Medigap for Veterans: VA Benefits vs Medicare Supplement Plans in 2026
Medigap for Veterans: VA Benefits vs Medicare Supplement Plans in 2026
If you served in the U.S. military and are approaching age 65, you face a healthcare decision that most civilians never think about: should you rely on VA benefits, enroll in Medicare with a Medigap supplement, or try to combine both? The answer depends on your health status, your VA Priority Group, whether your conditions are service-connected, and how much flexibility you want in choosing doctors and hospitals outside the VA system.
Quick Answer
Most veterans approaching 65 should enroll in Medicare Parts A and B, even if they have VA benefits. VA coverage does not replace Medicare — it complements it. Whether you also need a Medigap policy depends on your VA Priority Group, how often you see non-VA providers, and whether you want coverage for the 20% coinsurance that Medicare does not pay. Veterans in lower Priority Groups (higher copays) and those with non-service-connected conditions benefit most from adding Medigap.
Key Takeaways
- VA benefits and Medicare are separate programs — VA coverage only pays for care at VA facilities (or authorized community care), while Medicare covers any Medicare-participating provider nationwide
- Enroll in Medicare Part B at 65 even with VA benefits — delaying Part B triggers a 10% penalty per year and permanently higher premiums, and VA coverage alone may leave gaps for non-service-connected conditions
- Your VA Priority Group determines whether Medigap is worth it — Priority Groups 1–3 (service-connected disabilities ≥50%) have minimal VA copays and may skip Medigap; Priority Groups 5–8 face higher costs and benefit more from supplemental coverage
- TRICARE For Life acts as a supplement to Medicare for military retirees — if you have TFL, you generally do not need a separate Medigap policy
- Medigap Open Enrollment starts the month you turn 65 AND have Part B — this 6-month window gives you guaranteed issue rights with no medical underwriting, and missing it can make coverage expensive or unavailable
- 2026 VA copays increased 2.4% — making the Medigap-vs-VA-only math shift slightly more in favor of Medicare supplement coverage for veterans in higher Priority Groups
This article is for educational purposes only and does not constitute financial or legal advice. VA benefit rules, Medicare regulations, and Medigap pricing change frequently. Always consult a licensed insurance agent, your VA benefits coordinator, or a Veterans Service Organization (VSO) for personalized guidance specific to your situation.
How VA Health Benefits Work for Veterans 65 and Older
The Veterans Health Administration (VHA) operates the largest integrated healthcare system in the United States, serving over 9 million enrolled veterans at 1,321 healthcare facilities nationwide. But VA coverage works fundamentally differently from private insurance and Medicare.
VA Coverage Basics
VA healthcare is not insurance in the traditional sense. It is a direct healthcare delivery system — the VA employs the doctors, owns the hospitals, and fills the prescriptions. This distinction matters because:
- You can only use VA facilities (with limited exceptions through the Community Care Network)
- Coverage is not portable in the way Medicare is — if you travel or move, your access changes
- The VA does not pay for non-VA emergency room visits in most cases (the VA ER Copayment Waiver only applies in very narrow circumstances)
- Priority of coverage matters — the VA is always the payer of last resort, meaning if you have Medicare, TRICARE, or private insurance, those pay first
Eligibility for VA Healthcare
To receive VA healthcare benefits, you must meet basic eligibility requirements:
- Served on active duty and received an honorable or general discharge
- Completed 24 continuous months of active service (with exceptions for hardship, disability, or early-out programs)
- Enrolled in VA healthcare by submitting VA Form 10-10EZ
Once enrolled, you are assigned a Priority Group (1 through 8) that determines your copay amounts, eligibility for dental care, and access to long-term care services.
