The relationship between Medicare and VA benefits for disability is a common concern for recipients of VA disability benefits. It’s important first to understand that once something has been covered by Medicare, the VA (Veteran’s Affairs) cannot pay for the same service and vice versa.
Determining Who Pays Medical Expenses: Medicare or VA Benefits
Treatment generally can be received under any type of government benefit program the recipient receives. But it’s up to the beneficiary to decide which benefits will be used whenever taking a trip to the doctor or receiving other health services.
However, VA generally doesn’t pay for expenses incurred in a non-VA facility unless it’s been preauthorized. Yet it doesn’t mean that going to a VA facility prevents Medicare from covering the expenses, either.
Sometimes VA will authorize care in a non-VA facility, but not all costs will be covered. If any remaining expenses are covered under Medicare, it can pay for the rest.
Medicare Part A covers hospital expenses, while Part B covers medical expenses. Because the VA pays for a majority of medical costs, Part B isn’t always necessary, but it is still recommended when there is a chance that services could be provided in a non-VA facility.
Advantages of Enrolling in Medicare While Receiving VA Benefits
The following are some of the advantages of enrolling in Medicare, even when a disabled person is covered under VA:
- federal funding is not guaranteed to last forever;
- enrollment in Medicare after age 65 incurs a penalty; and
- coverage expands when covered under both programs, which could eliminate out-of-pocket costs; and
Enrollment in VA healthcare coverage is prioritized according to income and medical conditions (which means possibly not qualifying). If a veteran is enrolled in a lower-priority group, Medicare may be a helpful supplement. These groups range from Priority Group 1 to Priority Group 8, with those in the first group receiving priority care over those in the eighth.
Limited VA government benefits may require special criteria when it comes to eligibility. This includes (but is not limited to) hearing aids, dental care, ambulance services and home healthcare. Medicare, on the other hand, generally covers home health services and ambulance services. It’s important to know ahead of time what types of services and medical care are covered by either Medicare or VA benefits.
Comparing Advantages of Using Medicare or VA Benefits
One advantage of using VA disability benefits is that mileage reimbursement may be available when traveling for treatment of a service-connected condition. Medicare doesn’t reimburse for travel costs.
Another advantage is that veterans may be entitled to receive special modes of transportation, such as ambulances or wheelchair vans. This is based on the vet’s medical needs.
Raleigh Veterans’ Disability Attorney Help
When there are questions or concerns regarding coverage or eligibility for government benefits through the VA, it may be necessary to seek legal advice. If benefits have been denied, Raleigh veterans’ disability attorney at Brent Adams & Associates can help. A lawyer can answer questions regarding your rights to Medicare when receiving VA benefits.