Veterans Receiving VA Healthcare Benefits Need to Know This About Medicare

“My husband is a Vietnam Veteran and never enrolled in Medicare Part B because he goes to the VA close to where we live for his medical care. He is having to wait for care from the VA for his heart issues and he wants to go to a local cardiologist. He is 80 years old and retired when he turned 65. Social Security told him that he must pay more to now enroll in Medicare Part B because he never did enroll when he turned 65 in 2009. Is there a way that he can take Part B without having to pay the penalty?  – Carole 

Carole, I really do not have good news for Robert because he did not enroll in Medicare Part B when he first turned 65 and was no longer working with true employer benefits. The key words are, “still working.” If he enrolls during Annual Enrollment this year, he will get the famous Part B penalty.

For 2024, the Medicare Part B premium is $170.10 per month. The penalty for late enrollment is the monthly premium plus 10% of the premium for each 12-month period not enrolled. You said that Robert turned 65 in 2009, which is 15 years. So, here’s how to calculate:

• Base Premium: $170.10 per month
• Penalty Rate: 10% per year of delayed enrollment

To Calculate:

1. Calculate the total number of years of delay:
   • Robert turned 65 in 2009.
   • As of 2024, he has delayed enrollment for 15 years.
2. Calculate the penalty amount per month:
   • For each year of delay, the penalty is 10% of the base premium.
   • So, for 15 years: 15 years * 10% = 1.5 years.
   • Penalty per month: 1.5 years * $170.10/month = $255.15/month.
3. Calculate the total monthly premium:
   • Add the base premium and the penalty: $170.10/month + $255.15/month = $425.25/month.

So, Robert’s total monthly Medicare Part B premium in 2024, including the late enrollment penalty, would be $425.25.

No one can anticipate when they will need to receive healthcare outside of a VA Center. Even if you receive Veteran benefits, you should enroll in Medicare when you turn 65.

Part B covers your outpatient needs, including office visits, surgery, MRIs, chemotherapy, durable medical equipment (like wheelchairs and walkers), and more. Without Part B of Medicare, a person may have to pay 100% out of their pocket for Medicare Part B covered medical care and this care could be in the hundreds of thousands of dollars.

I do have some good news. Not enrolling in a Part D prescription plan is another story. Medicare considers the VA as creditable coverage. When you enroll in Part D after age 65, you do not get the late Medicare Part D enrollment penalty. And, guess what? There is NO Part D donut hole when receiving prescriptions from the VA!

It’s important to note that this information is based on current Medicare regulations. The donut hole in Medicare Part D coverage is gradually closing. This means that the gap in coverage where you pay out-of-pocket for your prescription drugs is becoming smaller each year. As of 2024, the donut hole is significantly smaller than it was in previous years. The goal is to completely eliminate it in the future.

Carole, my advice to Robert is to continue to receive his medical care through the VA, since the penalty may cost him an expensive Medicare Part B premium. Given his heart issues (or if he has other health problems), if Robert ever finds the VA drug formulary does not meet his needs, he can investigate Medicare Part D coverage.

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