What VA Covers for Seniors
For veterans 65 and older, VA healthcare covers:
- Primary care and preventive services
- Specialty care including cardiology, oncology, orthopedics, and neurology
- Mental health services including PTSD treatment
- Inpatient and outpatient surgery
- Prescription medications (copays range from $0 for Priority Group 1 to $15.40 per 30-day supply for Priority Groups 6–8 in 2026)
- Long-term care including nursing home, home-based care, and adult day health care (availability varies by Priority Group)
- Prosthetic and sensory aids including hearing aids and eyeglasses (for service-connected conditions or Priority Groups 1–4)
- Community Care through the VA Community Care Network when the VA cannot provide timely or geographically accessible care
What VA Does NOT Cover
This is where the gap between VA benefits and Medicare becomes critical:
- Non-VA emergency care — The VA may deny payment for emergency treatment at non-VA hospitals unless you meet strict criteria (no VA facility reasonably accessible, VA notified within 72 hours, and treatment for a condition that is not covered by other insurance)
- Care from private doctors of your choice — You cannot see a non-VA specialist without a VA referral through Community Care
- Services outside the VA formulary — If a medication you need is not on the VA National Formulary, you may need to pay out of pocket or use Medicare Part D
- Medical equipment from non-VA suppliers — Durable medical equipment like wheelchairs, oxygen, and hospital beds must come through VA prosthetics
- Routine dental care — Most veterans in Priority Groups 5–8 do not qualify for VA dental coverage
Medicare Enrollment Requirements for Veterans
One of the most common — and costly — mistakes veterans make is assuming their VA benefits mean they don’t need Medicare. This is a dangerous misconception.
Why Veterans Should Enroll in Medicare at 65
Even if you are fully satisfied with your VA healthcare, enrolling in Medicare at 65 is strongly recommended for several reasons:
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Part A is free for anyone who paid Medicare taxes for at least 40 quarters (10 years). Since military service counts toward Medicare eligibility, most veterans qualify for premium-free Part A automatically.
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Part B penalty is permanent and compounding — If you delay Part B enrollment and do not have creditable employer coverage, you pay a 10% penalty for each full 12-month period you were eligible but not enrolled. This penalty lasts for life. For a veteran earning $85,000 in modified adjusted gross income, the 2026 Part B premium is $185.00/month; a 10% late penalty adds $18.50/month forever, increasing with future base premium hikes.
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VA is not considered creditable coverage for Medicare Part B — Unlike employer group health plans, VA benefits do not qualify you for a Special Enrollment Period to delay Part B without penalty.
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Backup coverage for emergencies — If you need emergency care far from a VA facility, Medicare becomes your safety net.
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Choice of providers — Medicare lets you see any doctor or specialist who accepts Medicare nationwide, giving you options beyond the VA system.
When a Veteran CAN Delay Part B Without Penalty
There is exactly one scenario where a veteran can delay Medicare Part B penalty-free: if you have employer-sponsored health insurance through current employment (yours or your spouse’s) at a company with 20+ employees. This is not the same as VA benefits. TRICARE retirees, however, should be aware that TRICARE For Life requires both Part A and Part B.
Do Veterans Need Medigap If They Have VA Benefits?
This is the central question for most veterans reading this guide, and the honest answer is: it depends on your specific situation. Here is a framework for deciding.
Veterans Who Generally Do NOT Need Medigap
| Situation | Why Medigap May Be Unnecessary |
|---|---|
| Priority Group 1 (50%+ service-connected disability) | VA covers nearly all care with $0 copays; your cost exposure is minimal |
| Have TRICARE For Life | TFL acts as a Medicare supplement, covering most of the 20% coinsurance and deductibles that Medicare does not pay |
| Live within 30 minutes of a VA medical center | Easy access to VA facilities means less need for non-VA providers |
| All health conditions are service-connected | VA covers treatment for service-connected conditions with no copays |
| Budget is extremely tight | The $130–$250/month Medigap premium may not justify the benefit if VA covers most of your needs |
Veterans Who Generally DO Need Medigap
| Situation | Why Medigap Adds Significant Value |
|---|---|
| Priority Groups 5–8 (higher VA copays) | You pay VA copays for most services; Medigap covers the Medicare gaps that arise when you use non-VA care |
| Non-service-connected health conditions | VA may deprioritize treatment for conditions unrelated to your service, or charge higher copays |
| Travel frequently or live far from VA facilities | Medicare + Medigap gives you nationwide provider access with predictable costs |
| Want to choose your own specialists | Medigap lets you see any Medicare-participating specialist without referrals |
| Have chronic conditions requiring frequent care | The combination of Medicare’s 20% coinsurance and VA copays can add up quickly without a Medigap cap |
| Are considering leaving VA healthcare entirely | If you transition to Medicare-only, Medigap fills the gaps in Parts A and B |
The Hybrid Approach: VA + Medicare + Medigap
Many veterans find the best strategy is to enroll in Medicare Parts A and B, keep VA enrollment active, and add a Medigap policy during Open Enrollment. This hybrid approach provides:
- VA for service-connected care and prescriptions (often at lower or zero copay)
- Medicare + Medigap for everything else — non-service-connected conditions, emergencies near home or while traveling, and specialist referrals outside the VA system
- Maximum flexibility to choose VA or non-VA providers depending on wait times, convenience, and quality of care
Cost Comparison: VA-Only vs Medicare + Medigap vs Medicare Only
Understanding the total annual cost of each approach requires looking at premiums, copays, deductibles, and out-of-pocket maximums. Here is a side-by-side comparison for a hypothetical 65-year-old veteran in 2026.
