VA care and Medicare are separate
VA health care and Medicare are two different federal programs, and they don't work like a primary and a secondary insurance plan. Medicare.gov says that, in general, Medicare and the VA can't pay for the same items or services. Each time you get care, you choose which benefit you're using.
| Where you get care | Who pays |
|---|---|
| A VA medical center or VA clinic | The VA. You may owe a VA copay for care that isn't service-connected. The VA doesn't bill Medicare. |
| A non-VA doctor or hospital the VA authorizes in advance (community care) | The VA |
| A non-VA doctor or hospital you choose without VA authorization | Medicare, if you have it, for covered services |
| A VA-authorized non-VA hospital stay where some services weren't authorized | Medicare may pay for the services the VA didn't authorize |
VA medical centers in Arizona
Three VA health care systems serve Arizona: the Phoenix VA Health Care System (Carl T. Hayden VA Medical Center), the Southern Arizona VA Health Care System (Tucson VA Medical Center) and the Northern Arizona VA Health Care System (Bob Stump VA Medical Center in Prescott), each with community clinics around its region. Care at any of them is VA care, paid by the VA, not Medicare.
Many veterans in Arizona live far from a VA medical center, for example in La Paz, Apache or Greenlee County, or spend part of the year out of state. Medicare lets you see a local doctor or go to the nearest hospital without waiting for VA authorization.
Why many veterans keep Part B
- Care outside the VA. Part B pays for doctor visits, outpatient care and tests at non-VA providers.
- No delay without a penalty. VA health care isn't job-based coverage, so it doesn't give you a Special Enrollment Period for Part B later. If you sign up late, your premium can rise 10% for each full 12 months you went without Part B, for as long as you have it.
- VA funding can change. The VA notes that its funding could change in the future, which is one reason it recommends Medicare enrollment.
If you have a Medicare Advantage plan, the same rule applies: the plan generally doesn't pay for care at the VA. VA drug coverage counts as creditable coverage for Part D. More on Veterans and Medicare.
Get help
For VA eligibility and enrollment, call the VA health benefits line at 877-222-8387 (TTY 711). For Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).
A licensed insurance agent with Benefits Life can explain how Medicare plans from the companies they work with fit alongside your VA care, at no cost to you, at (602) SENIORS (602-736-4677), TTY 711.
Related questions
Do I need Part B if I'm still working?
Which coverage lets you delay Part B.
When does Medicare start?
Coverage start dates for each enrollment period.
Medicare phone numbers in Arizona
Official numbers for Medicare, Social Security, AHCCCS and the VA.
Sources
- Medicare.gov — Who pays first? (Veterans' benefits)
- VA — VA health care and other health insurance
- VA — How to apply for VA health care
- VA — Phoenix VA Health Care System (Carl T. Hayden VA Medical Center)
- VA — Southern Arizona VA Health Care System (Tucson VA Medical Center)
- VA — Northern Arizona VA Health Care System (Bob Stump VA Medical Center, Prescott)
- Medicare.gov — Avoid late enrollment penalties
Frequently asked questions
Can I use both VA health care and Medicare?
Yes. Each time you get care, you choose which benefit to use. Use the VA at VA facilities or for care the VA authorizes; use Medicare at non-VA doctors and hospitals. The two programs generally can't pay for the same service.
If I'm taken to a non-VA hospital in an emergency, who pays?
It depends. The VA may pay for emergency care at a community hospital if you meet its rules, including notifying the VA promptly. If the VA doesn't pay, Medicare pays for covered care if you have it. Ask the hospital to contact the VA as soon as possible.
Do I need Medicare Part B if I have VA health care?
You don't have to take it, but the VA encourages veterans to sign up for Medicare. VA health care doesn't let you delay Part B without a late penalty, and Part B covers you outside the VA.
Will a Medigap policy pay my VA copays?
The VA says it may bill a Medicare supplement policy for covered services. A Medigap policy pays only for Medicare-covered services under Original Medicare, so check with your policy before you rely on it for VA care.
Medicare in your Arizona county
Plans, local agents and help, county by county: Apache · Cochise · Coconino · Gila · Graham · Greenlee · La Paz · Maricopa · Mohave · Navajo · Pima · Pinal · Santa Cruz · Yavapai · Yuma
