Resource Type:

General Info

Provided By:

AMAC Foundation

Phone Number:

State: Florida

Zip: 32159

(The following article was produced by Russell Gloor, a U.S. Army Veteran and an AMAC Foundation Social Security Advisor, as a service to Veterans seeking information about their medical coverage.)

The VA provides healthcare services through a nationwide network of local clinics, each affiliated with a fully equipped and staffed VA Medical Center and hospital. While VA Medical Centers are more widely dispersed, VA clinics provide local direct care to our nation’s veterans and, when necessary, refer patients to the nearest VA Medical Center for more intensive treatment. The system works very well, offering healthcare service to eligible veterans of any age, for as long as the veteran lives. Not all veterans qualify[1] for VA healthcare services but, for those that do, the Veterans Administration offers very a comprehensive service.

The VA also has contractual arrangements with numerous private medical practices (including pharmacies), thus establishing a network of non-VA providers from whom veterans who do not have a VA care center in their local area can get urgent care and specialty healthcare services closer to home. In this way, eligible veterans have an even wider choice of providers but, except for emergency care for service-related conditions, the VA must pre-approve a veteran’s use of a private healthcare provider and the service needed must not be available directly from the VA.

For full disclosure, I am a Vietnam-era U.S. Army veteran who has benefited from healthcare services from the Veterans Administration (VA) for decades. I am fortunate to enjoy good health, have no service-related disability, and use the VA primarily for wellness checkups, immunizations, some prescription drugs, and occasionally for more intensive diagnostic testing. Based upon my years of personal experience, the VA provides excellent service to our country’s military veterans. I know fellow veterans who endorse that opinion, including some with serious health issues requiring much more acute and intensive medical care, including surgery and rehabilitation. I also know others who would not offer such a generous critique.

As a Social Security Advisor for The AMAC Foundation, veterans often tell me “I get all my healthcare services from the VA, so why should I take Medicare?” An excellent question, of course, and one we shall explore.

Let’s start with an overview of Medicare, to complement the VA overview above:

Medicare has several “Parts” – Part A, which covers inpatient hospitalization services; Part B, which is coverage for outpatient services such as doctors and medical tests; and Part D, which is private coverage for prescription drugs. Medicare Part C refers to so-called “Advantage” plans offered by private insurers in lieu of Medicare Part A and B; Medicare Part A is free to anyone who is also eligible for Social Security, but there is a monthly premium ($148.50 for 2021) associated with Part B (you must have Medicare Part A and B to enroll in a private Part C plan). Private insurers also offer premium-based prescription drug plans for those desiring Part D coverage. Medicare beneficiaries enjoy nearly universal coverage for healthcare services provided within the United States, but with some restrictions, service limitations, and with “deductibles” for Parts A & B.

So, why should a senior citizen veteran receiving VA healthcare benefits enroll in Medicare and pay the premiums associated with Part B and Part D? It is, essentially, a matter of convenience and freedom of choice. I’m fortunate to live near a VA clinic so obtaining many of my non-emergency healthcare services directly from the VA is very convenient. But the nearest VA Medical Center is nearly 50 miles away making access to comprehensive and specialized VA healthcare services considerably less convenient for me. Conversely, near where I live, there are a plethora of private healthcare services, including several hospitals, numerous medical specialties, rehab services, medical test laboratories, urgent care and emergency services, and independent physicians, all literally at my fingertips, and all of whom accept Medicare. I also travel frequently, making immediate access to emergency healthcare an important factor for me. Thus, I am enrolled in Medicare, and don’t mind paying the Part B premium in return for the total healthcare freedom of choice and convenience it buys me. At nearly every private healthcare provider in the United States, I can simply show my Medicare card and obtain healthcare services.

The VA’s healthcare services for veterans does include some services which Medicare Part B doesn’t usually cover, such as vision and hearing aid services and, if the veteran qualifies, dental services. Nevertheless, VA healthcare coverage is not considered “creditable” as coverage in lieu of Medicare Part B (VA prescription drug service, however, is considered “creditable”). The importance of having “creditable” healthcare coverage relates to avoiding a Medicare late enrollment penalty. If you do not have “creditable” healthcare coverage after age 65 and decide later to enroll in Medicare Part B or D, you will incur a late enrollment penalty. Depending upon how long you went without ‘creditable” healthcare coverage after you became eligible for Medicare, the late enrollment penalty could be significant, and it will be recurring for as long as you are on Medicare.

So, what’s the bottom line? Again, it’s a matter of freedom of choice and convenience. If you are 100% comfortable with and have convenient and easy access to all[2] of the comprehensive healthcare services you will ever need from the VA, and you wish to avoid the premium associated with Medicare Part B, then choosing not to enroll in Medicare Part B may be a prudent choice for you. But if you like the idea of 100% freedom of choice and easy access to nearly every medical service, wherever you happen to be in the U.S., then you should carefully consider enrolling in Medicare.

[1] VA benefits eligibility is determined by your military service record. The level of VA benefits available to you depends upon which Priority Group (1 – 8) you are assigned. Your Priority Group (and VA services level) will depend upon whether you served during combat periods, have a service-related disability, your financial need, and similar factors.

[2] You should find out which VA Priority Group you belong to and review the VA coverage available to that Priority Group. Not all Priority Groups have access to all VA healthcare services.