Scenario Assumptions
- 65-year-old male veteran, Priority Group 6 (non-service-connected, income above VA thresholds)
- Moderate healthcare usage: 12 primary care visits, 4 specialist visits, 1 outpatient procedure, 2 ER visits, 6 prescriptions per year
- Medigap Plan G (most popular comprehensive plan in 2026)
Annual Cost Comparison Table
| Cost Category | VA-Only | Medicare Only (No Medigap) | Medicare + Medigap Plan G |
|---|---|---|---|
| Monthly Premium | $0 | Part B: $185/mo | Part B: $185/mo + Medigap: ~$160/mo |
| Annual Premiums | $0 | $2,220 | $4,140 |
| Part A Deductible | N/A | $1,676 (per benefit period) | $0 (Medigap pays) |
| Part B Deductible | N/A | $257/year | $0 (Medigap Plan G pays) |
| Primary Care Copays | $15/visit × 12 = $180 | 20% coinsurance ≈ $480 | $0 |
| Specialist Copays | $50/visit × 4 = $200 | 20% coinsurance ≈ $320 | $0 |
| Outpatient Procedure | $300 copay | 20% ≈ $600 | $0 |
| ER Visits (2) | $0 at VA ER; potentially $0–$1,000+ at non-VA ER | 20% ≈ $400–$800 | $0 (excess charges covered) |
| Prescriptions (6/month) | $15.40 × 6 × 12 = $1,108.80 | Varies by Part D plan ≈ $600–$1,200 | Same Part D costs |
| Estimated Annual Total | $1,789–$2,789 | $4,377–$5,397 | $4,740–$5,340 |
Key Takeaways from the Cost Comparison
- VA-only is cheapest — but only if you can access all your care through VA facilities and accept the limitations
- Medicare-only is risky — the 20% coinsurance has no cap; a serious illness like cancer could cost $10,000+ out of pocket
- Medicare + Medigap costs more upfront but provides predictable, capped expenses and complete provider choice
- The hybrid approach (using VA for prescriptions and service-connected care + Medicare/Medigap for everything else) can yield the best value
Use our Medicare Supplement Penalty Calculator to run personalized cost estimates based on your specific situation.
Service-Connected vs Non-Service-Connected Conditions
One of the most important distinctions for veterans navigating healthcare is whether their conditions are service-connected. This directly affects VA copays and, consequently, whether Medigap is necessary.
Service-Connected Conditions
A service-connected condition is one that was caused or aggravated by your military service, as determined by the VA through a disability rating (0% to 100%). Key points:
- VA covers treatment for service-connected conditions with no copays, regardless of Priority Group
- You do not need Medicare or Medigap for service-connected care if you are willing to use VA providers
- Your disability rating percentage affects your Priority Group — a 50%+ rating places you in Priority Group 1 with the most comprehensive benefits
Non-Service-Connected Conditions
These are health issues that developed independently of military service — common examples include type 2 diabetes, heart disease, arthritis, and age-related conditions. For non-service-connected care:
- VA charges copays based on your Priority Group (ranging from $0 for Group 1 to full cost for Group 8)
- Wait times may be longer for non-service-connected appointments, as VA prioritizes service-connected care
- Medicare + Medigap becomes your primary coverage for these conditions if you seek treatment outside the VA
The Presumptive Conditions List
The VA maintains a list of “presumptive conditions” that are automatically assumed to be service-connected for specific groups of veterans. In 2025–2026, the PACT Act significantly expanded this list to include:
- Burn pit exposure — 23 types of cancer, constrictive bronchiolitis, and other respiratory conditions for post-9/11 veterans
- Agent Orange — bladder cancer, monoclonal gammopathy of undetermined significance, Parkinsonism
- Camp Lejeune water contamination — various cancers and chronic conditions for veterans stationed there 1953–1987
If you have any of these conditions and have not filed a VA disability claim, doing so could move you into a higher Priority Group with lower copays — potentially reducing or eliminating your need for Medigap.
