VA Health Care & Medicare
Using the VA does not make Medicare redundant, and enrolling in Medicare does not put your VA care at risk. They are two separate benefits you earned separately, and most of the trouble in this area comes from treating one as a replacement for the other.
No plan described here is a veterans plan, a VA plan, a military plan or a federal employee plan. Medicare Advantage and Part D plans are private insurance. None is issued by, sponsored by, endorsed by or affiliated with the Department of Veterans Affairs, the Department of Defense, any branch of the armed services, or the Office of Personnel Management. Your VA, TRICARE, CHAMPVA, FEHB or PSHB coverage is administered by those agencies and nothing on this page changes it.
VA Health Care & Medicare, step by step
Enrolling in Medicare changes nothing about your VA care
Your VA enrolment, your Priority Group and your disability compensation are not affected by taking Medicare or by joining a Medicare Advantage plan. They are administered by VA under a different body of law, and no private insurance enrolment reaches them. If anyone tells you otherwise, that is the moment to stop and call VA directly.
Confirm with: VA Health Benefits — 1-800-827-1000
Your VA pharmacy already counts as creditable drug coverage
That means it is at least as good as a Medicare Part D plan, so you are not accruing a late-enrolment penalty while you use it, and you generally do not need a separate drug plan. If a Medicare Advantage plan makes sense for you for other reasons, the structure that leaves your VA pharmacy alone is a plan with no Part D coverage in it.
Confirm with: VA Health Benefits — 1-800-827-1000
But VA care is not a substitute for Part B, and this one is expensive
VA health care is not creditable coverage for Part B and it creates no special enrolment period. Somebody who declines Part B because “the VA covers me” can end up with a late-enrolment penalty for life and a wait until the next General Enrollment Period before coverage can start. This is the single most common and most costly misunderstanding in this area.
Confirm with: Medicare — 1-800-MEDICARE, or Medicare.gov
What a Medicare plan actually adds next to VA care
Care outside the VA system: a civilian primary care doctor, a specialist you choose, emergency and urgent care wherever you are. A second opinion from outside. Routine dental, which most veterans have no VA benefit for. Hearing and vision. Some plans include an over-the-counter allowance, and some reduce part of your Part B premium — that feature varies by plan and by county, so it is something to check against the specific plan rather than assume.
Confirm with: Medicare.gov — compare plans in your county
And what it does not do
A Medicare Advantage plan pays nothing toward care you receive at a VA facility, and VA pays nothing toward care you receive outside. There is no coordination between them and no plan ‘covers your VA copays’. They are parallel systems, and the value of holding both is having a door into each one — not having one pay the other's bills.
Confirm with: VA Health Benefits — 1-800-827-1000
Where the drug coverage question lands
Every kind of coverage on this page already includes prescription drug coverage that Medicare counts as creditable — meaning it is at least as good as a Part D plan, so you are not building a late-enrollment penalty while you hold it. That one fact decides the shape of any Medicare Advantage plan that would make sense next to it.
A Medicare Advantage plan that carries no Part D drug coverage is usually written as “MA-Only” or a medical-only plan. It covers what Part A and Part B cover, plus whatever extras the plan includes, and it leaves your existing drug coverage alone. For two of the programmes below, that is not a preference — adding Part D takes a benefit away.
Check this yourself
Nothing here is a decision about your benefit. These are the people who administer it and can tell you how it applies to you.
- VA Health Benefits — 1-800-827-1000 · www.va.gov
- Medicare — 1-800-MEDICARE · www.medicare.gov
Talk it through with somebody who knows how these fit together
No medical questions, no pressure, and no application on the first call. If the honest answer is that your existing coverage already does the job, that is the answer you will get.
The ones that come up every week
Does enrolling in a Medicare Advantage plan affect my VA health care?
No. Your VA enrolment, your Priority Group and your disability compensation are administered by VA and are not changed by a private insurance enrolment. What a Medicare Advantage plan does is give you a way to get care outside the VA system. It pays nothing toward care you receive at a VA facility.
I use the VA for all my prescriptions. Do I need a Medicare drug plan?
Generally no. VA pharmacy benefits are creditable prescription drug coverage, which means you are not building a Part D late-enrolment penalty while you use them. The same is true of TRICARE, CHAMPVA and federal plan drug benefits. Confirm your own situation with the programme that administers your coverage.
Can I keep my FEHB plan and take a Medicare Advantage plan at the same time?
OPM states that an individual may enrol in a Medicare Advantage plan and also remain enrolled in an FEHB plan. If you do, OPM requires you to tell your FEHB plan, because it needs to know whether you have Original Medicare or a Medicare Advantage plan in order to coordinate benefits correctly. Confirm the specifics with your own carrier and with OPM at 1-888-767-6738.
What is the difference between suspending and cancelling FEHB or PSHB?
Suspension is reversible — an annuitant can return during a later Open Season, or immediately if a Medicare Advantage plan is involuntarily lost. Cancellation is generally permanent, and takes the government's share of the premium with it. They are different administrative actions. Before filing either, call OPM Retirement Services at 1-888-767-6738 and get the answer for your own enrolment.
I get my CHAMPVA medications in the mail. Should I take a Medicare drug plan?
VA states that Meds by Mail is available only to CHAMPVA beneficiaries with no other prescription coverage, and that you do not need Part D to get CHAMPVA. A Medicare drug plan would end Meds by Mail rather than add to it. Confirm with CHAMPVA at 1-800-733-8387 before changing anything.
Will a Medicare Advantage plan lower my Part B premium?
Some plans include a Part B premium reduction, often called a giveback. It is a feature of particular plans in particular counties rather than something Medicare Advantage does generally, and the amount varies. It is worth asking about for your own county, and worth checking on Medicare.gov rather than taking anyone's word for it — including ours.
Does TRICARE For Life end if I join a Medicare Advantage plan?
No. You still have Medicare, the Medicare Advantage plan becomes the primary payer, and TRICARE For Life remains the second payer for TRICARE-covered services. Note that TRICARE's guidance says Medicare Advantage claims do not cross over automatically, so a claim may occasionally need following up. Dropping Part B, on the other hand, does end TRICARE For Life.