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 in the future, when you're well past 65, you happen to lose VA coverage or otherwise decide that you need Medicare and are not already signed up for Part B, you’d pay a late penalty to enroll at that time. The Part B penalty permanently adds an extra 10 percent to your monthly 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 50 percent more for the same coverage for the rest of your life.
- 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 instead of going to a VA doctor for a prescription and having it filled through the VA mail order service. And may be able to obtain medications that the VA doesn’t cover.
Patricia Barry is a senior editor at the AARP Bulletin.