People With Medicare

I get my health care, including drugs, through the Department of Veteran's Affairs (VA).

In most cases, your drug coverage with the VA will be as good as, if not better than, Medicare drug coverage.

There are a couple of situations where the Medicare Prescription Drug Coverage may work better for you:

If you live in a nursing home:

The Medicare Prescription Drug Coverage may help you if you live in or move into a nursing home that doesn't let you use your VA drug benefits, and you expect to be there for some time.

If the VA facility is far away:

You may benefit from Medicare Prescription Drug Coverage if you live a long way from the nearest VA medical facility. You may want to get your medical care from local doctors and your prescription drugs from local pharmacies. You could use Original Medicare (Part A or B) and join a Medicare Prescription Drug Plan.

With VA drug coverage, you must usually get your drugs at a VA pharmacy. You can either go to a pharmacy or get your drugs by mail—the VA Consolidated Mail Outpatient Pharmacy Program (CMOP) will send them to you. You may want to join a Medicare Prescription Drug Plan if you want to get your prescriptions at other pharmacies.

Comparison of VA and Medicare Prescription Drug Coverage Benefits

VA Co-pay Medicare Co-pay

Some high priority veterans, including those with low incomes (below VA pension thresholds), do not have a co-pay.

Other veterans have a $8 co-pay. This covers 30 days or less of each drug. The co-pay is the same for each drug.

Some veterans do not have to pay more than $960 in co-pays each year.

VA has no deductible.

 

If you have limited income and resources and qualify for extra help with Medicare prescription drug costs, your Medicare co-pay may be as low as $2.40 for generic drugs or $6.00 for brand name drugs covered by your plan. You will pay this co-pay for each prescription, whether it is for a 30, 60 or 90 day supply.

If you do not have limited income and resources, your co-pay will vary by drug.

There may be other plans in your area with different premiums, deductibles and co-pays.
VA Premiums Medicare Premiums

There is no premium for VA drug benefits.

If you have limited income and resources, Medicare will pay all or part of your monthly premium for you. If you do not get extra help from Medicare, you will pay the premium. The average monthly premium is about $28.

If you lose your VA coverage and you join a Medicare plan now, you probably won't have to pay a penalty--if you join within 63 days of losing VA coverage.

For more information about the VA Health Care Benefit:

  • Visit the VA's web site.
  • Call the VA Health Benefits Service Center at 1-877-222-VETS (8387).
  • Visit your local medical facility.

Continue
Preparing

The material on the Medicare.gov site may make more sense if you read this information first:

These sections explain terms such as deductibles, cost-sharing, coverage gap and other information you will find on the Medicare site.

 

When you
are ready

Find and compare specific plans on the Medicare site. Enroll in a plan when you are ready.

Find out if you qualify for Extra Help with Costs

 

Print these instructions for using the Medicare.gov Prescription Drug Plan Finder