Is Medicare Required If You Have VA Medical Coverage?

Although veterans age 65 and older do not have to enroll in Medicare, individuals who qualify for Medicare and Veterans' health insurance benefits can receive medical treatment under either program. If you have both types of insurance coverage, you must decide which benefits to use each time you receive a medical service. In most cases, Medicare and VA insurance can't pay toward the same service.

What the VA Pays

• If you want the Department of Veterans Affairs to pay for your medical services, you must go to a VA hospital or see a doctor who works with the VA. The VA will also pay for services it authorizes you to receive at a non-VA facility. In cases where you get services that the VA has authorized in a non-VA hospital, Medicare will pay for any Medicare-eligible services the VA does not cover. In addition, Medicare may cover the VA copayments that some veterans are required to pay when they receive medical care from a doctor or hospital authorized by the VA but not part of the VA health system.

VA Fee Basis ID Card

• Veterans who have a service-connected disability are usually given a VA fee basis ID card. You can also get the card if there are no VA hospitals located in your area. Doctors participating in the plan agree to accept the VA's payment for services as payment in full. The doctor may not bill you or Medicare for the difference even if you are enrolled in a Medicare health plan. If you go to a doctor who does not accept the card, you must file a claim with the VA yourself. The VA will either reimburse you or pay the doctor directly. Payment will be for no more than the VA-approved amount.

Making a Choice

• Veterans who choose to enroll in Medicare can only receive their medical care from providers who accept Medicare. These individuals are not eligible to receive medical services from VA facilities. Veterans who enroll in Medicare are responsible for paying monthly Medicare premiums, annual deductibles and co-insurance. Those veterans who do not enroll in Medicare will not have these costs. However, by enrolling in only the VA Health Benefits Program, veterans limit themselves to using VA facilities for their health-care needs. By enrolling in both Medicare and the VA Health Benefits programs, veterans are eligible to receive services under either program.

Benefits of Additional Insurance Coverage

• The Department of Veterans Affairs does not require veterans to enroll in a health insurance program other than that offered by the VA. However, veterans are encouraged to obtain additional health-care coverage if they can. A veteran can still receive VA benefits even if enrolled in another health plan. Furthermore, because federal law establishes VA benefits and appropriates funding for the VA Health Benefits Program, the health benefits a veteran receives can change each year. The number of medical benefits depends on how much money Congress approves for the program.