6 reasons veterans need Medicare even if they have VA health coverage

Medicare can provide coverage if you need care from a non-VA hospital or doctor, if you want a second opinion, or if you’d like care closer to home.
Kait Hanson Avatar

Share

Of the more than 8 million veterans who have healthcare benefits from the Department of Veterans Affairs, almost half are 65 or older, meaning Medicare is an option for their healthcare coverage. 

Some veterans may wonder why enrolling in Medicare is necessary if they have access to VA healthcare facilities. We asked Scott Mathis, a U.S. Army veteran who now works for Humana, to help us understand why enrolling in Medicare is important for those who are eligible. 

“If you are a veteran who receives VA healthcare benefits, the VA still encourages you to enroll in Medicare Part B when you are eligible,” Mathis told We Are The Mighty. “Medicare can provide coverage if you need care from a non-VA hospital or doctor, especially if you want a second opinion, or if you’d like care closer to home. If you are at a VA authorized care facility, Medicare may (also) cover services the VA doesn’t.”

Here are six factors to consider:

1. Expanded access to care

Enrolling in Medicare gives veterans access to a broader range of healthcare providers, including non-VA doctors, hospitals and specialists. This flexibility can be particularly valuable for veterans who live in areas with limited VA access. Understand that having a Medicare Advantage plan does not interfere or disrupt your VA healthcare.

2. Complementary healthcare

Veterans can use both Medicare and VA healthcare in a complementary manner. For example, a veteran may receive care at a VA facility for their service-connected disabilities and use Medicare to see a non-VA specialist or hospital when needed. 

3. Prescription drug coverage

Veterans can receive most medications through the VA at a low cost, but not all drugs may be available through VA pharmacies. Enrolling in a Medicare plan that includes Part D (either a Medicare Advantage Prescription Drug plan or a stand-alone Part D benefit) may include coverage for prescriptions that the VA may not provide.

“With Medicare Part D, only available through private insurers as a part of a Medicare Advantage plan or a stand-alone prescription drug plan, you can get medication prescribed by non-VA doctors and pick it up at your local pharmacy,” Mathis said.

4. Avoid late enrollment penalties

Veterans who do not enroll in Medicare during their initial enrollment period may face lifetime penalties if they choose to enroll later. The Part B late enrollment penalty increases costs over time, so enrolling when you are first eligible means you can avoid higher future premiums.

“If you elect to cancel your Medicare Part B coverage, you would not be able to choose a Medicare Advantage plan until January of the following year when you can enroll in Part B, even if your VA healthcare benefits change,” Mathis explained. “A delay in Part B enrollment may also mean a financial penalty when you do sign up.”

5. Emergency care outside the VA

VA benefits may not cover emergency care outside VA facilities even if you are service connected. Having a Medicare plan ensures veterans have emergency and urgent care coverage at non-VA hospitals, which is critical for veterans who live in areas without VA facilities or those who may experience a medical emergency while traveling.

VA healthcare primarily focuses on service-connected conditions. Having a Medicare plan ensures veterans have coverage for non-service-related health issues, preventive care, routine medical care and any additional benefits that may not be available through the VA. It is always important to share your records with your VA provider to ensure they are aware of any new diagnoses or medications.

What are my Medicare options?

Senior man at pharmacy checking out with pharmacist

Medicare: Medicare is the original government-managed fee-for-service program for individuals 65 and older — or those who are eligible because of a qualifying disability. 

It includes Part A (which covers hospital services such as: inpatient care, skilled nursing facilities and hospice) and Part B (which covers doctor visits, outpatient care and preventive services); however, prescription drugs are not covered under Original Medicare, so beneficiaries would need to purchase a separate Part D plan for prescription drug coverage.

With a Medicare plan, beneficiaries can visit any doctor or hospital that accepts Medicare without needing a referral or being restricted to a network. 

Original Medicare typically covers approximately 80% of the cost, and beneficiaries are responsible for the rest. Medicare Supplement insurance, or Medigap, can be purchased from private insurance companies to help pay for the out-of-pocket costs.

Medicare Advantage: Medicare Advantage plans (also known as Part C) cover medical bills and doctors’ visits like Original Medicare, but many also cover prescription drugs and often include extra benefits like routine dental, vision, or hearing coverage. 

“With Medicare Advantage, we ensure your covered medical costs, including doctor visits and necessary emergency care, will never go above a maximum out-of-pocket amount, which you know beforehand,” Mathis said. “They provide access to a network of non-VA doctors, pharmacies and hospitals, allowing veterans to receive care close to home.”

When can I enroll in Medicare?

Senior couple sitting a kitchen table together paying bills and using laptop computer

You are eligible for Medicare when you turn 65. Your initial enrollment period opens three months before the month you turn 65 and closes three months after. Individuals with certain disabilities are eligible before age 65. 

Every year, you will be able to change or select a Medicare Advantage or Prescription Drug Plan during Medicare’s annual enrollment window, which is Oct. 15 through Dec. 7.

“Plan benefits and costs can change annually, so even if you are already on a plan you like, I recommend reviewing the information you receive from your insurance carrier to be sure you get the coverage that meets your needs. At Humana, we make adjustments to our plans every year to ensure we’re delivering affordable care and the benefits our members say matter most to them,” Mathis said.

To learn more about how Medicare Advantage can complement VA healthcare benefits, visit Humana.com/Medicare/Veterans.


Disclaimers: Humana is a Medicare Advantage HMO, PPO, and PFFS organization and a stand-alone PDP prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Y0040_GCHMHBEEN_M

Kait Hanson is a Hawaii-based writer and photographer. Her work has been featured by Military Spouse Magazine, Coastal Living, Frommer’s, Fodor’s Travel, Jetstar Magazine, TODAY.com and more. She is also the creative stylist behind her award-winning lifestyle website, CommuniKait. When she’s not traveling, Kait enjoys spending time with her husband and two chocolate Labs, trying out new recipes or relaxing at the beach with a good book.