How Do VA Benefits Work With Medicare?

VA Benefits Introduction


VA or Veteran Affairs Benefits are a topic always on the mind of our clients who have served. Many seniors have these benefits and may not understand what they entail. The VA can be a bit bureaucratic, and this often leads to confusion among VA beneficiaries. We salute those who have served our country, and the least we can do is explain VA benefits to you in plain English. This article will go over what VA Benefits are, how to claim VA benefits, and how VA benefits work with Medicare.


What are VA Benefits?


The Department of Veteran's Affairs is a government agency designed to give benefits to our Veterans. These benefits include healthcare, life insurance, education, disability compensation, pensions, and more. It is our country's way of thanking veterans for their service.


As it pertains to healthcare, VA medical benefits include a network of hospitals and doctors that only take care of Veterans. Veterans can get quality inpatient and outpatient care, as well as caregivers, therapy, dental, prescriptions and more at little to no cost. We have seen incredibly expensive procedures and medicines get completely paid for by the VA. (VA Benefits Flyer)


The caveat to VA medical coverage is it only works at VA hospitals and doctors' offices. You typically cannot receive VA benefits in a traditional inpatient or outpatient setting, but this is on the cusp of changing. (VA Benefits Flyer) The main exception to this rule is if you have a life-threatening health issue, and you cannot get to a VA hospital in time. In this case, the VA will step in to cover your out-of-pocket costs anywhere.


Who Qualifies for VA Benefits?


To qualify for VA healthcare, you must be a veteran. We specify this to point out that active-duty personnel are not eligible for VA coverage. But not all veterans are eligible. For instance, if you were dishonorably discharged, you would not qualify for VA healthcare.

If you enlisted after 1980, you must have served 24 months continuously to receive VA benefits. If you were disabled due to your military service, this requirement is often waived. People enlisted prior to 1980 do not have to worry about the continuous service requirement. Members of the national guard who were called to active-duty service (non-training) and complete said service will also most likely qualify for VA benefits. (VA Eligibility)


How Do I Apply for VA Benefits?


You can apply for VA benefits in many ways. You can apply online, by mail, by phone, in person or with a trained professional. For more information, visit the VA website for applications:

https://www.va.gov/health-care/how-to-apply/

Here you will also find the paperwork necessary for your application.


Are There Different Tiers of VA Benefits?


The VA puts their beneficiaries into a system called “Priority Groups.” When you are accepted into the VA healthcare system, they will assign you a Priority Group ranging from 1-8. 1 is the highest and 8 is the lowest. As a rule of thumb, the higher your priority group, the more coverage you will receive. If you have a high priority group, you will also receive your benefits faster. Your priority group is determined by a multitude of factors such as your military service history, your disability rating, your income level, your Medicaid status, and more.

Every priority group will cover any service-related conditions free of charge at VA facilities. Priority Group 1 will also cover all healthcare needs for free at any VA facility. Priority Groups 2-8 will cover non-service healthcare but will require you to pay a copay or some other out-of-pocket expense.

Your priority group can change over time. If your income or disability status changes, you may be assigned a new priority group. This is up to the discretion of the VA. (VA Priority Groups)


Part 2: VA Benefits and Medicare


Now that we have covered VA benefits in detail, we can talk about them as it pertains to Medicare. Many VA members ask us why they need Medicare if the VA is already covering their health needs. Even if you have VA coverage, you will still need to take Medicare when you are deemed Medicare eligible. Let’s look at how these two interact with each other.


How Do the VA and Medicare Interact?


Medicare and the VA are not an either/or scenario, you get to use both simultaneously. Once you are on Medicare you can still use VA doctors. And even if you have VA benefits you can still use the Medicare network whenever you would like. We will specify that the VA does not come in to help you cover Medicare expenses. If you want to see a Medicare doctor, the out-of-pocket costs will be yours to bear.


Do I Need a Medicare Supplement or Advantage Plan If I Have VA Benefits?


We recommend that you do for a few reasons. The first is that the VA limits you to only VA doctors. While the service at the VA can be good, it is limited geographically. In our home state of New Jersey, the VA hospital is about 2 hours away from many of our clients. And the closest VA doctor can be 45 minutes away. Using Medicare allows many of our VA clients to access medicine closer to their homes.


The second reason is having both Medicare and the VA will allow you to have more choices. While the VA is great, having it as your only medical insurance can box you in. If you have a poor experience at the VA, you may be stuck having that same experience in the future. Having a Medicare Supplement will allow you to see the Medicare doctors you want to see at a low cost.


If you want to access the full scope of Medicare, you should get a Medicare Supplement on top of your VA benefits. This will allow you to see any Medicare doctor you would like and as well as access your VA benefits. If you like your VA benefits and believe that it is where you will receive most of your Medical Care, you should get a Medicare Advantage Plan. This will allow you to use your VA benefits while also giving you a local network of medical professionals you can use.


To go over any issues you may find making Medicare and the VA work together, reach out to the trusted brokers at NJ Life & Health. We have helped many veterans make informed decisions about the VA and Medicare and would love to help you as well. Call our office at 848-226-6897 or visit our website at www.njlifeandhealth.com to schedule an appointment.


This article was created using a combination of our own experience with clients who are veterans, literature from the VA, and articles from Military.com.

Works Cited

Absher, Jim. “VA Health Care Eligibility | Military.Com.” Military.Com, https://www.facebook.com/Militarydotcom, 20 Jan. 2022, https://www.military.com/benefits/veterans-health-care/va-health-care-eligibility.html.

Absher, Jim. “VA Medical Services and Medication Copayments | Military.Com.” Military.Com, https://www.facebook.com/Militarydotcom, 23 Aug. 2021, https://www.military.com/benefits/veterans-health-care/va-medical-services-and-medication-copayments.html.

“Eligibility For VA Health Care | Veterans Affairs.” Veterans Affairs, The U.S. Department of Veterans Affairs, 18 Jan. 2022, https://www.va.gov/health-care/eligibility/.

“Summary of VA Benefits.” VA Benefits, The U.S. Department of Veterans Affairs, Sept. 2012, https://benefits.va.gov/BENEFITS/benefits-summary/SummaryofVABenefitsFlyer.pdf.

“VA Priority Groups | Veterans Affairs.” Veterans Affairs, The U.S. Department of Veteran Affairs, 8 Mar. 2022, https://www.va.gov/health-care/eligibility/priority-groups/.

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