Medicare Benefits for Veterans - VA Coverage & Medicare Advantage Guidance

No. You can have both VA coverage and Medicare at the same time without giving up either one. VA coverage usually requires you to receive your care in a VA facility, though the VA Community Care Program lets some veterans get VA-covered care from outside providers when they meet certain wait-time or distance standards. These rules have changed before, from the Veterans Choice Program in 2014 to the current Veterans Community Care Program under the VA MISSION Act in 2019, and there's no way to know whether future rules will be more flexible or more restrictive. Medicare gives you a direct path to civilian providers without needing VA approval for care outside the VA system.

Yes, if you enroll in a Medicare Advantage plan. Medicare Advantage plans include an annual out-of-pocket maximum that caps what you pay for covered care each year, a safety net that VA benefits and Original Medicare don't guarantee on their own.

Original Medicare, Part A and Part B, covers hospital care, medical care, and preventive services. Medicare Part A, hospital insurance, and Medicare Part B, medical insurance, together give you coverage for:

• Inpatient hospital care
• Skilled nursing facility care
• Hospice care
• Home health care
• Medically necessary services
• Preventive and screening services

Learn more about Original Medicare coverage.

Medicare Advantage plans include everything Original Medicare covers, plus optional extra benefits many veterans find useful, such as:

• Dental, vision, and hearing coverage
• Transportation for doctor visits
• Gym memberships
• Wellness programs
• Prescription drug coverage
• Adult day-care services

VA coverage varies by veteran, but it generally includes hospital care, urgent and emergency care, preventive services, mental health care, home health and assisted living support, and prescriptions written by a VA doctor.

Each veteran's benefits package is unique, but services covered include care to help:

• Enhance your quality of life
• Improve your ability to function
• Prevent future health problems
• Treat illnesses and injuries

VA insurance often covers:

• Inpatient hospital services such as surgeries, medical treatments, specialized care, acute care, and kidney dialysis
• Urgent and emergency care such as emergency care in a non-VA facility under certain conditions and urgent care for non-life-threatening conditions that need immediate attention
• Preventative services such as health exams, health education, counseling on genetic diseases, and immunizations
• Mental health services to treat issues like depression or PTSD
• Assisted living and home health care
• Prescriptions written by a VA doctor

Depending on your priority group, the advice of your VA doctor, and medical standards for treating your health conditions, you may also qualify for added benefits such as dental or vision coverage.

No. VA coverage does not count as creditable coverage for Medicare Part B, the way active employer coverage does. If you skip Part B when you first become eligible and rely only on VA benefits, you can face a permanent late enrollment penalty, an extra 10% added to your Part B premium for every 12-month period you went without it. VA prescription drug coverage works differently and is considered creditable for Part D, so that penalty doesn't apply the same way to prescription drugs. Because of this difference, most veterans are better off enrolling in Part B during their Initial Enrollment Period even if they plan to keep using VA care for most of their needs.