In the following video she says Medicare is primary and VA pays secondary. This is not true. Remember that Medicare does not pay for care received at a VA facility. Likewise, VA benefits do not pay secondary to Medicare.
Dual Eligibility: Medicare & VA Benefits
-
Medicare and VA benefits do not coordinate, but you can have both.
-
Veterans are encouraged to enroll in Medicare to ensure broader coverage, especially outside VA facilities.
-
TRICARE users must enroll in Medicare Part A & B to maintain TRICARE benefits.
Enrollment Guidance
-
Initial Enrollment Period: Begins 3 months before turning 65.
-
Late Enrollment Penalties: Apply if you delay Medicare Part B without creditable coverage.
-
VA coverage is not considered creditable for Medicare Part B.
Coverage Differences
| Feature | VA Benefits | Medicare |
|---|---|---|
| Facility Coverage | Only VA-approved facilities | Any Medicare-certified provider |
| Prescription Drugs | Covered by VA | Covered by Medicare Part D (optional) |
| Dental, Vision, Hearing | Limited | Not covered unless medically necessary |
| Emergency Civilian Care | May not be covered | Covered if facility accepts Medicare |
Key Characteristics
| Feature | Medicare | VA Benefits |
|---|---|---|
| Eligibility | Age 65+ or disability | Military service qualification |
| Coverage Scope | Civilian providers nationwide | VA-approved facilities only |
| Coordination | Does not coordinate with VA | Does not act as secondary to Medicare |
| Prescription Drugs | Part D (optional) | Included; creditable for Part D |
| Enrollment Timing | Initial Enrollment Period (IEP) at 65 | Based on VA eligibility |
| Late Penalties | Apply if Part B is delayed without coverage | No penalties, but limited civilian access |
| Supplemental Options | Medigap, Medicare Advantage | Community Care (limited civilian access) |
Supplemental Options
-
Medigap (Medicare Supplement): Covers out-of-pocket costs Medicare doesn’t.
-
Medicare Advantage (Part C): Private plans offering additional benefits.
-
Part D: Optional for drug coverage if VA drug access is limited.
Who Pays First?
-
VA pays at VA facilities.
-
Medicare pays at civilian facilities.
-
In rare cases, Medicare may pay for services not covered by VA if care is authorized outside VA.
Disabled Veterans & Under 65
-
Eligible for Medicare after 24 months of SSDI.
-
May face higher premiums or limited Medigap availability depending on state.
Common Questions Answered
-
You can opt out of Medicare, but risk penalties and limited civilian care.
-
VA does not act as secondary insurance to Medicare.
-
Community Care is separate from Medicare and not a supplement.