Can you still keep VA coverage when eligible for Medicare?

8 answers | Last updated: Aug 07, 2017
A fellow caregiver asked...

Can you still keep VA coverage when eligible for Medicare? My friend is currently recieving VA medical benefits and is soon to be eligible for Medicare. Is he required to take medicare coverage if he wants to continue with just VA coverage? What are the benefits of have both coverages

Expert Answers

Many people eligible for Medicare are also eligible for some Veterans medical benefits. If your friend is completely satisfied with the medical care and coverage he gets from the VA, there is no requirement that he enroll in Medicare, too. But most people find that at some point they would prefer to get certain care from outside the VA system, or that the care they want is simply not available from the VA where and when they want or need it. In those situations, being enrolled in Medicare would give your friend a much wider choice of health care providers. On the other hand, it means that he would have to pay a monthly premium for Medicare Part B medical coverage, unless he has very little income and few assets other than the home he lives in, in which case he might also be eligible for Medicaid, which would pay his Medicare premium for him.

If your friend does enroll in Medicare, he will usually have a choice about which system will cover a particular medical treatment or service. However, the VA and Medicare won't both pay for the same treatment -- it's one or the other.
Your friend might be able to receive a specific medical treatment directly from the VA system, which means the VA pays for it. This could include healthcare-related services that Medicare doesn't cover, such as physical exams and other preventive care, dental care, and long-term in-home and nursing home care. Also, VA co-payments are generally lower than Medicare's, including for prescription drugs.

Or for any particular treatment or service, your friend could receive it outside the VA system and have Medicare cover it (if he enrolls in Medicare, that is). If he's treated outside the VA system, the VA won't pay any part of the bills that Medicare doesn't pay.

To learn more details about how Medicare and VA medical benefits work in tandem, your friend can look at the Medicare online booklet Medicare and Other Health Benefits: Your Guide to Who Pays First.

Community Answers

Robind64 answered...

As the Admissions Director for a Veterans only Skilled Nursing Facility that is NOT a VA facility, I would highly advise to enroll in Medicare.  Although the VA has their own Nursing Home the requirements are more specific (must be 70% or above service connected to be admitted)  The majority of our Veterans are admitted under their Medicare Part A policy.  In Virginia, without Medicare, they do not have the option to admit to a SNF when they really need it unless they have Medicaid (state funded) and usually Medicaid beds are few and rarely available.

Ca-claire answered...

It also depends on whether your friend has coverage for more than 50% of a Veterans' related disability.  If the coverage is under 50%, the VA covers only medical care/medications related to the covered disability.  If the disability rating is over 50%, then the VA may cover all medical conditions, whether related to the disability or not.  They are also odd about what they consider related to the medical condition.  My husband is 35% disabled due to a severe stroke (should be more, but did not push to have the neurospsych reports to show the frontal lobe impairment).  He has stroke related seizure (when he has a seizure, only the areas neglected by the stroke light up and move), they do not consider the seizures to be related to his 30% disability.  I work full time and am way too tired to push back.

Robind64 answered...

Bottom line is you should always have Medicare Part A. Part B is very helpful if you need ongoing therapy.

Jimmyacorn answered...

Mr. Joe Matthews said, "If he's treated outside the VA system, the VA won't pay any part of the bills that Medicare doesn't pay."

This is not entirely true. The VA Fee Basis reviews all medical bills sent to them and there are always exceptions to "rules". In an emergency where your closest emergency medical provider is a non-VA facility, the VA will often pay the difference of all medical expenses accrued during your stay at that facility. The non-VA facility is required to stabilize you and set up a move to a VA hospital after a certain period of time. This is NOT true if you are in a motor vehicle accident as you would have medical coverage with that insurance policy and the VA would not pay any of the associated costs.

There are so many exceptions, so many challenges when it comes to afixing VA disability benefits with any form of Medicare Coverage. I've not found one site or one person who can provide easy to understand solutions when it comes to Medicare. The bottom line is that if you want to be completely covered (insured) you're going to have to pay for it. And the claim that medicare is draining this country (a financial burden) is completely absured.

A fellow caregiver answered...

I am a Vietnam Vet 80 percent and for $104.00 a month will jump at the chance to get coverage I can use for a second opinion or in case the backlog in the VA system gets overwhelmed as in could with the new veterans comming into the system.

Coronel sanders answered...

Something to think about.., the Choice Program.

What is the Choice Program? If you are already enrolled in VA health care, the Choice Program allows you to receive health care within your community. Using this program does NOT impact your existing VA health care, or any other VA benefit.

Am I Eligible? If you are already enrolled in VA health care, you may be able to receive care within your community, instead of waiting for a VA appointment or traveling to a VA facility.

Chipperboy answered...

I'm enrolled through the VA in the Veterans Choice Program. SO do I need to take Medicare Part B? as all my medical is free through the VA?