How to Choose the Right Medicare Plan When You Have VA Benefits
Navigating how VA benefits work with Medicare coverage can be overwhelming, and you probably have a lot of questions. If you have VA coverage, do you even need a Medicare plan? How does the coverage work together? What type of plan makes the most sense for you?
Deciding what Medicare plans you need when you also have VA benefits takes some planning up front, but getting it right means better coverage and lower costs down the road. You've earned both. So let's look at how you can make the best coverage decisions when it comes to VA benefits and Medicare plans.
Can You Have Medicare and VA Benefits at the Same Time?
Yes, those eligible for VA benefits can also enroll in Medicare coverage, but they don’t work together automatically.
If you are enrolled in both, your VA benefits will cover care received at VA facilities and Medicare coverage applies outside the VA system.
Why Medicare Still Matters If You Have VA Benefits
For those who are eligible for VA benefits and Medicare, you may wonder if having both is necessary. Although it is not a requirement to enroll in Medicare, if you have VA benefits, it can be advantageous. Having additional coverage through either Original Medicare or another Medicare-sponsored plan can give veterans the ability to receive emergency and routine care outside VA facilities and greater access to a broader provider network.
Find out more about: Do Veterans Need Medicare if They Have VA Benefits?
Medicare Parts Explained for Veterans
Medicare Part A (Hospital Insurance)
Medicare Part A is the first part of Original Medicare which covers hospital stays, skilled nursing and hospice. Most veterans do enroll in Medicare Part A, as many individuals are eligible for it, premium-free.
Medicare Part B (Medical Insurance)
Medicare Part B is the second part of Original Medicare, which covers many things, including doctor visits, outpatient care, certain vaccines and more. It's important to be aware that if you do not apply for Medicare Part B when you are first eligible, you will most likely have late enrollment penalties when you do sign up.
Find out more about Original Medicare Parts A & B
Medicare Part C (Medicare Advantage Plan)
Medicare Part C, or Medicare Advantage Plans, are offered by private insurers that combine Part A (hospital) and Part B (medical) coverage, and often provide extra benefits beyond traditional Medicare. There are many different types of Medicare Advantage Plans available, and some are designed specifically with veterans in mind to provide coverage that works to complement their VA benefits.
Find out more about Medicare Part C
Medicare Part D (Prescription Drug Coverage)
Medicare Part D is commonly known as prescription drug coverage. Veterans may choose to obtain their prescriptions from a VA pharmacy. However, some may choose to utilize both a VA pharmacy and non-VA retail pharmacy, especially if they take many medications. Most individuals with VA benefits can avoid late enrollment penalties for Part D, even if they decide to enroll at a later time.
Find out more about Medicare Part D
Medicare Advantage vs. Original Medicare for Veterans
Having both VA benefits and a Medicare Advantage Plan can provide more flexibility and access to care outside the VA system, but it’s important to understand how each type of coverage works independently before enrolling. We break it down for you in the chart below.
VA Benefits Alone vs. VA Benefits & Medicare Advantage (MA)
| VA Benefits Only | VA Benefits & Medicare Advantage | |
| Where You Can Receive Care | VA Medical Facilities | VA Facilities plus Medicare Advantage network providers |
| Non-VA Care | Typically not covered unless pre-authorized by VA | Increased access to non-VA providers |
| Doctors & Specialists | VA doctors and specialists only | You choose between VA providers and MA network providers |
| Emergency Care | Covered by the VA, but there are rules and reporting requirements | Covered by Medicare Advantage Plan for emergency visits outside of the VA |
| Access To Care | More limited choice of providers | Greater access to providers |
| Prescription Drug Coverage | VA pharmacy benefits | VA pharmacy and MAPD drug coverage (if included in plan) |
Top Considerations For Veterans When Choosing a Medicare Plan
As a veteran, choosing the right Medicare plan can greatly affect your access to medical providers and overall healthcare experience. It is essential to thoroughly evaluate your plan options to know that the plan you decide to enroll in meets your specific needs.
Here are some of the most significant considerations to keep in mind:
Provider Network
Medicare Advantage Plans can provide greater access to care; however, they do have provider networks. It's important to choose a plan that aligns with your preferences for where you receive care. Be sure to understand the network so that you can have in-network benefits at your preferred non-VA medical clinics.
Travel and Access Needs
For veterans who travel frequently or live in multiple locations, a Medicare plan with robust travel coverage can be reassuring, knowing you can receive care where you need it, even if there isn't a VA medical facility nearby.
Prescription Coverage
Decide if having prescription drug coverage through your Medicare Advantage Plan is an important factor for you. Many Medicare Advantage Plans do have coverage for medications, but not all, and is an uncommon feature of Advantage Plans designed for veterans. If you do choose a Medicare Plan with drug coverage, make sure that your medications are on the plan's formulary and covered.
Budget and Premiums
Assess your budget and choose a plan that offers the best value for you by taking into account premiums, deductibles, and potential out-of-pocket costs. Fortunately, there is a wide range of Medicare Advantage Plans, and the premiums can be as low as $0/month.
Find Out How Can Medicare Advantage Plans Have No Premium Cost?
Additional Benefits
For most veterans, the ancillary benefits that many Medicare Advantage Plans offer are a key factor in their plan selection. Some of the most common benefits include:
- Dental
- Hearing
- Vision
- Fitness
- Over-the-counter pharmacy allowance
- Part B premium reduction
By focusing on these considerations, you can choose a Medicare plan that fits your personal healthcare and lifestyle needs. Also, remember to review your options each year, as plan benefits and personal circumstances may change.
8 Questions to Ask When Enrolling in a Medicare Advantage Plan
Get Help Navigating Medicare and VA Benefits
At Twin City Underwriters, we take pride in supporting Medicare beneficiaries, veterans, and their families for over 50 years as they explore their Medicare coverage options. As experienced Medicare brokers, we offer free Medicare education, ongoing support, and unbiased recommendations to help you determine the best choices for your lifestyle and healthcare needs.
Schedule a no-cost, no-obligation meeting or give us a call for a no-pressure conversation to have your questions answered and receive personalized guidance.
Choosing a Medicare plan can be difficult. Twin City Underwriters helps Medicare recipients in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa and Florida find the Medicare plan that meets their unique needs. Schedule a one-on-one meeting with one of our Medicare insurance brokers to get your questions answered!
Do you need help with Medicare, insurance and health plans? Explore your options with Allina Health Aetna, BlueCross BlueShield of Minnesota, Medica, HealthPartners, United HealthCare and more. We work with you to find the best plan for your needs and budget. Contact us today to get started.