Key Takeaways
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VA benefits and Medicare serve different roles. Clients with VA coverage may be under the impression that it makes Medicare optional—it doesn’t. You need to step in with facts before inaction leads to costly gaps.
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The risks of skipping Medicare enrollment can include lifetime late penalties, lack of emergency coverage outside VA facilities, and severe restrictions on provider choice. These risks compound over time.
Start Here: The False Sense of Security
You’re likely encountering Medicare clients who tell you, confidently, that they don’t need to enroll because they have VA benefits. This is one of the most common misconceptions veterans carry into retirement—and one of the most damaging if not corrected in time.
As their independent agent, it’s your job to clear up the confusion before it turns into a crisis. The VA and Medicare are entirely separate systems. They don’t replace each other. And depending on one while ignoring the other can cause lifelong financial and health consequences.
Understanding How VA and Medicare Actually Work Together
The Department of Veterans Affairs (VA) offers health coverage to eligible veterans, but it’s not a comprehensive or guaranteed lifetime alternative to Medicare. Medicare, on the other hand, is a federal health insurance program available to individuals age 65 and older or those with qualifying disabilities.
Here’s what your clients need to know:
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VA benefits are tied to the federal budget: Funding levels can fluctuate year to year, potentially limiting access or availability of services.
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VA care is location-restricted: Treatment is usually limited to VA hospitals and affiliated clinics.
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Medicare offers broader access: It allows treatment in a wider range of hospitals, specialists, and providers—nationally.
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Enrollment windows matter: Missing your Medicare Initial Enrollment Period (IEP) results in permanent late penalties.
By enrolling in Medicare while retaining their VA coverage, your clients can open doors to a more complete care network and avoid unnecessary risk.
What Happens If They Skip Medicare? The Real-World Impact
Clients who skip Medicare based on the belief that VA benefits are enough face serious consequences. Here’s what to explain:
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No emergency care outside VA: If a veteran has a medical emergency away from a VA facility, the VA may not cover the cost unless specific eligibility criteria are met. Medicare would.
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Permanent penalties: If your client misses their Initial Enrollment Period and later decides to enroll in Medicare Part B, they will owe a 10% premium penalty for every 12-month period they delayed. In 2025, that adds up fast.
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No coordination between systems: Medicare does not pay second to VA. And VA does not pay second to Medicare. They operate independently. Having both allows clients to use whichever is most appropriate in the moment.
You must make these trade-offs crystal clear—especially to those who only use VA services now but may need wider access later.
Key Medicare Deadlines Veterans Can’t Afford to Miss
Educate your clients on the critical Medicare timelines:
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Initial Enrollment Period (IEP): This is the 7-month window around your client’s 65th birthday—starting 3 months before the birthday month, including the birthday month, and ending 3 months after.
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General Enrollment Period (GEP): Runs from January 1 to March 31 every year. It’s the fallback option if they missed their IEP, but coverage only starts July 1—and late penalties apply.
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Special Enrollment Period (SEP): Not available just for having VA benefits. SEPs apply to those who delay Medicare due to creditable employer coverage—not government benefits like VA.
Explain that VA coverage is not considered creditable for Medicare Part B purposes. So unless your client has other employer-sponsored insurance, they must enroll during IEP to avoid penalties.
Clearing Up Medicare Part B Confusion
The main point of friction is usually Medicare Part B. Veterans with VA coverage often decline Part B because of the monthly premium. They assume they can enroll later if they need it.
Here’s why that’s dangerous:
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Late enrollment penalties apply for life
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Coverage delays—up to 6 months if enrolling after missing the IEP
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Loss of access to non-VA outpatient services such as physical therapy, diagnostic imaging, and specialist visits
Instead of pushing clients toward enrollment with fear alone, help them understand the value proposition. With Part B, they can:
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See non-VA doctors and specialists without waiting for referrals
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Access care when traveling or living far from VA facilities
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Receive covered preventive care and screenings in the private system
How Medicare Part D Fits the Picture
Veterans often assume they don’t need Medicare Part D (prescription drug coverage) because they use the VA pharmacy. While VA drug coverage is considered creditable for Part D purposes, your clients should still evaluate whether dual enrollment makes sense.
Consider these talking points:
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VA prescriptions require using VA providers and mail-order pharmacies
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Medicare Part D offers retail pharmacy access
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Not all drugs are covered under the VA formulary
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Emergency or non-VA hospital stays may require Part D to cover prescriptions afterward
Encourage them to weigh the costs and flexibility. In some cases, enrolling in a standalone Part D plan may provide a worthwhile safety net, even if they don’t use it right away.
Helping Veterans Prepare for Future Healthcare Changes
In 2025, more veterans are retiring earlier, moving across state lines, or living in rural areas where VA access is limited. They may not be thinking about future mobility—but you should be.
Use these prompts:
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“What happens if you move somewhere without a nearby VA hospital?”
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“Would you want the option to see a specialist next week if needed?”
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“How would you handle a medical emergency on vacation or visiting family?”
When you frame Medicare enrollment as a matter of freedom and flexibility, rather than just cost, the message resonates. Veterans have earned choices. Medicare gives them that.
Explaining Why Dual Enrollment = Smarter Coverage
The most effective Medicare strategy for your veteran clients is dual enrollment—using both VA benefits and Medicare together.
This approach:
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Reduces gaps in care
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Expands provider access
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Offers fallback options in case of policy changes or service issues
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Strengthens their health and financial protection in retirement
Make it clear that dual enrollment doesn’t mean abandoning VA care—it means complementing it.
Don’t Wait Until It’s Too Late
If your client is turning 65 this year, the window to act is open now. Waiting leads to avoidable costs and coverage problems.
Action steps you should help them take:
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Enroll in Medicare Part A and B during their IEP
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Consider whether a Medicare drug plan adds value
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Reassess their access to providers and specialists based on their location
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Prepare for emergencies by securing broader coverage
It’s not your job to tell them what to do—it’s your job to make sure they know what could happen if they do nothing.
Supporting Veterans Means Telling the Full Truth
Veterans deserve the full picture—not just what sounds convenient or budget-friendly. When you walk them through the differences between VA and Medicare, and show them how they can work together, you’re giving them the tools to make a truly informed decision.
At BedrockMD, we support independent agents like you by offering the tools, training, and automation you need to focus on what matters most—your clients. When you sign up, you gain access to our CRM, quote engines, lead systems, and compliance-ready enrollment support—all tailored to help you serve your Medicare base confidently.