VA Priority Groups and How They Affect Coverage Decisions
Your VA Priority Group is perhaps the single most important factor in deciding whether to purchase a Medigap policy. Here is a breakdown of each group and the corresponding Medigap recommendation.
Priority Group 1
Who qualifies: Veterans with 50%+ service-connected disability rating
VA costs: $0 copays for all VA care, $0 prescription copays
Medigap recommendation: Generally not needed unless you want complete freedom to use non-VA providers for convenience. The cost of Medigap premiums ($1,500–$3,000+/year) is unlikely to save you money given your near-zero VA costs.
Priority Group 2
Who qualifies: Veterans with 30%–40% service-connected disability rating
VA costs: $0 copays for service-connected care; small copays for non-service-connected care
Medigap recommendation: Consider Medigap if you have significant non-service-connected health conditions that require frequent non-VA care. The modest VA copays for non-service-connected care can add up over time.
Priority Group 3
Who qualifies: Veterans with 10%–20% service-connected disability, former POWs, Purple Heart recipients, or those with a VA-awarded Medal of Honor
VA costs: $0 copays for service-connected care; moderate copays for non-service-connected care ($15 primary care, $50 specialty care in 2026)
Medigap recommendation: Recommended if you use non-VA providers regularly. The $50 specialist copay and 20% Medicare coinsurance together create meaningful cost exposure.
Priority Groups 4–5
Who qualifies: Veterans receiving VA pension, housebound benefits, or in increased-income Category 1 (Group 4); those with income below VA geographically-adjusted thresholds (Group 5)
VA costs: $0 copays for most care; $15.40 per 30-day prescription in 2026
Medigap recommendation: Case-by-case. If you qualify for Priority Group 5 based on income, the VA covers most care affordably. But if you have non-service-connected conditions needing specialists not available at your VA, Medigap provides important backup coverage.
Priority Groups 6–8
Who qualifies: Veterans with no service-connected disability or low incomes above VA thresholds, including Priority Group 8 (enrolled with copays)
VA costs: Full copays — $15 primary care, $50 specialty care, $1,576 inpatient copay per episode (2026), $15.40 per 30-day prescription
Medigap recommendation: Strongly recommended. Your VA copays mirror commercial insurance levels, and you have no special protections. Adding Medigap ensures predictable costs whether you use VA or Medicare providers.
TRICARE For Life vs Medigap for Military Retirees
Military retirees (those who completed 20+ years of service and retired from active duty or reserves) have an additional option that most veterans do not: TRICARE For Life (TFL). Understanding how TFL compares to Medigap is critical.
What Is TRICARE For Life?
TFL is the Medicare-wraparound coverage available to military retirees and their eligible family members once they turn 65 and enroll in Medicare Parts A and B. There is no additional premium for TFL — it is included as a retirement benefit.
How TFL Works with Medicare
TFL acts as a second payer to Medicare:
- Medicare pays first for all covered services
- TFL pays the remainder — the 20% coinsurance, deductibles, and excess charges that Medicare does not cover
- TFL also covers some services Medicare does not — including overseas care and certain preventive services
TFL vs Medigap: Direct Comparison
| Feature | TRICARE For Life | Medigap (Plan G) |
|---|---|---|
| Monthly Premium | $0 (included with military retirement) | $130–$250/month (varies by state, age, gender) |
| Part B Deductible | TFL pays | Plan G pays |
| Part A Deductible | TFL pays | Plan G pays |
| 20% Coinsurance | TFL pays | Plan G pays |
| Part B Excess Charges | TFL pays | Plan G pays |
| Foreign Travel Emergency | Covered (TFL covers overseas care beyond emergencies) | Plan G covers up to $50,000 lifetime |
| Prescription Drugs | Must use TRICARE Pharmacy or Part D | Must use Part D |
| Provider Network | Any Medicare-participating provider + TRICARE network | Any Medicare-participating provider |
| Skilled Nursing Coinsurance | TFL pays days 1–100 | Plan G pays days 1–20; $209.50/day days 21–100 |
Bottom Line on TFL vs Medigap
If you have TRICARE For Life, you almost certainly do not need a Medigap policy. TFL provides comparable coverage to Medigap Plan G at zero additional cost. The only scenarios where a military retiree with TFL might consider Medigap are:
- You want coverage for the Part B deductible (Plan G does not cover it in 2026, but Plan C and Plan F do for those eligible before 2020)
- You want a second layer of protection in case TRICARE benefits are reduced in future legislation
- You live overseas and want coverage beyond what TFL provides
For more on choosing the right Medigap plan, see our guide to the best time to buy a Medigap policy.
