How VA and a Medicare Advantage plan fit together
Medicare.gov says that if you have Medicare and VA benefits, you can get treatment under either program, but Medicare and VA generally can't pay for the same items or services. A Medicare Advantage plan is a private plan approved by Medicare that covers your Part A and Part B services (and usually Part D). So:
- At a VA medical center or clinic, VA pays under its rules, including any VA copay for your priority group. VA doesn't bill Medicare.
- With the plan's doctors and hospitals, the plan pays under its rules and you pay its copays or coinsurance. VA doesn't pay them.
- Emergencies: Medicare Advantage plans cover emergency and urgently needed care, including outside the plan's network.
Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
Things Ohio veterans should check
- Map your care. List the VA sites you use (Ohio has VA medical centers in Cleveland, Dayton, Chillicothe and Cincinnati and an ambulatory care center in Columbus) and the non-VA doctors and hospitals you'd want.
- Check networks. Make sure the plan's network includes the non-VA providers you'd use. Plans and networks vary by county; see your county page for how many plans are offered.
- Check drug coverage. VA drug coverage is creditable. If you'll keep getting drugs from VA, a plan's Part D coverage may matter less to you.
- If you have TRICARE For Life too, you must keep Part B. TFL can reimburse plan copayments for TRICARE-covered services when you file a paper claim.
Whatever plan you consider, read its Evidence of Coverage: no plan can pay for care at a VA facility. Compare plans in your county at Medicare.gov or see plans for your ZIP code.
You can change plans during Open Enrollment, October 15 to December 7 each year, or switch once from January 1 to March 31 if you're already in a Medicare Advantage plan. More in Medicare Advantage in Ohio and our guide to veterans, TRICARE and Medicare in Ohio. To compare plans from the companies they work with, you can request a call from a licensed insurance agent.
Related questions
Do I need Medicare if I have VA care?
Why VA says to sign up at 65.
Does TRICARE For Life work with Medicare?
For military retirees.
Do I need Part B with TRICARE For Life?
Who must keep it.
Sources
- Medicare.gov — Who pays first? (Veterans' benefits)
- U.S. Department of Veterans Affairs — VA health care and other insurance
- Medicare.gov — Compare Original Medicare and Medicare Advantage
- Medicare.gov — Health Maintenance Organization (HMO) plans
- TRICARE — TRICARE For Life Handbook
More questions in this guide
- Can military retirees on Medicare use the Wright-Patterson pharmacy?
- Do I need Medicare if I have VA health care in Ohio?
- Do I need Medicare Part B to keep TRICARE For Life?
- Does TRICARE For Life work with Medicare in Ohio?
- What happens to TRICARE Prime when I turn 65?
Part of the guide: Veterans, TRICARE and military retirees in Ohio: how Medicare fits · All questions
Frequently asked questions
If I have VA care, should I pick Original Medicare or Medicare Advantage?
It depends on where you get non-VA care. Original Medicare works with any provider in the U.S. who accepts Medicare; Medicare Advantage uses a network and service area and may require prior authorization. Compare both against the doctors and hospitals you'd use outside VA.
Can I use VA drug coverage and a plan's Part D at the same time?
You can have both, but Medicare.gov says you can't use both for the same drug at the same time, and you can't use VA's Meds by Mail program for a drug your Part D plan covers.
Does a Medicare Advantage plan affect my VA eligibility?
No. VA eligibility is based on your VA enrollment and priority group, not on your Medicare choice. Tell VA about your other coverage when you enroll or update your information.
Medicare in your Ohio county
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