by VA and basic Medicare, including dental, hearing, prescriptions, and vision care. However, plans cost more, along with other limitations.
• The Medicare Part D plan is for prescription drugs. It covers some drugs not covered by the VA plan, though the cost of others can be higher than in the VA plan. It can be more convenient for getting prescriptions since it allows you to get them from non-VA doctors and fill them at any retail pharmacy.
• The Medigap plan is a supplementary plan you can use to get health care coverage in emergency situations or when you’re traveling outside the U.S. It can also help if you’ve been assigned a lower-priority VA benefit group or you live far from a VA health care clinic.

TRICARE

TRICARE is medical insurance for the military.

Several plans exist, and you become eligible for a plan called TRICARE for Life once you turn 65, after you retire from military service, and if you’re enrolled in Medicare parts A and B.

TRICARE is a second payer, meaning that it will cover eligible services after you’ve already received Medicare coverage you’re eligible for.

Coordination of benefits

If you’re a Veteran, you can get comprehensive coverage by combining both Medicare and VA healthcare benefits, plus TRICARE if you’re eligible.

Medicare is typically primary payer, but your VA benefits and TRICARE may cover healthcare services not covered by Medicare.

To coordinate your benefits, speak with a VA healthcare specialist, and they can help you coordinate your plans based on your needs and budget.

Medicare enrollment for Veterans

The way Veterans can enroll for Medicare is similar to the process for the general population, with some exceptions.

If you’re a Veteran, you’re automatically enrolled in Part A at age 65, if you receive Social Security or Railroad Retirement Board (RRB) benefits. If not, you can enroll via the Social Security Administration (SSA) or RRB.

Veterans can enroll in Medicare Part A during the Initial Enrollment Period (IEP). This is the period of 7 months around when you turn 65, starting 3 months before your 65th birthday.

Part B enrollment is also typically during IEP or later during the General Enrollment Period (January 1 to March 31). It’s important to get your application in on time because late fees may apply.

You can also enroll for Medicare Part D during IEP or the Annual Enrollment Period (Oct 15 to Dec 7).