Information for veterans eligible to enroll in Medicare

The introduction of Medicare’s new prescription drug program (Medicare Part D) has caused confusion among veterans who are faced with choices in their health care. This is true for veterans who are already enrolled in Medicare and those who will become eligible to enroll in the future. Because each veteran’s situation is unique, VA cannot provide a single answer to the question of whether a veteran should enroll in Medicare but offers the following information to assist veterans in weighing their options.

Key points about the two programs:

1. Remember, the VA medical benefits program is separate from Medicare. Veterans may be enrolled in both programs but the enrollment process (and the eligibility criteria) is distinct for each.
2. The Medicare program is divided by types of care or service: inpatient ("Medicare Part A"), outpatient ("Medicare Part B"), and prescription drug ("Medicare Part D"); seniors can decide in which "parts" of Medicare they wish to participate. VA offers a comprehensive medical benefits program that does not distinguish among the types of care or services received; generally veterans who are enrolled in VA health care are eligible for the entire medical benefits package (including prescription drugs), however, some veterans may be subject to a copayment for some care or medications received.
3. VA does not recommend that veterans cancel or decline coverage in Medicare (or other health care or insurance programs) solely because they are enrolled in VA health care. Unlike Medicare, which offers the same benefits for all enrollees, VA assigns enrollees to priority levels based on a variety of eligibility factors, such as service-connection and income. There is no guarantee that in subsequent years Congress will appropriate sufficient medical care funds for VA to provide care for all enrollment priority groups. This could leave veterans, especially those enrolled in one of the lower priority groups, with no access to VA health care coverage. For this reason, having a secondary source of coverage may be in a veteran’s best interest.
4. In addition, a veteran may want to consider the flexibility afforded by enrolling in both VA and Medicare. For example, veterans enrolled in both programs would have access to non-VA physicians (under Medicare Part A or Part B) or may obtain prescription drugs that are not on the VA formulary if prescribed by non-VA physicians and filled at their local retail pharmacies (under Medicare Part D).
5. Veterans could be subject to a penalty for enrolling "late" for Medicare Part B, even if they are enrolled in VA health care. This is different than Medicare Part D (prescription drugs) where veterans can delay enrollment without penalty if they are enrolled in a prescription drug plan that provides a benefit at least as good as that offered by Medicare. The prescription drug benefit in the VA medical benefits program is at least as good as that offered by Medicare. In addition, "late" enrollment in Medicare may only be allowed at certain times (like the beginning or end of the year) and individuals who choose not to enroll when they are first eligible may be left without access to health care until they can enroll in Medicare.
6. Veterans should take time to understand their options under the Medicare program. They should read carefully all information received from Medicare or the Social Security Administration—action may be required. For example, seniors are required to sign and return a card if they choose NOT to enroll in Medicare Part B. Failure to return the card could result in automatic enrollment and deduction of the Medicare Part B premium from the beneficiary’s Social Security check. Conversely, without some action, a senior would not be automatically enrolled in the prescription drug coverage under Medicare Part D.

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For questions about Health Care Eligibility, please visit the VA inquiry website.