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VA Benefits and Medicare
(From Medicare Rights Center, Dear Marci, Volume 5, Issue 5, Week of January 30, 2006)
Dear Marci is a service of the Medicare Rights Center (MRC) (www.medicarerights.org), the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
Topic of the Month: Coordinating My Medicare Benefits
Marci's Mailbox
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Dear Marci,
My uncle receives veterans’ benefits and just became eligible for Medicare. Recently, he was admitted to a VA hospital for a stroke. Will Medicare pick up the costs that the VA doesn’t?
–Tom (Erwin, TN)
Dear Tom,
No, because Medicare and Veterans Affairs (VA) benefits do not work together. To receive VA benefits, you must get care at a VA facility. Medicare never pays for care provided at a VA facility. (Note: Medicare may wrap around VA benefits in limited instances when you have VA permission to get services in a non-VA facility.)
You can, however, use both Medicare and VA benefits separately. This means that if your uncle initially stayed at a VA hospital, his VA benefits will cover a majority, if not all, of the cost, most likely leaving him with only modest copayments. If he is then transferred to a non-VA hospital, Medicare will pay its normal amount under the Medicare hospital benefit. For each benefit period, Medicare Part A covers inpatient hospital stays for up to 90 days. Because the benefits are not overlapping, the time that he had already spent in the VA facility would not shorten the amount of time that Medicare would cover in the new hospital.
Qualified veterans – those that have been honorably discharged or released from the military, naval, or air service – and their families are entitled to benefits through the Department of Veterans Affairs (VA). Benefits include a wide range of free or low-cost medically necessary services, such as hospital inpatient and outpatient care, prescription drugs prescribed by a VA doctor, emergency care at VA facilities, preventive care, rehabilitation, mental health and substance abuse treatment, home health, and hospice care.
To guarantee coverage outside of the VA system, your uncle should be enrolled in Medicare Part A and Part B. If he is not, he will have to get all of his health care at VA facilities. And since the VA does not guarantee benefits to all veterans and he may not always be near a VA facility, he could be left with no coverage at all.
It is different with the new Medicare prescription drug benefit. Your uncle does not need to enroll in the Medicare drug benefit (Part D). He can use his VA drug coverage which has no premiums and no or limited copayments for prescriptions. The VA benefit is more comprehensive than Medicare drug coverage. If your uncle ever wants to enroll in the Medicare drug benefit, VA drug coverage is “creditable coverage,” so he will not have to pay a penalty as long as he enrolls in the Medicare drug benefit within 63 days of losing VA benefits.
Your uncle may want to get Medicare drug coverage if he lives far away from a VA facility, or if he lives in a nursing home that does not accept his VA drug coverage.
Stay tuned next week to learn more about your rights to your Medicare benefits and the ever-changing Medicare appeals process!
–Marci
Due to high email volume, we are not currently able to accept your questions to Marci. Please direct your questions to your local State Health Insurance Assistance Program (SHIP).
Spotlight on Resources
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For more information about VA benefits, visit Medicare Interactive.
To find out if you are eligible for VA benefits and information about how to get them, call the VA Health Administration Center at 800-733-8387 or 877-222-VETS (877-222-8387), or visit the Veterans Benefits Administration online. You will find answers to frequently asked questions, help to determine your eligibility and a search tool to identify where you can go for services.
Your ability to enroll in VA benefits depends on what priority group you are assigned. For more about priority group assignment as well as important information about coverage and copayments, including long-term care, log on to ElderLawAnswers.
Do you need help paying for your health care costs? Do you have Medicare? Visit the Medicare Rights Center for a list of government programs that can help pay your Medicare costs.
Call your State Health Insurance Assistance Program for more information on Medicare benefits, rights and options. Call Social Security (800-772-1213) for questions about enrolling in Medicare.