When to Drop or Skip Medigap as a Veteran
Not every veteran needs Medigap. Here are clear scenarios where dropping or skipping a Medigap policy makes financial sense.
You Should Skip or Drop Medigap If:
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You have TRICARE For Life — As explained above, TFL duplicates Medigap coverage at zero cost.
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You are Priority Group 1 with all service-connected conditions — Your VA costs are minimal, and Medigap premiums would be money spent on coverage you don’t use.
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You live within 15 minutes of a major VA medical center and are satisfied with VA care quality — Convenience and zero copays make VA-only a strong option.
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You enrolled in Medicare Advantage instead of Original Medicare — Medigap policies cannot be used with Medicare Advantage plans. If you chose MA, you do not need and cannot buy Medigap.
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You cannot afford the Medigap premium — If choosing between Medigap and prescription drug coverage (Part D), Part D is usually the higher priority for veterans who use VA for most care but need non-formulary medications.
You Should Keep or Add Medigap If:
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You travel frequently — VA coverage does not travel well; Medicare + Medigap gives you nationwide access.
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You have non-service-connected chronic conditions requiring specialist care not available at your VA facility.
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Your VA facility has long wait times — Medigap lets you bypass VA scheduling by seeing private specialists directly.
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You want to keep your non-VA doctors — If you have established relationships with specialists who do not work for the VA, Medigap ensures you can continue seeing them affordably.
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You are approaching your Medigap Open Enrollment window — This is the one-time opportunity to buy any Medigap plan with no medical underwriting. Even if you’re not sure you need it, locking in coverage during Open Enrollment preserves your options.
Important warning: Dropping a Medigap policy after your Open Enrollment Period ends means you may not be able to get it back without medical underwriting. Before dropping coverage, review our Medicare Supplement Enrollment Mistakes to Avoid in 2026 guide.
2026 Policy Changes Affecting Veteran Healthcare
Several regulatory and legislative changes in 2025–2026 affect how veterans should think about VA benefits, Medicare, and Medigap.
PACT Act Full Implementation
The Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act of 2022 reached full implementation in 2025–2026. Key impacts:
- Expanded eligibility — An estimated 3.5 million additional veterans became eligible for VA healthcare due to toxic exposure presumptions
- New Priority Group assignments — Veterans newly recognized with service-connected toxic exposure conditions may move to Priority Groups 1–3, reducing their VA copays and potentially changing their Medigap calculus
- Backlog effects — VA enrollment surged by 30% since 2022, causing longer wait times at some facilities and making backup Medicare/Medigap coverage more valuable
VA Copay Increases for 2026
The VA adjusted copays effective January 1, 2026, reflecting a 2.4% increase tied to the medical care component of the Consumer Price Index:
| VA Service | 2025 Copay | 2026 Copay | Change |
|---|---|---|---|
| Primary care visit (Groups 2–8) | $15.00 | $15.40 | +$0.40 |
| Specialty care visit (Groups 2–8) | $50.00 | $51.30 | +$1.30 |
| Inpatient care per episode (Groups 7–8) | $1,539.12 | $1,576.04 | +$36.92 |
| 30-day prescription (Groups 2–6) | $11.00–$15.00 | $11.20–$15.40 | +$0.20–$0.40 |
| 30-day prescription (Groups 7–8) | $11.00–$15.00 | $11.20–$15.40 | +$0.20–$0.40 |
While modest individually, these increases compound across a year of regular care and make Medigap slightly more attractive for veterans in higher Priority Groups.
Medicare Part B Premium Stabilization
The 2026 Medicare Part B standard premium held at $185.00/month (up from $174.70 in 2025), a more modest increase than many projected. This stability makes the total cost of Medicare + Medigap more predictable for budgeting veterans.
Community Care Access Improvements
The VA expanded Community Care eligibility criteria in early 2026, making it easier for veterans to receive care from non-VA providers when:
- Wait times exceed 20 days for primary care or 28 days for specialty care
- The nearest VA facility is more than 30 minutes’ drive for primary care or 60 minutes for specialty care
- The VA does not offer a needed service
This expansion partially addresses one of the traditional reasons veterans bought Medigap — difficulty accessing VA care — but Community Care still requires VA authorization and does not give veterans the same freedom as Medicare + Medigap.
