Veterans can apply for benefits from different governmental departments, charities, and other organizations, as well as Medicare.
Both the United States Department of Veterans Affairs (VA) and Medicare offer benefits to veterans.
However, if a person is eligible for both types of coverage, it is important that they understand the different options and benefits available. They may also want to determine if a supplementary Medicare plan might offer additional coverage.
This article looks at VA healthcare coverage, the different parts of Medicare coverage for veterans, and costs. It also discusses Medigap and how Medicare coverage could work in a VA facility.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Veterans can receive healthcare through the VA. The Veterans Health Administration is the largest integrated healthcare system in the U.S., with more than 1,255 healthcare facilities.
The VA cover healthcare needs for veterans and, in some cases, their family members. Coverage includes inpatient hospital services, preventive care services, mental health services, and emergency and urgent services.
If a veteran uses a VA hospital or other facility, they get complete coverage. A person can use this tool to find a VA location.
If a person requires specialized care or cannot have a specific healthcare need met in their location, the VA could allow them to seek care in a non-VA facility. However, if they use a non-VA facility, they may need to pay a copayment.
Because the VA and Medicare programs are separate, it is important to understand what each system provides in terms of coverage.
VA coverage relies on funding from Congress. If Congress reduces the funding, this reduces VA healthcare coverage. Also, the government does not guarantee healthcare coverage for all veterans, so they may wish to consider other options for healthcare coverage.
If a veteran uses a non-VA facility and their VA insurance does not provide the coverage they need, Medicare could help.
Medicare provides benefits for people over 65 years and those with other qualifying conditions. Enrolling in Medicare could mean that someone has fewer out-of-pocket expenses.
Different parts of Medicare could help with veterans’ healthcare costs. The sections below will look at each part in more detail.
Medicare Part A
People with Medicare Part A usually do not pay a premium. If someone needs emergency care in a non-VA hospital, or if there is no local VA facility, Medicare Part A could provide coverage.
Medicare Part B
When someone enrolls in Medicare Part B, they will receive coverage for non-VA healthcare providers. Part B may also provide additional coverage that the VA healthcare plan does not cover.
If a person does not sign up for Medicare Part B as soon as they are eligible and they join at a later date, they will have to pay a late enrollment fee.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, is an alternative way to receive Medicare benefits. Private insurance companies offer these plans, and they usually provide coverage above that which the VA and original Medicare offer.
Plans often provide dental, vision, and hearing care, as well as prescription drug coverage and wellness benefits.
Medicare Part D
Medicare Part D offers prescription drug coverage. It is a benefit available to people with original Medicare. Part D may cover medications the VA do not cover, although the cost of the drugs may be higher.
People with Part D plans can also choose a pharmacy and fill prescriptions from non-VA physicians.
As with Medicare Part B, if someone does not immediately join a Part D plan when they are eligible, there is a penalty. The surcharge applies if someone has not had coverage for 63 consecutive days.
People who find it difficult to pay for their medication may receive help from Medicare through the Part D Low-Income Subsidy. The level of assistance depends on an individual’s income and financial situation.
Private insurance companies offer Medigap plans to help people to pay for gaps in Medicare coverage. People with Medicare Advantage plans cannot enroll in Medigap.
Medigap covers copayments, coinsurance, and deductibles.
Veterans who do not live close to a VA medical facility may find a Medigap plan beneficial, depending on their assigned VA priority group.
When a veteran uses a VA health facility, the VA healthcare system provides coverage. The VA pay for physician consultations, prescription drugs, and other care from a VA facility.
Medicare does not need to cover any expenses.
If a person uses a non-VA hospital or facility for services, Medicare provides coverage.
If the VA has authorized a person to receive a VA-approved treatment in a non-VA facility, VA and Medicare could both contribute to the costs.
For example, if the VA authorize treatment for a medical issue at a non-VA facility, they will cover the cost of the treatment. However, if a veteran also receives treatment for a separate issue that the VA do not cover, Medicare may provide coverage for this part of the treatment.
People with Medicare must still pay their Part B premium and the out-of-pocket costs of the treatment, which are a 20% copayment or coinsurance.
The VA provide free healthcare for injuries and illnesses connected to a person’s military service, as well as other services, including mental health services and readjustment counseling.
When a person applies for VA healthcare, they will be assigned to a priority group.
Medicare costs vary significantly depending on the individual, their location, and the plan provider.
A veteran’s disability rating, income level, and military service record will dictate their priority group within the VA healthcare system. There are eight priority groups.
Veterans may need to pay copayments for some medical care services and medications that are not service-related. For example, those assigned to priority group 1 will pay a $0 copayment for the first three urgent care visits per year and $30 for each visit afterward.
Most people do not pay a premium for Medicare Part A. The 2021 deductible is $1,484.
Medicare bases Part B premiums on income. The standard Part B premium that most people pay in 2021 is $148.50, with a deductible of $203. After the person meets the deductible, they will typically pay a 20% copayment.
Medicare Advantage premiums can be $0, but according to the Kaiser Family Foundation, the average 2019 cost was $29.
The VA provide healthcare coverage for veterans of all ages. However, people may find that the VA program does not cover all their healthcare needs.
For this reason, if someone is eligible for Medicare, they may find that enrolling in original Medicare or a Medicare Advantage plan could offer better coverage.
Because the VA and Medicare programs are unconnected, an individual may need to compare the coverage that each offers to determine which options would be most suitable for them.