Veterans older than 65 years of age may be able to get health benefits from both Medicare and the Veterans’ Administration. In order for that to happen, several things must be in place. A veteran must have applied for and be entitled to Veterans benefits, and the veteran must be enrolled in Medicare Parts A and B.
Medicare, as a federal health insurance provider, pays 80 percent of the cost of covered services, leaving the beneficiary to pay remaining amounts, including deductibles, copayments or coinsurance. Most Medicare beneficiaries enrolled in Parts A and B also purchase a Medicare supplement insurance plan or enroll in a Medicare health plan, both of which are sold by private insurance companies.
Entry into the VA health care system begins by applying for enrollment. Veterans will be assigned to a priority group which determines the level of benefits they can receive. Check with your local Veterans Service officer for assistance in applying for or determining your benefit package.
Some veterans are required to make copays to receive VA health care and/or medications. The copay amounts are determined by the priority level assigned to the veteran. Copays for medications filled at the VA pharmacy will either be $8 or $9 for a 30-day supply, based upon the veteran’s income level. Likewise, when you receive health care services, the copayment is your share of the cost of your treatment and is based on income.
The Veterans Administration and Medicare will not both pay for a procedure. Because they are both federal agencies, they are prohibited from doing so.
When you receive health care services, you must choose which benefits to use each time you see a doctor or are provided a health care service. Choose one agency or the other depending upon which one covers the procedure.
For the U.S. Department of Veterans Affairs to pay for services, you must go to a VA facility, or have the VA authorize services in a non-VA facility. If the VA authorizes services in a non-VA hospital, but doesn’t pay for all of the services you get during the hospital stay, then Medicare may pay for the Medicare-covered part of the services the VA did not allow. Medicare may also be able to pay all or a portion of the copayment if you are billed for VA-authorized care by a doctor or hospital who isn’t part of the VA.
If your VA coverage includes a benefit for prescription drugs, you do not need to enroll in a Medicare Part D prescription drug plan. You will not be subject to a penalty for not signing up for the Part D plan because Medicare considers VA drug benefits to be credible coverage.
Veterans may choose to sign up for a Medicare prescription drug plan even if they have VA drug benefits. The VA does not cover all medications. Neither will the VA pharmacy fill a prescription that is not issued by a VA provider.
A Veteran can enroll in a Part D plan specifically to cover medications prescribed by health care providers outside the VA system, or drugs not paid for by the VA. In 2013, there are several Part D plans with a low- or zero-dollar copay for generic medications. Veterans could save money by enrolling in this type of a Medicare drug plan. For someone taking ten generic maintenance medications each month, the total copays at the VA pharmacy would be in the $80-$90 range. The average Part D drug premium is $37; by using a plan’s preferred network pharmacy, it is possible to obtain those same generic medications at a local pharmacy for $0 co-pay, making the monthly insurance premium your only expense.
VA benefits or Medicare? If you are eligible, consider both.
This article was written by Mary Ann Holland, University of Nebraska-Lincoln Extension Educator and Trained SHIIP Professional located at the Cass County Extension office. She can be reached at 402-267-2205 or by e-mail at: firstname.lastname@example.org.