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Should I Apply for Medicare if I have Veterans Affairs Coverage?

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The Veterans Administration (VA) encourages veterans to enroll in Medicare Parts A and B at age 65, during the initial enrollment period. This gives you more options for the care you may need in the future. VA health care will cover care you receive in VA clinics and hospitals, but it does not generally cover care provided by other doctors and facilities. Even if you are currently satisfied with your VA health care benefits, either your medical needs or the VA health system’s coverage and costs could change in the future.

How Does VA Health Care Coverage Work?

Coverage varies with VA health care. You are assigned to a priority group, ranging from one to eight, and that determines what your coverage and out-of-pocket expenses within the VA system will be.

  • Number one priority is granted to Medal of Honor recipients and veterans with service-connected injuries or illnesses that are at least 50% disabling.
  • The lowest priority, number eight, is given to veterans who do not have a service-connected disability and who earn a higher income.

Priority level can affect eligibility for certain treatments and services, for example, dental care. If you have been assigned a lower priority level, you may be required to pay copayments for doctor visits, diagnostic testing, and hospital stays not related to a disability connected to your military service.

How Do Veterans Health Benefits Work with Medicare?

Medicare and VA health benefits are two separate health care systems. VA health benefits only cover care received at VA hospitals and facilities within the VA system. Generally, they do not cover care provided by doctors, hospitals, and other healthcare providers that participate in Medicare. VA benefits will not cover Medicare copayments, coinsurance, or deductibles.

Why Might I Need Medicare in the Future?

One thing we know about life is that nothing stays the same. Changes could occur in the future that affect your VA health benefits.

  • Government financing could change, particularly for veterans assigned lower priority levels.
  • Your health care needs could change as you grow older, or if health conditions develop.
  • You may relocate to an area far from a VA facility.
  • There is always the possibility that you may choose to see a doctor outside of the VA system.

If you do not enroll in Medicare during your initial enrollment period when you turn 65, you may have to pay a late enrollment penalty if you decide to enroll in the future. Also, VA health care benefits only cover VA providers and pharmacies. In addition to Medicare Parts A and B, some people with VA benefits sign up for Part D, so they can get prescriptions from providers outside of the VA system and fill them more conveniently at nearby pharmacies.

If you are undecided about whether to enroll in Medicare, speak with one of our friendly agents. We can help you determine how to get the best health coverage at the lowest cost.

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