Choosing the Right Medigap Plan as a Veteran
If you have decided that Medigap makes sense for your situation, choosing the right plan is the next step. For veterans, the most popular plans in 2026 are:
Plan G (Recommended for Most Veterans)
- Covers all Medicare gaps except the Part B deductible ($257 in 2026)
- Average monthly premium: $130–$250 depending on age, gender, state, and tobacco use
- Best for veterans who want comprehensive coverage with a modest annual out-of-pocket exposure
Plan N (Budget-Friendly Alternative)
- Covers most Medicare gaps but requires copays ($20 office visits, $50 ER visits) and does not cover Part B excess charges
- Average monthly premium: $90–$170
- Best for healthy veterans who want backup coverage at lower cost
Plan A (Minimal Coverage)
- Covers only the basics: Part A coinsurance, Part B coinsurance, and the first 3 pints of blood
- Average monthly premium: $70–$140
- Best for veterans who rely primarily on VA but want minimal Medicare gap coverage
For detailed information about medical underwriting requirements when applying for Medigap outside your Open Enrollment Period, see our Medigap Underwriting Questions Guide.
State-Specific Medigap Protections for Veterans
Some states offer Medigap protections that are especially valuable for veterans:
- Connecticut, Maine, Massachusetts, New York, Vermont — Year-round guaranteed issue, allowing you to switch Medigap plans annually without medical underwriting
- California, Oregon, Nevada — Birthday rule allowing plan switches within 30 days of your birthday
- Missouri — Annual enrollment period allowing Medigap switches each year
- Illinois — 45-day birthday rule for plan changes
These state protections are particularly valuable for veterans who initially skip Medigap (relying on VA) but later want to add coverage when health needs change. Learn more in our Medigap Guaranteed Issue Rights by State guide.
Enrollment Strategy: A Step-by-Step Plan for Veterans
Here is a recommended enrollment sequence for veterans approaching 65:
Step 1: Verify VA Enrollment and Priority Group (Age 64)
Contact your VA medical center or check online at VA.gov to confirm your enrollment status and Priority Group. If you have conditions that may be service-connected but haven’t filed a claim, now is the time.
Step 2: Enroll in Medicare Parts A and B (3 Months Before 65)
- Part A is automatic if you receive Social Security benefits
- Part B requires active enrollment — sign up through Social Security
- Even if you plan to use VA for most care, enroll in Part B to avoid the late penalty
Step 3: Assess Your Medigap Need (Month You Turn 65)
Use this guide’s Priority Group framework and cost comparison tables to decide whether Medigap is right for you. If you have TRICARE For Life, you can generally skip Medigap.
Step 4: Apply for Medigap During Open Enrollment (Months 1–6 After Part B Starts)
- Compare Plan G and Plan N quotes from at least 3 insurance companies
- Apply during your 6-month Open Enrollment Period for guaranteed issue
- Do not wait until month 6 — allow processing time
Step 5: Enroll in Part D or Use VA Pharmacy (Before Age 65 or During Initial Enrollment)
- If your medications are on the VA formulary, VA pharmacy may be cheaper
- If you need medications not on the VA formulary, enroll in a Part D plan
- You can use both VA pharmacy AND Part D for different medications
Step 6: Review Annually
Each year during Medicare Open Enrollment (October 15 – December 7), review your coverage to ensure it still meets your needs. Changes in VA Priority Group, health status, or financial situation may warrant adjusting your approach.
If you missed your initial Medigap Open Enrollment and are worried about medical underwriting, review our Medigap vs Medicare Advantage cost comparison to evaluate whether Medicare Advantage might be a better alternative for your situation.
Frequently Asked Questions
Can I use VA benefits and Medicare at the same time?
Yes. VA benefits and Medicare are entirely separate programs. You can use VA facilities for service-connected conditions and VA-covered care, and Medicare for non-VA providers, emergency care near home, and any care outside the VA system. They do not coordinate benefits in the traditional sense — each program pays independently for the care it covers. If you have both, Medicare can serve as your primary coverage for non-VA providers while VA handles care within its system.
Do I need Medigap if I have VA healthcare and am in Priority Group 1?
