If you have health care through the Department of Veterans Affairs, it’s easy to look at a Medicare Part B premium of $202.90 a month and think, “Why would I pay for that? The VA’s got me.”
Here’s the thing: The VA disagrees. Its website urges veterans to get Medicare the moment they’re eligible.
And if you skip Part B and change your mind later, Medicare doesn’t just let you in. It charges you a penalty that grows the longer you wait — and in most cases, you keep paying it for as long as you have Part B.
Here are six reasons to think hard before you skip Part B, plus what to do if you already did.
1. The VA won’t send your bill to Medicare
It’s natural to assume the two systems work together, like a primary insurer and a backup. They don’t.
The VA says that it doesn’t bill Medicare. Get care at a VA facility, and the VA handles it. Get care somewhere else, and the VA generally covers it only if it authorized that care ahead of time.
That’s the gap Part B fills. The VA’s explanation is simple: With Medicare, you’re covered if you end up at a non-VA hospital or doctor.
Think about how life actually works after 65.
You visit the grandkids three states away. You spend the winter somewhere warm. Your knee surgeon of choice isn’t in the VA system.
Without Part B, every one of those situations can turn into a bill with your name on it.
2. An emergency away from the VA comes with strings
The VA can pay for emergency care at a non-VA hospital, but read the fine print before you count on it.
According to the VA, it needs to hear about your ER visit within 72 hours — from the hospital, from you or from someone acting for you. It covers emergency care only in an emergency department — an urgent care clinic doesn’t qualify.
If the care wasn’t authorized and isn’t tied to a service-connected condition, the rules get tighter. One example: You generally must have received care through the VA or its community network within the previous 24 months, and that’s only one of several conditions.
I’m not saying the VA won’t come through. I’m saying a heart attack is a lousy time to find out which box you didn’t check. Part B gives you a second set of rules to fall back on.
3. The penalty grows every year and doesn’t go away
Here’s where the CPA in me gets worked up, because the math is relentless.
Medicare adds 10% to your Part B premium for every full year you were eligible and stayed out. Medicare.gov says penalties like this generally last as long as you have the coverage, which for most people means for life.
Medicare’s example: Wait two full years without a Special Enrollment Period, and you pay a 20% penalty. At the 2026 standard premium, that turns $202.90 a month into about $243.50.
Now take an illustrative case. Say you skip Part B for five full years because the VA was working fine. That’s a 50% penalty — about $101.45 a month on top of the 2026 premium, or roughly $1,217 a year.
Pay that for 20 years and you’ve handed Medicare about $24,350 extra, based on today’s premium alone. That’s a decent used car, gone, for the privilege of signing up late.
One caution: The premium changes every year, and the penalty rides along with it.
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4. Your spot in VA health care isn’t guaranteed
It’s tempting to treat VA health care like it’s carved in stone. The VA is more candid than that.
On its page about VA care and other insurance, the VA warns that funding for its health care could change. It also says veterans in lower priority groups could lose their VA health benefits down the road.
Even if you keep your eligibility, the VA notes that your priority group, wait times at your local facility, and your own health can change over time.
In other words, the VA is telling you not to build your entire retirement health plan on one system. When the provider itself says that, I’d listen.
5. Military retirees: TRICARE For Life needs Part B
If you’re a military retiree, this one isn’t optional advice — it’s a rule.
TRICARE’s rule: Once you qualify for Medicare Part A, you usually need Part B, too, or your TRICARE goes away. Skip Part B, and in most cases you lose TRICARE coverage entirely.
The VA’s guidance for veterans turning 65 says the same thing: TRICARE For Life doesn’t kick in until you have both Part A and Part B.
So skipping Part B doesn’t just leave a gap. It can knock out the coverage you were counting on to fill it.
6. If money’s tight, your state may pay the premium
For some veterans, the real reason to skip Part B is simple: $202.90 a month is a lot of money. If that’s you, don’t assume you’re stuck.
Medicare Savings Programs, run by the states, can pay Part B premiums for people with limited income. The most generous version, the Qualified Medicare Beneficiary program, can also cover Part B deductibles, coinsurance and copays.
In 2026, the federal monthly income limit for an individual is $1,350 for that program and $1,816 for the Qualifying Individual program, which covers the premium. Some states set higher limits, so it’s worth checking even if you’re a bit over.
There’s a bonus. Medicare.gov says getting into a Medicare Savings Program generally wipes out the Part B late penalty.
Already skipped Part B? Here’s your way back
Your first chance to sign up starts three months before you turn 65 and ends three months after the month of your birthday. Miss that window without qualifying for a Special Enrollment Period, and you’re looking at the General Enrollment Period.
That runs Jan. 1 through March 31 every year, and Part B kicks in the first of the month after you enroll.
One thing that won’t help: Medicare’s fall open enrollment, which runs through Dec. 7. It’s for joining, dropping or switching Medicare Advantage and drug plans — and if you’re comparing those, know that your Medicare drug plan costs will be higher in 2027.
Once you do have Part B, use it, but wisely. For example, Medicare’s free yearly checkup isn’t a physical, and knowing the difference can spare you a surprise bill.
Bottom line
The VA has served a lot of veterans well, and nothing here says you should stop using it. But the VA itself is telling you to get Medicare, too.
If you’re approaching 65, sign up for Part B on time. If you’ve already skipped it, mark Jan. 1 on your calendar, because every full year you wait makes the penalty bigger — and it follows you for life.
You earned your VA benefits. Don’t let a Medicare technicality turn them into a lifetime surcharge.
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