Two programs that work side by side
VA health care is run by the Department of Veterans Affairs. You generally get care at a VA facility, or from a community doctor the VA has approved ahead of time. Medicare is a separate federal program. It lets you see doctors and hospitals outside the VA, as long as they work with Medicare or with your Medicare plan.
The two programs do not pay for the same visit. Each time you get care, you pick which one to use. Go to the VA, and the VA covers it under its rules. Go to a non-VA doctor, and Medicare covers it under its rules. Many veterans use both: the VA for some care, and Medicare for a doctor close to home or a hospital in an emergency.
Why many veterans keep Part B
Part B is the part of Medicare that covers doctor visits and outpatient care. It has a monthly premium (see this year's Medicare costs), so some veterans ask if they need it. The VA itself gives a few reasons to think it over:
- VA coverage can change. The VA says it does not know if Congress will fund care for every enrolled veteran in future years. Veterans in lower priority groups could lose VA health care later.
- More choices. Medicare covers you at non-VA doctors and hospitals. That matters if a VA facility is far away, or if you end up in a non-VA emergency room.
- The late penalty. If you wait to sign up for Part B, you may pay a penalty that grows the longer you wait. You pay it for as long as you have Part B.
- Getting it back takes time. If you cancel Part B, the VA notes you cannot get it back until the next January, and you may owe a penalty.
Every veteran's situation is different. Before you turn down or cancel Part B, call us first so we can go over it with you.
Option one: Original Medicare plus a Medicare Supplement
Original Medicare is Part A (hospital) and Part B (medical). A Medicare Supplement, also called Medigap, helps pay the costs Original Medicare leaves behind. You can see any doctor in the country who takes Medicare, with no network. This works well for veterans who want freedom to see non-VA doctors while still using the VA. Learn about Medicare Supplements.
Option two: Medicare Advantage plans
Medicare Advantage plans (also called Part C) are offered by private insurance companies. They cover Part A and Part B, and many include drug coverage and extras. Most use a network of doctors and hospitals. Some plans are built for people who also use VA care, for example plans that leave out drug coverage because you get your medicines from the VA. Networks can change each year, so we check your doctors first. Learn about Medicare Advantage.
Drug coverage: Part D or VA pharmacy
The VA pharmacy fills prescriptions written by VA doctors, often by mail. A Part D plan lets you fill prescriptions from non-VA doctors at a local pharmacy. VA drug coverage counts as creditable coverage. That means there is generally no Part D late penalty while you have it. If you lose VA health care later, the VA says to sign up for Part D within 63 days to avoid a penalty. Learn about Part D.
TRICARE For Life
If you are a military retiree (or the spouse of one) and have Medicare, you may have TRICARE For Life. It works as a second payer after Medicare. You generally need both Part A and Part B to keep it. Read how TRICARE For Life works with Medicare.
CHAMPVA for spouses and family
VA health care covers the veteran, not the family. CHAMPVA is a VA program that shares the cost of care for some spouses, children and survivors, mainly families of veterans rated permanently and totally disabled from a service-connected condition. If you can get TRICARE, you cannot get CHAMPVA.
At 65, or any time you qualify for Medicare, the VA says you must have Medicare Part A and Part B to get or keep CHAMPVA. A Medicare Advantage plan also meets that rule. If you are a CHAMPVA spouse turning 65, talk with us before your Medicare start date.
Senior Veteran Guidance
Not sure how your benefits fit together? Send us your name and number. A licensed agent who works with veterans will call you to go over your VA care, TRICARE or CHAMPVA and Medicare.
Prefer to talk now? Call (816) 307-6165 or book a free review. Our help is free, and the price of a plan is the same as going direct.
Questions people ask us
Do veterans need Medicare Part B?
It depends on your situation, but many veterans keep Part B. It lets you use non-VA doctors and hospitals, and signing up late can mean a lifelong penalty. If you have TRICARE For Life, Part B is generally required. Call us and we will go over your case.
If I have VA health care, do I need Medicare?
You do not have to sign up, but the VA encourages many veterans to think about it. Medicare lets you see non-VA doctors and hospitals, and signing up for Part B late can mean a penalty that lasts for life. We can walk through your own situation with you.
Will the VA and Medicare both pay for the same visit?
No. Each time you get care, you choose which benefit to use. If you go to a VA facility, the VA covers it under its rules. If you go to a non-VA doctor, Medicare and any Medicare plan you have cover it under their rules.
Can I keep using the VA if I join a Medicare plan?
Yes. Joining a Medicare plan does not end your VA health care. You can still use VA facilities for care the VA covers.
Do I need a Part D drug plan if I get medicines from the VA?
Not always. VA drug coverage counts as creditable coverage, so there is generally no Part D late penalty while you have it. Some veterans add Part D so they can fill prescriptions from non-VA doctors at a local pharmacy.
Is Cole Insure part of the VA?
No. We are an independent insurance agency. We help veterans and their families understand how Medicare fits with the benefits they already have.