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GUIDE TO MEDICARE: Veterans’ health care and Medicare can be confusing


Even if military veterans receive health care through the VA, they may be eligible for further coverage under Medicare

If you’re a veteran who uses VA health care benefits and also become eligible for Medicare, you can run into a confusing array of options.

When does this happen? Veterans receiving health care benefits through the U.S. Department of Veterans Affairs may enroll in Medicare either by reaching age 65 or due to disability through the Social Security Disability Insurance program.

Each health care program offers different advantages, so it’s important to understand your options when using VA health care vs. Medicare. Let’s begin with the basics: VA health care.

VA Health Care Coverage

The VA provides health care coverage for those who served on active duty in the armed forces and who meet certain eligibility criteria. These eligibility criteria include length of service, service-connected disabilities, income level, and available VA resources.

One important part of VA health care coverage is known as “priority group.” If the VA determines that you qualify for health care coverage, you will be assigned a priority group based on a scale of 1 to 8. One (1) is the highest priority and eight (8) is the lowest. Your priority level determines what type of health benefits you receive. It may also determine when you will be scheduled for medical care or, if necessary, your placement in a VA long-term care facility.

For example, if you’re considered a priority level 8, you will get far less coverage and slower access to care than if you were a priority level 1 or 2. In general, the more you need health care coverage due to a combination of service-related disability and low income, the more coverage you receive from the VA.

Regardless of what priority group you are, you get access to the VA benefits package, which includes: preventive care and services, inpatient hospital care, emergency care, dental coverage, mental health care, assisted living and home health care, substance abuse treatment services, diagnostic services, rehabilitation services, prescription drug coverage, and other forms of care.

Medicare: Another Option for Veterans

The VA encourages individuals using VA health care to sign up for Medicare benefits for several reasons. These include the ability to receive health care insurance coverage through this government provided plan if the VA health care program experiences funding restrictions.

Medicare gives veterans more options, including the ability to see non-VA approved providers, such as non-VA hospitals and non-VA doctors, which also can mean speedier access to health care, if they otherwise face delays in getting appointments and care.

Medicare Part B

One reason to enroll is that you can avoid a Medicare Part B penalty, which comes into the picture if someone delays Medicare and then signs up later (after their original eligibility period).

The penalty can be substantial as it adds an extra 10% to your monthly Part B premium for each full 12-month period that you could have had Part B but didn’t sign up for it. Plus, you’ll have to wait until the general enrollment period to sign up. This period lasts from Jan. 1 to March 31 each year, and coverage does not begin until July 1.

Note: There are exceptions to the Part B enrollment penalty. The most common exception is having comparable coverage through a spouse’s employer, which can allow you to delay your enrollment in Part B until after you lose that coverage.

Medicare Part D (Prescription Drug)

You may wish to purchase Medicare Part D coverage for your prescription drugs if you’d like to go to a non-VA-approved provider. There is no penalty for delaying enrollment in Medicare Part D because the drug coverage you receive through the VA is considered as good as or better than that offered under a Part D plan and is premium-free, so you may not need both.

Using Medicare or VA Health Care Benefits

Following are some things to keep in mind for veterans who choose to use Medicare, in addition to their VA health care benefits:

  • VA health care benefits and Medicare benefits are two different programs. They do not work together.
  • If you use VA health care, you will need to see VA-approved providers and visit VA-approved facilities, unless you receive prior authorization (contact the VA for questions).
  • There are exceptions. For example, an emergency may require you to go to the nearest medical provider, which is a non-VA facility. In this case, the VA may pick up some of the cost until you can be moved to a VA facility for further care.
  • Having Medicare in addition to VA health care gives you a secondary option to pursue care from non-VA approved medical providers. This means that if you want medical care now, but there’s a waiting period at the VA, you may be able to find a Medicare provider to see you sooner.
  • You may have additional costs. This includes the Medicare Part B premium and cost-sharing that is required by Medicare, plus an extra Part D prescription drug premium, if you choose this added coverage.
  • You may face Medicare Part B late-enrollment penalties if you improperly handle your Medicare enrollment and deferral choices.

Decisions for Veterans

Since your VA coverage may be free or have very low costs, it could be wise to use your VA coverage instead of Medicare. This is especially true if you’re higher on the priority list and face little to no wait time for benefits. However, every VA office operates differently, and one facility may provide a different quality of care than another. Also, some facilities may have shorter wait times than others for access to specialists, certain medical procedures or treatment.

If you face a long wait time for medical care (for example, you need to see a physical therapist or have an operation, but the VA waiting list is several months long), you might want to consider using your Medicare coverage outside the VA health care system. The same applies if you want to undergo a medical procedure or take a prescription drug that’s not approved by the VA.

Because your health care situation is unique, you should carefully consider both your financial and health care needs when choosing what health care coverage will work best for you.

Visit for more information about VA health care. The Allsup Medicare Advisor provides more information on choosing your Medicare plan at

Tricia Blazier is health care and financial planning director for Allsup and oversees the Allsup Medicare Advisor, a Medicare plan selection service that provides Medicare plan assistance to seniors and people with disabilities nationwide. Find more at