Medicare & VA benefits

how they work together

The Department of Veteran’s Affairs (VA) and Medicare are two separate medical coverage programs. If you served in the military, you might have access to VA benefits and Medicare. How do the two types of coverage work together?

When You Use a VA Hospital

If you get medical care at a VA hospital, your VA benefits will generally cover the costs. This is because the VA uses providers who are covered under the plan, so you won’t necessarily need the institution to submit any claims to Medicare. However, Medicare can also cover services included with your VA medical benefits. In some cases, you can choose which provider to use.

As the official site for Medicare notes, you can’t use VA benefits and Medicare simultaneously. In other words, if the VA covers a treatment or office visit, Medicare can’t cover services rendered at the same time. The only exception occurs when you’re sent to a non-VA hospital by the VA. In that case, you can use your Medicare insurance plan to cover services that the VA won’t.

When You File Your Own Claim

Some disabled veterans don’t live near VA hospitals. In this case, they may receive fee-based identification cards. They can present these for treatment at a health care facility or doctor’s office. Be sure to call ahead before accepting an appointment since not all providers accept these cards.

The process varies depending on the provider’s preferences:

  • The provider can file the claim with the VA, and you only pay any applicable deductibles. You can also choose to use your Medicare benefits.
  • You pay for the fees relating to the services you received, then submit your own claim to the VA. This option takes longer, but it might prove necessary if you can’t get to a VA hospital.
  • Use your Medicare benefits instead of your VA medical benefits. You might prefer this option if you don’t have the money to pay up front for services rendered as described in the second option.

Try VA Benefits Drug Plans

Unfortunately, many patients fail to enroll in a Medicare Part D plan on time. When this happens, they have to pay a penalty. If you have VA coverage, there is a good way to avoid the penalty.

To avoid paying penalties, make sure you enroll in a creditable drug plan by the due date. VA medical benefits offer a creditable drug plan that might prove more cost-effective than other options, such as Medicare or TRICARE.

Sometimes, paperwork gets lost or buried. If you’re sent a Part D penalty invoice, you can contest it by proving that you had a creditable drug plan within 63 days of applying for Medicare. It helps to keep all of your paperwork on hand. That way, you can prove when you signed up for your VA drug benefits.

Also Get Medicare

You might think that you don’t need Medicare if you qualify for VA medical benefits. However, Medicare can pick up the slack when the VA won’t cover the bill for certain services or at specific facilities. For instance, maybe you live around the block from a VA hospital, but you get sick or injured while traveling.

You’ll enjoy more flexibility if you have both Medicare and VA benefits. Additionally, the VA benefits program is subject to government oversight. The government can suspend or lower funding at any time, and you don’t want to find yourself without viable medical coverage.

Just remember that you can’t use both benefits at the same time. If you use Medicare to help pay for an MRI scan, for instance, the VA won’t pick up the rest of the cost. When you get treatment, try to determine which set of benefits will allow you to pay the least money out of pocket.

Deciphering your Medicare and VA benefits options can prove tricky, especially if you’re new to the process. Share this post with your community to help them understand how they might use their VA medical benefits in conjunction with Medicare.