How VA Benefits Work with Medicare Advantage
If you’re a veteran approaching Medicare, or already on Medicare, it’s important to know the options and benefits available to you outside of your VA coverage. You’ve earned your VA benefits by protecting our country, and adding Medicare with a Medicare Advantage plan will only strengthen your coverage, not disrupt it. Let’s dive into the details of what benefits and money-back savings you could be entitled to by having Medicare!
What VA Health Benefits Cover
The Veterans Administration is not "insurance." It's designed to provide care through VA facilities, doctors, and credible prescription coverage. When you have Medicare, they are completely separate systems, one is not primary to the other.
IMPORTANT: The VA does not pay for care received at non-VA facilities unless it's pre-authorized. This is the #1 reason to have Medicare as a backup.
The VA encourages you to sign up for Medicare when eligible to act as another form of coverage should the VA health care system change in the future. Medicare also gives you access to non-VA facilities and providers in case you need additional coverage that the VA cannot provide.
How VA Benefits and Medicare Advantage Work Together
You can continue to keep your VA coverage (providers, facilities, and prescriptions) exactly the same while adding an Advantage plan on top, often at a $0 premium. It's important to remember, neither is considered primary coverage, they act separately and give you more freedom to use civilian providers, facilities, and urgent care. These plans may also offer additional benefits the VA may not cover, such as:
Part B Giveback
On select plans, you may get a monthly reimbursement to pay for part (or all) of your Part B medical premium!
You may be eligible for a part B reimbursement of up to $202.90 (2026 Part B Premium).
Benefits vary by state and zip code and are subject to change each year.
Dental
Another popular benefit among veterans is preventative and comprehensive dental coverage.
Since many veterans do not have access to dental coverage through the VA, Medicare Advantage plans often include dental coverage at no additional cost.
Most plans will provide preventative services, comprehensive coverage, and sometimes a yearly allowance to assist with out-of-pocket costs.
Additional Benefits Often Included
Vision and hearing coverage (with allowances or reimbursements)
Over the counter (OTC) allowances, transportation, fitness memberships, and more!
Why Choose an MA-Only Plan (No Drug Coverage)
There are specific plan types known as MA-only plans, designed for consumers and people with credible drug coverage. These plan types may offer higher part B reimbursements among other benefits than plans that include drug coverage (MAPD,) because the insurer doesn’t have to pay for the drug portion.
If you get all your medications through VA pharmacies, these MA only plans are often recommended considering the benefits and cost savings they provide.
Things Veterans Should Watch Out For
Networks and rules: MA plans have networks (HMO/PPO) that may require referrals or prior authorizations.
Emergencies: Advantage plans cover emergencies at any hospital, which is important to consider if you’re far from a VA facility or traveling.
Prescriptions: If you have any prescriptions that the VA will not cover, adding additional drug coverage through a Medicare Advantage plan with prescription drug coverage (MAPD) may be helpful.
How Does CHAMPVA and TRICARE Work With Medicare Advantage?
CHAMPVA + Medicare Advantage:
CHAMPVA can work together with a Medicare Advantage plan, often acting as secondary coverage for certain costs. That means the Medicare plan would pay first (primary,) and CHAMPVA would cover additional costs that Medicare didn’t cover (secondary.)
TRICARE for Life + Medicare Advantage:
When you have TRICARE for Life with a Medicare Advantage plan, it becomes secondary coverage picking up any TRICARE covered services Medicare Advantage didn’t cover. TRICARE provides credible prescription drug coverage, which allows many beneficiaries to select a Medicare Advantage plan without Part D while keeping TRICARE as their drug coverage.
Note: You may have to manually submit claims to TRICARE after Medicare pays to make sure those bills get taken care of through TRICARE, so it can sometimes be a difficult task for some individuals. It’s important to thoroughly understand network restrictions and manual work you must do on your end before adding an Advantage plan with TRICARE.
Key Takeaways
VA and Medicare are separate systems, Medicare adds access to civilian doctors and hospitals without changing your VA benefits.
Medicare Advantage can add extras like dental, vision, hearing, OTC allowance, possible Part B reimbursements, and more!
MA-only plans often work with veterans using credible VA drug coverage.
CHAMPVA and TRICARE for life coordinate differently than VA healthcare, both can work with a Medicare Advantage plan but may require attention to networks and claims.