Jan 10, 2023

6 min read

Key Takeaways

• Do veterans need Medicare? There are many advantages to enrolling in Medicare when you become eligible—even if you have other military health benefits.
• Medicare can add another layer of coverage, cost savings, and convenience if you already have VA benefits or TRICARE for Life.
• This guide will help you understand how Medicare can work with or supplement your existing military health benefits.

Service members who leave active duty may be eligible for health care coverage through either the Department of Veterans Affairs (VA) or TRICARE, depending on how they separated from the military.

But what happens to your VA or TRICARE benefits when you turn 65, which is the age most people become eligible for Medicare? Do veterans and military retirees have to take Medicare, or do the VA and TRICARE provide enough coverage? Find answers in our guide below.

If You Have VA Benefits When You Become Medicare-Eligible

Do I have to enroll in Medicare if I have VA benefits?

It’s not mandatory to enroll in Medicare at age 65 if you’re a veteran with VA benefits. However, if you opt not to sign up for Medicare, you won’t have coverage for services received in facilities outside the VA health system.

Additionally, if you choose not to enroll in Medicare during your Initial Enrollment Period and don’t have employer-sponsored coverage, you may have to wait until the next General Enrollment Period (January 1 to March 31 each year) to enroll. You could also face a financial penalty for late enrollment.

Can a veteran have Medicare and VA benefits?

Yes. If you have VA health benefits and qualify for Medicare at age 65, you can be enrolled in both plans at the same time. In fact, the VA strongly encourages veterans without employer-sponsored insurance to sign up for Medicare Parts A and B as soon as they qualify.

Having VA benefits and Medicare gives you more choices for your care. With Medicare, you’re covered if you ever need to or choose to go to a non-VA hospital or doctor. And keeping your VA benefits means you can get coverage for services and items excluded by Medicare, such as hearing aids and over-the-counter medications. Plus, there’s no guarantee the VA will have the funding to continue to cover all eligible veterans in the future. Medicare can give you peace of mind you’ll be able to get the medical care you need.

How do the VA and Medicare work together?

VA benefits and Medicare are distinct systems and not coordinated in any way. Rather, you decide which benefits you want to use when receiving care:

• To use your VA benefits, you must visit a VA doctor or facility. In some cases, the VA will cover care at a non-VA facility if it’s pre-authorized. Medicare may step in to pay for services the VA has not authorized.
• To use your Medicare benefits, you must receive care at a Medicare-authorized facility. Your VA benefits will not cover your Medicare out-of-pocket (OOP) costs (e.g., copayments).

VA benefits include coverage for prescription drugs. However, if you sign up for Medicare Part D drug coverage, you can use it to get prescriptions from non-VA doctors. Having Part D will also allow you to fill your prescriptions at a local pharmacy instead of through the VA mail-order system.

Some veterans sign up for premium-free Medicare Part A (hospital insurance) but opt out of Part B (doctor visits) since it has an additional monthly premium. If you choose to do this, you should know that delays in signing up for Medicare Part B can incur a penalty. This fee grows each year you delay enrollment, and you’ll be required to pay it annually for the rest of your life. If you’re worried about affording the Part B premium, see if you qualify for programs that can help pay your Medicare OOP costs.

The bottom line: If you have VA benefits and then qualify for Medicare, it’s important to weigh the coverages provided by both plans. Depending on your priority group, you may lack benefits for certain VA health services or have more OOP costs. Also, even if you’re satisfied with your current VA benefits, consider the fact that life changes. You might end up moving somewhere with less access to VA facilities, or decide you want to see a non-VA provider. Having Medicare can give you the added flexibility you need.

If You Have TRICARE When You Become Medicare-Eligible

Do I have to get Medicare at 65 if I have TRICARE?

As a military retiree, your coverage under traditional TRICARE ends once you become eligible for Medicare. If you have no group insurance from a current employer, you’ll want to enroll in Medicare Parts A and B within three months before turning 65 to avoid any lapse in health care coverage.

Enrolling in Medicare does not mean you’ll lose out on TRICARE benefits completely. Instead, you’ll switch to TRICARE for Life. This change is 100% automatic, so there’s no need to fill out any special paperwork. If you are listed as TRICARE-eligible in the Defense Enrollment Eligibility Reporting System (DEERS), your TRICARE for Life coverage should begin on the same day as your Medicare Parts A and B coverage.

Do military retirees have to pay for Medicare?

For most beneficiaries who have worked and paid Social Security taxes for at least 10 years, Medicare Part A costs nothing. However, Part B comes with a standard monthly premium ($164.90 for most people in 2023).

How does TRICARE for Life work?

TRICARE for Life serves as “wrap-around” coverage for your Medicare plan and acts similarly to supplemental plans offered by private insurance carriers. Essentially, it enhances your existing benefits by reducing or eliminating out-of-pocket costs for many treatments, such as deductibles, coinsurance, and copayments. It may also pay for certain services not covered under Medicare, such as health care coverage outside the U.S.

It’s important to note that TRICARE for Life is tied to the individual person; it does not extend to family members. If you have family members not eligible for Medicare, they will still be covered under their regular TRICARE plan.

How does Medicare affect TRICARE for Life?

Unlike Medicare and the VA, Medicare and TRICARE for Life coordinate benefits. With TRICARE for Life, you may see any participating or non-participating Medicare provider. You can get services at military hospitals and clinics if space is available. Medicare pays its obligation first, if any, and then TRICARE pays its share. In general, you’ll pay nothing out of pocket for services covered by both plans. You may, however, have OOP costs for services not covered by TRICARE for Life and/or Medicare.

There’s no special enrollment card for TRICARE for Life. You’ll just need to show your uniformed military ID card and Medicare card as proof of coverage.

Do I need Medicare Part B if I am a veteran who has retired?

You must have Medicare Part B to maintain coverage under TRICARE for Life, even if you’re still actively working. That’s why it’s important to enroll in Part B as soon as you become eligible. If you delay enrollment, you could face late enrollment penalties in addition to coverage gaps.

Newnan Medicare can help lower your Part B premium and provide you with additional benefits to supplement your TRICARE for Life.