Many Veterans do not realize they can take advantage of both Veterans Affairs benefits and Medicare benefits. While you can use both healthcare benefits as a Veteran, Medicare and VA benefits do not work together. With VA benefits, individuals must see VA providers and use VA facilities. If a Veteran prefers to see a physician or seek treatment outside of the VA all expenses will be out-of-pocket.
Medicare does not pay for services received at a VA facility and/or VA only providers. Medicare covers healthcare services received at facilities and/or providers accepting Medicare. Utilizing VA benefits and Medicare benefits gives Veterans a choice on where to go for care.
You have End Stage Renal Disease (ESRD)
You have received Social Security Disability Income (SSDI) payments for 24 months
Age 65 and Older:
Medicare Coverage Options (Brief Overview):
Original Medicare Part A & B; covers hospitalization and outpatient services. Beneficiaries are responsible for deductibles and co-insurance. There is no limit on out of pocket expenses.
Medicare Advantage Plans; offered through private insurance companies. May have monthly premiums. At a minimum must provide same coverage as Original Medicare. These plans usually PPO or HMO plans and offer more coverage, including lower or no deductibles and co-pays. And the plans have annual maximum out of pocket limits. They may include prescription coverage.
Medigap/Supplement Plans; offered through private insurance companies. Have monthly premiums. Also offer more coverage. They do not have networks. All facilities and providers accepting Medicare must accept Medigap/Supplement plans anywhere in the US. These plans pay secondary to Original Medicare and have no prescription coverage.
Stand-alone Prescription Plans; offered through private insurance companies. Have monthly premiums (unless qualify for subsidies) and co-pays/coinsurance for prescriptions. Co-pays/coinsurances vary by plan. NOTE: Generally private insurance prescription drug coverage is not needed as they are included in VA benefits.
Choosing a Medicare Plan in addition to VA benefits provides greater flexibility and choices to enhance beneficiaries healthcare coverage.