How Medicare Works With Veterans Benefits

As of 2018 (the most recent data available), the U.S. Census Bureau reported there were 18 million veterans living in the U.S., and half were over 65. That’s the age when most Americans, including those who have served in the armed forces, become eligible for Medicare. At this point, veterans make crucial decisions that determine whether they will have health insurance that fits their needs and financial situations. 

This article will help you to understand how to make the most of your health coverage by pairing a Medicare plan with the benefits you’re entitled to as a veteran.

Do Veterans Need Medicare?

Though veterans are often eligible for support from other sources, Medicare is a vital part of their health coverage. For both the active-service members of the military who are enrolled in TRICARE for Life after retirement and those who receive benefits from U.S. Department of Veterans Affairs (VA), Medicare has a big role to play. 

TRICARE and Medicare

TRICARE, a healthcare program from the U.S. Department of Defense, is for retired military personnel as well as the families of servicemembers. People who are eligible for TRICARE at the time when they enroll in Medicare automatically receive TRICARE for Life (TFL).  

If you expect to receive TFL, the first step is to enroll in Medicare Parts A, which covers stays at inpatient facilities like hospitals, and B, which covers services like routine doctor’s office visits. Your first chance to sign up is the initial enrollment period, beginning three months before the one when you turn 65. 

TFL is supplemental coverage that’s added onto Medicare. That means Medicare is the primary payer for health services, but TRICARE takes over for out-of-pocket costs like coinsurance and deductibles. Plus, TFL beneficiaries receive coverage for prescription drugs under the TRICARE Pharmacy Program. TFL does not have its own membership card; generally, members just need their Medicare card and military ID. 

Since Original Medicare only provides hospital and medical insurance, you should consider additional coverage. For example, veterans with TFL have the options to enroll in a standalone dental or vision plan, such as the ones offered through the federal government’s Benfeds program, or in the Federal Employees Dental and Vision Insurance Program (FEDVIP). 

TFL beneficiaries can also choose to join Medicare Advantage (MA), often called Medicare Part C. MA plans, offered by private insurers as a substitute for Original Medicare, commonly include additional services or benefits like assistance with dental, vision, and hearing care. While most MA plans come with Medicare Part D, the program that covers prescription drugs, there are some that leave out this coverage for veterans who are already in the TRICARE Pharmacy Program. 

To take advantage of your MA coverage, you will be required to see doctors and other healthcare providers who are included in the plan’s network. You will also have to coordinate with your doctor and other healthcare providers to ensure TRICARE handles the costs that are not included in your Medicare coverage, or you may need to complete forms to have your copays reimbursed. 

VA Benefits and Medicare 

Those who have met the minimum requirements for time spent in active military, naval, or air service can obtain healthcare through the VA. According to the Census Bureau, the VA provides more than a third of veterans with health services like: 

• Routine health exams 
• Surgeries 
• Inpatient acute care for a severe illness 
• Urgent care  

This coverage only can only be used for services that are either administered at a VA facility or at another location specifically authorized by the agency. The VA encourages beneficiaries to sign up for Medicare because: 

• If you need to visit a non-VA facility or receive services beyond what the VA has authorized, Medicare will fill those gaps at Medicare-certified facilities. 
• Funding for the VA depends on authorization from the U.S. Congress and is subject to change every year. 
• If you don’t enroll in Medicare Part B when you become eligible, you risk paying a penalty to sign up after you do decide to enroll. That penalty increases every year until you sign up for Part B coverage. 

Veterans can receive drug coverage through their VA benefits, but they may also decide to switch over to Part D. One excellent reason is the list of prescriptions that are covered by a healthcare plan, called a formulary: The VA formulary doesn’t include some commonly prescribed drugs that are covered by Part D. 

Medicare consumers who don’t have drug coverage through Medicare Part D or another source that’s considered “creditable” under federal law for 63 days in a row are subject to a late enrollment penalty. Since the VA is a creditable source, people who receive drug coverage through veterans benefits don’t have to pay the penalty when they join Part D.  

Why Some Veterans Choose Medicare Advantage Plans

Whether you’re enrolled in TRICARE, receive health benefits from the VA, or neither, you may enroll in Medicare Advantage. MA can give you more flexibility to customize your insurance, and some plans include giveback benefits that pay for some or all of your Medicare Part B monthly premiums. As of 2024, those premiums cost $174.70 per month without assistance. 

If you’re a veteran trying to make the best use of the benefits available to you, start by considering all the options. Tailoring your coverage to fit your personal health and financial situation could make it easier to access the care you need. 

About GoHealth 

GoHealth is a leading health insurance marketplace and Medicare-focused digital health company. Enrolling in a health insurance plan can be confusing for customers, and the seemingly small differences between plans can lead to significant out-of-pocket costs or lack of access to critical medicines and even providers. GoHealth combines cutting-edge technology, data science, and deep industry expertise to build trusted relationships with consumers and match them with the healthcare policy and carrier that is right for them. Since its inception, GoHealth has enrolled millions of people in Medicare plans and individual and family plans. For more information, visit GoHealth.com.