Medicare for Veterans with VA Benefits
As a veteran, you might have access to free or almost-free health care through the VA – but veterans over the age of 65 can still benefit from enrolling in Medicare. VA care is limited to providers who accept VA treatment, and having Medicare coverage will expand your doctor network as well as provide supplemental coverage opportunities. If you’re nearing Medicare eligibility (turning 65), you should decide whether or not to enroll now (or face penalty fees for waiting).
Who qualifies for VA benefits?
Almost everyone who has served in active military duty is eligible for VA benefits. Since 1980, you must have served for 24 continuous months or for the full time for which you were called to active duty or you must have been honorably discharged to be eligible. The VA encourages all servicemen and women to apply as there are many exceptions that may leave you eligible for benefits you didn’t even know you were eligible for. The VA states that some veterans can receive “enhanced eligibility” if they:
- Are a former POW (prisoner of war)
- Received the Purple Heart Medal or the Medal of Honor
- Have a service-connected disability of 10% or more
- Hold a VA pension
- Were discharged from service for a disability
- Served in a Theater of Operations for 5 years after discharge
- Served in Vietnam (1962-1975)
- Service in the Persian Gulf (1990-1998)
- Were stationed at Camp Lejeune for 30 days or more (1953-1987)
- Are catastrophically disabled
- Have a household income below the VA’s National Income
Do you think you qualify? You can apply for VA coverage by completing this form!
Veterans Health Insurance
Veterans health insurance applies to active service members and their families as well as retired or injured service members and their family members. In many cases, family members of deceased veterans can receive veteran health insurance as well.
Some veterans may have to pay a copay for doctor visits and prescription drugs, but others may receive free appointments. VA care is not limited to service-related illnesses and injuries.
VA Prescription Drug List
Not sure if the VA covers your prescription drugs? You can download this official VA prescription drug list from the VA. The VA prescription drug list can tell you all generic drugs that the VA covers and what dosage form or other restrictions there are. This is is from July 2018, but the list is subject to change.
What are the VA hospitals near me?
There are 1,921 VA facilities across the country. If you’re looking for a VA hospital or VA clinic near you, you can use the VA’s official guide to search by your address or zip code.
What are the VA wait times in my area?
Wait times at VA facilities have been a problem for years. The U.S. Department of Veterans Affairs has conveniently created a tool that allows you to search VA wait times in your area, so you can know before you go. Use the tool to search your address and find VA hospitals or VA clinics near you. Select what type of facility or doctor you are looking for and how far you are willing to travel, and you can find out what your best option is to avoid wait times.
One of the biggest problems with VA facilities, which you will see when you use the search tool, is that you may have to wait a few weeks to get an appointment. That’s fine if all you need is a yearly checkup, but if you have a serious health issue that you’re worried about, you may find yourself needing to visit another facility that is not covered by Veterans Affairs just so that you can get the care you need. That’s where Medicare may be able to help (if you are eligible).
Does VA coverage include VA dental (VADIP)?
VA dental can be purchased through the VADIP (VA Dental Insurance Program). Services include diagnostic and preventative services (like cleanings), oral surgeries, emergency dental treatments, and restorative treatment. Depending on the plan selected, you may be responsible for a monthly premium and copayments for services.
Does VA coverage include VA eye glasses?
VA coverage does include routine eye exams and testing, like for glaucoma. It only covers eye glasses in certain circumstances. To qualify for VA eye glasses, you must:
- Have a service-related disability
- Be a former Prisoner of War
- Have been awarded a Purple Heart
- Receive Title 38 benefits
- Receive increased pension due to being housebound or needing regular aid
If you do not qualify based on the above, you may still qualify if you suffer from stroke, diabetes, multiple sclerosis, vascular disease, or geriatric chronic illness. Additionally, if while receiving VA care for other symptoms you have a negative reaction to a prescription or you require cataract surgery or brain surgery that interferes with your vision, you may qualify for VA eye glasses.
If you’re blind or have low-vision already, you may qualify for extra vision services.
Does VA coverage include VA hearing aids?
Once you have VA coverage, there are a few ways you can get VA hearing aids. You’ll need to start by visiting a VA Audiology and Speech Pathology Clinic for a hearing evaluation. If a doctor recommends hearing aids for you, your VA coverage will cover your hearing aids, any necessary repairs, and batteries.
To order VA hearing aids batteries, use the blue VA Form 2346, “Request for Batteries and Accessories.” You should have received this with your last battery order. You can send it to “VA Denver Acquisition and Logistics Center, P.O. Box 25166, Denver, CO 80225-0166.” If you do not have this form or would prefer to use the phone, you can call the Denver Acquisition & Logistics Center (DALC) at 303-273-6200 and press “one.” You can also press “two” to speak with a customer service agent or “three” for hearing aid repair concerns.
If you have a Premium Account with eBenefits, you can also request hearing aid batteries from ebenefits.va.gov. You’ll need your last name, last four digits of your SSN, and date of birth.
Similar to VA, Tricare is available to retired service members and those who are discharged for disease or disability. Some Veterans are eligible for both VA benefits and Tricare. Generally, the VA provides more coverage but Tricare provides more flexibility. Tricare coverage can include care received in a VA facility. This comparison sheet from Tricare shows the differences. To enroll in Tricare, you must already have Medicare Part A and B.
Since you do not have to go to a VA hospital or VA clinic to receive TriCare covered care, you can use the TriCare website to search for a TriCare provider near you. However, your network can be expanded even further if you add Medicare coverage.
Tricare Dental Program
There are six classifications for TriCare Dental Programs:
- Active Duty Service Members
- Active Duty Family Members
- Guard/Reserve Members
- Guard/Reserve Family Members
- Retired Service Members and Families
Each plan comes at a different cost with a different level of coverage. Generally, TriCare dental plans can cover:
- Preventative care (cleanings, exams, x-rays)
- Root canals
- Gum and oral surgery
- Crowns & dentures
VA Benefits and Medicare Advantage Plans Together
Have you considered placing VA benefits and Medicare Advantage plans together? Once you turn 65, you’ll be eligible for Medicare. Even if you already have VA benefits, Medicare can help you expand your provider network (more doctors and pharmacies, less wait times) and potentially provide more financial coverage.
Medicare Advantage comprises of Medicare Part A (hospital coverage), Medicare Part B (medical coverage – doctor visits), and can include other benefits like dental, vision, hearing, fitness, transportation, etc. If your VA coverage does not include enough prescription drug coverage for you, you can also get a Medicare Advantage plan with prescription drug coverage.
Penalty for not Signing up for Medicare when 65
Don’t forget that even if you have VA benefits, you should still sign up for Medicare as soon as you turn 65. Why? If you miss the deadline, there is a penalty for not signing up for Medicare when 65. You’ll have a penalty fee added to your Medicare premium. The cost will depend on how long you waited to enroll.
To avoid the Medicare late enrollment penalty fee, you’ll want to enroll in Medicare during your initial enrollment period. This begins three months before your 65th birthday and ends three months after.
The good news is that we can help you find a Medicare Advantage plan that will help fill in the gaps in your VA coverage and get you the care and coverage you deserve. Click here to get in touch with a Medicare benefits advisor, or give us a call at 833-438-3676.
This post was originally published on October 5, 2017, and updated on September 26, 2018.