Generally, no. Veterans in Priority Group 1 (50% or greater service-connected disability rating) pay $0 copays for VA care and $0 for VA prescriptions. The value of adding a $130–$250/month Medigap policy is minimal unless you frequently need non-VA providers or travel often. However, consider buying Medigap during your Open Enrollment Period anyway to preserve the option — you can always drop it later if unused.
How does TRICARE For Life compare to Medigap for military retirees?
TRICARE For Life provides coverage very similar to Medigap Plan G at no additional premium for military retirees with Medicare Parts A and B. TFL pays the Medicare deductibles, 20% coinsurance, and most excess charges. If you have TFL, purchasing a separate Medigap policy is almost always redundant and unnecessary. The rare exceptions involve veterans who want coverage for overseas care beyond TFL’s scope or who want additional protection against potential future TFL benefit reductions.
Will the VA pay my Medicare Part B premiums?
No. The VA does not pay Medicare premiums, deductibles, or coinsurance. These are your responsibility. However, veterans receiving VA pension or Compensation may have those benefits offset by Medicare costs, and some states have programs that help pay Medicare premiums for low-income beneficiaries through Medicare Savings Programs. Contact your state’s Medicaid office or a Veterans Service Organization for details.
Can a veteran with VA benefits get a Medigap policy without medical underwriting?
Yes, during your Medigap Open Enrollment Period — the 6-month window starting the month you are both 65 and enrolled in Medicare Part B. During this period, insurance companies cannot deny you coverage or charge more based on health conditions. After this window closes, you may face medical underwriting unless you qualify for a guaranteed issue right through a qualifying event (like losing employer coverage or your Medicare Advantage plan ending). Veterans in states with year-round guaranteed issue protections (Connecticut, Maine, Massachusetts, New York, Vermont) can also switch plans annually without underwriting.
What happens if I go to a non-VA emergency room with VA benefits but no Medigap?
If you have Medicare without Medigap, Medicare will cover 80% of the emergency room visit costs, and you are responsible for the remaining 20% coinsurance with no annual cap. The VA may cover some or all of the non-VA emergency care costs only if specific conditions are met: you have no other health insurance, the VA was notified within 72 hours, the emergency was for a condition that would normally be covered by VA, and a VA facility was not reasonably available. Without Medigap or VA coverage of the ER visit, a $10,000 emergency could cost you $2,000+ out of pocket.
Should disabled veterans under 65 buy Medigap before turning 65?
It depends on your state. Federal law requires insurance companies to offer at least one Medigap plan to Medicare beneficiaries under 65 with disabilities, but only in certain states and often at significantly higher premiums. Some states (like Connecticut, Maine, and New York) require guaranteed issue for disabled beneficiaries. If you are a disabled veteran under 65, you get a second Medigap Open Enrollment Period when you turn 65, which is typically the better time to buy comprehensive coverage at standard rates. Before 65, evaluate whether VA coverage plus Medicare without Medigap is sufficient.
How do VA prescription benefits compare to Medicare Part D for veterans?
For veterans enrolled in VA healthcare, VA pharmacy benefits are often significantly cheaper than Medicare Part D. VA prescriptions cost $0 (Priority Group 1), $5–$11.20 (Groups 2–6), or $11.20–$15.40 (Groups 7–8) per 30-day supply in 2026. There is no VA deductible and no coverage gap (“donut hole”). By comparison, the standard 2026 Part D deductible is $590 and the coverage gap begins at $5,030 in total drug costs. However, Part D covers medications not on the VA formulary, and many veterans use both: VA for formulary medications and Part D for everything else.
Calculate Your Personalized Costs
Every veteran’s situation is unique. Your Priority Group, service-connected disability rating, health conditions, and location all affect whether Medigap makes financial sense. Use our free tool to compare your options:
→ Medicare Supplement Penalty Calculator
Enter your age, estimated household income, and preferred Medigap plan to see your projected premiums, penalties for late enrollment, and total annual costs side by side.
Related Resources
- Medigap vs Medicare Advantage: Cost Comparison — When Medicare Advantage might be a better fit than Medigap for veterans on a budget
- Best Time to Buy a Medigap Policy — Understanding your 6-month Open Enrollment window and why timing matters
- Medigap Underwriting Questions Guide — What to expect if you apply for Medigap outside your Open Enrollment Period
- Medicare Supplement Enrollment Mistakes to Avoid in 2026 — Common pitfalls for first-time Medicare enrollees, including veterans
- Medigap Guaranteed Issue Rights by State — State-specific protections that may help veterans switch plans without medical underwriting