I already have drug coverage through the VA. Do I still need to sign up for Part D Medicare?

In most cases, if you have drug coverage through the VA, the benefits are considered creditable by Medicare. This means that as long as you are enrolled in VA drug coverage, you don’t have to enroll in a Part D drug plan to avoid incurring a late enrollment penalty if you ever do need or choose to enroll in a Part D plan. In most cases, if you have VA drug coverage, there are no premiums and no or low copayments for your drugs. You will have to have your prescriptions filled at VA pharmacies or facilities, though. There are some cases in which you may want to also consider enrolling in a Part D plan even if you have VA drug coverage.

  1. If you live a long distance from a VA pharmacy or facility
  2. You live in a non-VA nursing home and want to be able to get your prescriptions filled from the pharmacy that works with your nursing home
  3. You want to be able to have prescriptions filled at retail pharmacies
  4. You do not want to use a VA provider to have prescriptions filled
  5. You want to have access to drugs that are not on the VA formulary but may be covered by a Part D formulary.
  6. If you qualify for full Part D Extra Help, also known as low-income subsidy, which may have lower coinsurance or copays than your VA coverage

If you have VA drug coverage and are thinking of also enrolling in a Part D plan, it is crucial to understand that there is no coordination between the two different plans. Your VA drug will be filled at VA pharmacies and facilities with any VA copays or coinsurance applied, and your Part D prescriptions can only be filled at pharmacies in your plan’s network. Your Part D plans, copays, and coinsurance will apply.

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