How Does Medicare Work for Veterans? 

Original Medicare (Part A and Part B) is available to all U.S. citizens at age 65. Medicare beneficiaries who have the required credits, earned through employment and tax payments, are eligible for premium-free Part A. While you serve in the military, your Social Security (SS) and Medicare taxes are automatic payroll deductions.

Veterans can get both SS and military retirement benefits. If you receive SS benefits when you turn 65, your enrollment in Medicare is automatic. Otherwise, you can enroll in Medicare through the Social Security Administration (SSA).

Medicare drug coverage

Part D is an optional Medicare plan to cover prescription drugs. Generally, Medicare beneficiaries sign up for Part D when they first become eligible to avoid a late enrollment penalty. The penalty applies if there is a lapse of 63 or more consecutive days without creditable prescription drug coverage.

A stand-alone Medicare drug plan requires that you have either Part A (health insurance), Part B (medical insurance) or both. Medicare Advantage, which may include Part D, requires that you have Part A and Part B.

Healthcare coverage through the U.S. Department of Veterans Affairs (VA) is available to people with past military service. If you enroll in a Medicare drug plan while you have VA drug benefits, you cannot collect benefits from both plans for the same prescription. Creditable prescription drug coverage includes VA and TRICARE.

TRICARE

TRICARE is a program covering health and drug benefits for military service members (active and retired) and their families. Usually, to keep your TRICARE healthcare benefits, you must enroll in Parts A and B when eligible. However, enrollment in Part B is not a prerequisite for active-duty members and their families.

If you have both Medicare and TRICARE, Medicare is the primary payer. In this scenario, Medicare pays the claim first, and TRICARE pays the balance of covered expenses according to the plan. An exception applies if you are on active duty or receive medical supplies/services from a military healthcare facility or federal healthcare provider.

If you want to keep your TRICARE drug benefits, you need to have Part A and Part B. Should you choose to join a Medicare drug plan, Medicare Part D pays first. TRICARE pays second. If you sign up for a Medicare Advantage plan with drug benefits (MA-PD), the two plans may coordinate benefits contingent on your pharmacy’s participation in both networks (MA-PD and TRICARE).

CHAMPVA

CHAMPVA, which stands for Civilian Health and Medical Program of the Department of Veterans Affairs, is a healthcare program with cost sharing. The VA and eligible beneficiaries share the cost of medically and psychologically necessary services and supplies. Qualified beneficiaries include the spouse, widow or widower, and children of veterans who became disabled or deceased due to a service-related condition.

To qualify for CHAMPVA, you must enroll in Parts A and B once you become Medicare-eligible. If you have both Medicare and CHAMPVA, Medicare is the primary payer. CHAMPVA offers a Meds by Mail program that provides no-cost maintenance drugs. Although joining a Medicare drug plan is allowed, you will lose the Meds by Mail benefit.

More information

If you served in the United States military, contact the VA for more information about your veteran benefits and CHAMPVA. The main phone number is 1-800-827-1000 or TTY 711, and the website is va.gov. TRICARE falls under the Department of Defense, not the VA. For questions on TRICARE, go to health.mil, an official site managed by the Military Health System and Defense Health Agency.