Ask Ms. Medicare: Medicare and VA Health Coverage

Q.  I have good medical coverage from the Veterans Affairs health program. Do I need to enroll in Medicare as well when I turn 65?

A. You don’t have to, but there are good reasons why you should. In fact, the VA strongly recommends that all veterans who have VA health care also enroll in Medicare as soon as they become eligible (unless they have other coverage—for example, from an employer or union). Here’s why:

• VA health coverage isn’t set in stone and isn’t the same for everyone. The VA assigns enrollees to different priority levels according to various factors, such as income and whether they have any medical condition that derives from their military service. If federal funding drops, or doesn’t keep pace with costs, some vets in the lower priority levels could lose VA coverage entirely.

• Having both Medicare and VA benefits widens your coverage. If you need to go to a non-VA hospital or doctor, you’re automatically covered under Medicare Part A (hospitalization) and Part B (doctors and outpatient services)—whereas with VA coverage alone, you may end up having to pay the full cost yourself. The VA has rules about who qualifies for coverage at non-VA facilities, even in emergencies.

• If you happen to lose VA coverage in the future, when you’re well past 65 and not already signed up for Medicare Part B, you’d pay a late penalty to enroll at that time. The Part B penalty adds 10 percent of the premium for each year that you delay. So if you wait five years to sign up for Part B and in that time you have no other health insurance apart from the VA’s, you’d pay an extra 50 percent of the premium for the rest of your life. For example, instead of paying the monthly premium of $96.40 (in 2008 and 2009), you’d pay $144.60—or an additional $578.40 over the year.

• Your prescription drug coverage in the VA is much better than Medicare’s, so you don’t need to join a Part D drug plan, and you wouldn’t incur a Part D late-enrollment penalty if you lose VA coverage in the future. Still, if you do decide to have Part D coverage as well as the VA’s, you’d have the flexibility of being able to use one or the other. You could get prescriptions from non-VA doctors and fill them at local retail pharmacies, and may be able to obtain medications that the VA doesn’t cover.

See information on signing up for Medicare Part A and Part B and information on VA health coverage.

Patricia Barry is a senior editor at the AARP Bulletin.