How does Medicare work with VA health care?

Who pays, Medicare or the VA?

If you have (or can get) both Medicare and VA benefits, you can get treatment under either program, but generally Medicare and the U.S. Department of Veterans Affairs (VA) can't pay for the same items or services. Each time you get health care, you choose which benefit to use. The VA doesn't bill Medicare for care you get at a VA facility, and depending on your priority group, you may pay a VA copayment for care that isn't for a service-connected disability.

• Medicare pays for Medicare-covered items and services, such as care from a non-VA doctor or hospital that accepts Medicare.
• The VA pays for VA-authorized items or services in a VA or non-VA facility, including care at a non-VA provider when the VA gives you an authorized referral.
• Both, for one stay: if the VA authorizes services in a non-VA hospital but doesn't authorize all of the services you get during the stay, Medicare may pay for the Medicare-covered services the VA didn't authorize.

Why does the VA encourage veterans to sign up for Medicare?

VA.gov encourages veterans with VA health care to sign up for Medicare as soon as they're eligible. Your first chance is the Initial Enrollment Period, which starts 3 months before you turn 65 and ends 3 months after the month you turn 65. The VA gives these reasons:

• Medicare covers you if you need to go to a non-VA hospital or doctor, so you have more options. VA health care doesn't cover care from non-VA providers outside its community care network.
• Your priority group, local wait times and health needs can change over time, and if you're in one of the lower priority groups, you could lose VA health care benefits in the future if funding changes.
• If you delay Part B and sign up later, you'll pay a penalty that gets bigger the longer you wait and lasts for as long as you have Part B.

What happens if I delay Medicare Part B because I have VA coverage?

VA coverage doesn't count as coverage based on current employment, so you generally aren't eligible for a Special Enrollment Period to sign up for Part B because of it. Medicare.gov warns that you can't sign up for Medicare anytime just because you can't get VA services when you need them, and you might have to wait to sign up.

If you miss your Initial Enrollment Period, you can sign up during the General Enrollment Period, January 1 to March 31 each year, and coverage starts the month after you sign up. The Part B late enrollment penalty is an extra 10% for each full 12-month period you could have signed up but didn't, added to the Part B premium ($202.90 a month, standard, in 2026) for as long as you have Part B. See What are the Medicare late enrollment penalties, and how do I avoid them?.

How does VA drug coverage work with Medicare Part D?

You may be able to get drug coverage through the VA, and Medicare lists VA coverage as creditable prescription drug coverage, so you typically don't need to join a Medicare drug plan while you keep it. You may also join a Medicare drug plan, but you can't use both types of coverage for the same drug at the same time.

• With Medicare Part D, VA.gov notes you can fill prescriptions from non-VA doctors at your local pharmacy instead of through the VA mail-order service.
• There's no Part D penalty as long as you join when you're first eligible, or within 63 days of when you no longer have VA health care or other creditable drug coverage.
• If you have VA coverage, a Special Enrollment Period lets you drop a Medicare drug plan or a Medicare Advantage Plan with drug coverage at any time.

Can I have Medicare Advantage or Medigap along with VA health care?

Yes, you can have both Medicare Advantage and VA health care. According to VA.gov, you use the Medicare Advantage Plan when you get care from a non-VA provider in the plan's network, the plan won't pay for care at a VA facility, and to keep the plan you must pay its monthly premium and the Part B premium even if you only get care through the VA. Medicare Advantage Plans must cover what Original Medicare covers, and some offer extra benefits; rules and costs vary by plan.

If you have Original Medicare with a Medigap (Medicare Supplement Insurance) policy, the VA doesn't bill Medicare but may bill the Medicare supplement policy for covered services. See What is the difference between Original Medicare and Medicare Advantage?.