Medicare, VA & TRICARE at 65: Healthcare Guide for Veterans

November 13, 2024•5 min read

For military veterans and retirees, understanding healthcare coverage at age 65 can be overwhelming. The combination of VA, TRICARE, and Medicare benefits offers different options, but knowing how they work together is essential. This guide explains your options and helps you make the best choices for comprehensive coverage.

Why Turning 65 Changes Your VA or TRICARE Coverage

When military veterans reach age 65, they’re generally eligible for Medicare, which can complement or replace existing VA or TRICARE coverage. While Medicare enrollment isn’t mandatory, it can offer broader access to healthcare services, including those outside VA facilities or military hospitals. Understanding how Medicare, VA, and TRICARE benefits interact can help you plan for your healthcare needs and avoid costly penalties.

If You Have VA Benefits When You Become Medicare-Eligible

Do Veterans with VA Benefits Need Medicare?

If you’re a veteran with VA benefits, it’s not required to enroll in Medicare at age 65. However, without Medicare, your coverage may be limited to VA-authorized doctors and VA facilities only. This could leave you without coverage if you need care in a non-VA hospital or during an emergency outside VA facilities.

Note: If you decide not to enroll in Medicare when you’re first eligible, you could face penalties and have to wait until the next General Enrollment Period (January 1–March 31) to sign up. These penalties can increase over time and lead to higher healthcare costs.

Can a Veteran Have Both Medicare and VA Benefits?

Yes, veterans can be enrolled in both Medicare and VA benefits. In fact, the Department of Veterans Affairs recommends that veterans without employer-sponsored insurance enroll in Medicare Parts A and B when they turn 65. Here’s why:

Access to More Providers: Medicare allows you to see any provider in the Medicare network, giving you more options if you live far from a VA facility or face a long wait time.
Complementary Coverage: VA benefits cover certain items that Medicare doesn’t, such as hearing aids and some prescriptions. With both coverages, you’ll have a broader range of services.

How Do VA Benefits and Medicare Work Together?

VA and Medicare are separate systems that do not coordinate coverage. Here’s how they work:

To use VA benefits, you must go to a VA-approved facility or doctor. In some cases, the VA may cover care at a non-VA facility if pre-authorized.
To use Medicare benefits, you must go to a Medicare-approved facility. Medicare won’t cover costs at a VA hospital, and VA won’t cover Medicare copayments or out-of-pocket expenses.

If you enroll in Medicare Part D, you’ll have the flexibility to get prescriptions from non-VA doctors and fill them at local pharmacies instead of through the VA’s mail-order system.

If You Have TRICARE When You Become Medicare-Eligible

Do Military Retirees Need Medicare If They Have TRICARE?

For retirees, TRICARE coverage changes when you turn 65. Enrolling in Medicare Parts A and B automatically shifts you to TRICARE for Life (TFL), which acts as secondary coverage to Medicare. TFL covers many out-of-pocket expenses that Medicare does not, so you’ll avoid gaps in healthcare coverage.

This transition is seamless. As long as you’re listed as TRICARE-eligible in the Defense Enrollment Eligibility Reporting System (DEERS), TRICARE for Life begins the same day as your Medicare coverage.

How Does TRICARE for Life Work with Medicare?

TRICARE for Life coordinates directly with Medicare to reduce costs and improve coverage:

Medicare is Primary: Medicare pays its portion of the bill first, and then TRICARE for Life covers most of the remaining balance.
Little to No Out-of-Pocket Costs: For services covered by both plans, you typically pay nothing out of pocket. For services not covered by Medicare, TRICARE for Life may still cover some costs, particularly for care outside the U.S.
Available at Military Facilities: You can still access care at military hospitals and clinics, though space availability may vary.

Is Medicare Part D Necessary for TRICARE for Life Beneficiaries?

If you have TRICARE for Life, there’s no need to enroll in Medicare Part D. TRICARE for Life includes prescription drug coverage under the TRICARE Pharmacy Program, which allows you to fill prescriptions through military pharmacies, retail pharmacies, and TRICARE’s mail-order pharmacy.

Do I Need a Medicare Supplement (Medigap) with TRICARE for Life?

TRICARE for Life acts as a Medigap policy by covering many out-of-pocket costs Medicare doesn’t. If you’re enrolled in TRICARE for Life, there’s no need to purchase an additional Medigap policy, as TFL serves this purpose effectively.

Bottom Line: How to Make the Most of Medicare, VA, and TRICARE Benefits at 65

As a military retiree or veteran, combining VA or TRICARE with Medicare can offer extensive, flexible healthcare coverage. While each option has unique rules, having both Medicare and VA or TRICARE for Life gives you the peace of mind that you’ll have access to care, even outside VA or military facilities.

Consider the potential long-term benefits and costs. For instance, if you only rely on VA benefits, you could face limitations if you’re unable to reach a VA facility. By adding Medicare, you expand your network of providers, gain access to broader services, and reduce the risk of out-of-pocket expenses.

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