You choose, visit by visit
Medicare.gov says that if you have both Medicare and VA benefits, you can get treatment under either program, and that Medicare and VA generally can't pay for the same items or services. VA puts it the same way: you need to choose which benefits to use each time you get care.
| Where you get care | Who pays |
|---|---|
| A VA medical center or VA clinic | VA (you may owe a VA copay for non-service-connected care) |
| A non-VA provider that VA authorized in advance | VA |
| A non-VA provider VA didn't authorize | Medicare, under its usual rules |
| A VA-authorized hospital stay where VA didn't authorize every service | VA for what it authorized; Medicare may pay for the other Medicare-covered services |
What VA bills, and what it doesn't
- No Medicare billing. VA says it doesn't bill Medicare or Medicaid. It bills private insurance for non-service-connected care and may bill a Medicare supplement policy.
- Medicare Advantage. VA says Medicare Advantage won't pay for care received at a VA health facility. Outside VA, the plan's network rules apply. Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
- Prescriptions. VA drug coverage is creditable. Medicare.gov says that if you join a Medicare drug plan, you can't use both types of coverage for the same drug at the same time.
- TRICARE too? If you also have TRICARE For Life, TRICARE says it pays only up to 20% of its allowable charge for non-service-connected care at VA, so Medicare providers are usually less expensive for that care.
How it plays out in Florida
Florida's VA medical centers are in Bay Pines, Gainesville, Lake City, Miami, Tampa, West Palm Beach and Orlando, with community clinics across the state; the Panhandle is served by the VA Gulf Coast system, based in Biloxi, Mississippi, with clinics in Pensacola, Panama City Beach and at Eglin AFB. A common pattern: VA for primary care and prescriptions, and Medicare for an emergency room near home, a hospital stay VA didn't authorize, or a specialist closer than the nearest VA center. Medicare also works in every state, which helps if you spend part of the year outside Florida. See snowbirds and Medicare.
Tip: before a non-VA visit, ask whether VA authorized it. If not, show your Medicare card so the provider bills Medicare, not VA.
Original Medicare or Medicare Advantage with VA?
With Original Medicare you can see any provider who accepts Medicare, and a Medigap policy can cover Medicare's deductibles and coinsurance. With Medicare Advantage, outside-VA care follows the plan's network. Which fits depends on how much of your care is at VA. You can request a call from a licensed insurance agent to compare options from the companies they work with.
Related questions
Do I need Part B with VA care?
Why VA encourages it, and the penalty.
Does TRICARE For Life work with Medicare?
Medicare first, TFL second.
Can military retirees use base pharmacies?
Prescriptions on Florida bases.
Sources
- Medicare.gov — Who pays first? (Veterans' benefits)
- U.S. Department of Veterans Affairs — VA health care and other insurance
- U.S. Department of Veterans Affairs — Veterans turning 65: VA health care, Medicare and TRICARE For Life
- TRICARE — Using TRICARE For Life at Veterans Affairs facilities
- U.S. Department of Veterans Affairs — VA Gulf Coast health care locations
More questions in this guide
- Do I need Medicare Part B if I have VA health care in Florida?
- Does TRICARE For Life work with Medicare in Florida?
- Can military retirees on Medicare use base pharmacies at MacDill, Jacksonville or Pensacola?
Part of the guide: Military retirees, veterans and TRICARE in Florida: how Medicare fits · All questions
Frequently asked questions
Will Medicare pay my VA copay?
No. VA doesn't bill Medicare, so Medicare doesn't pick up VA copays. VA says it may bill a Medicare supplement (Medigap) policy for non-service-connected care.
Can I have a Medicare Advantage plan and VA care?
Yes. You can use VA for care at VA and your plan for care in its network. VA says Medicare Advantage won't pay for care received at a VA health facility.
Can I use VA pharmacy and a Part D plan?
You can have both, but Medicare.gov says you can't use both types of coverage for the same drug at the same time.
Medicare in your Florida county
Plans, local agents and help, county by county: Miami-Dade · Broward · Palm Beach · Hillsborough · Orange · Duval · Pinellas · Lee · Polk · Pasco · Brevard · Volusia · Seminole · Sarasota · Osceola · Manatee · Lake · Marion · Collier · St. Lucie · All 67 counties →
