6 Medicare Costs That Start at 65: What Veterans Should Know

Watch: Six Medicare costs that can affect veterans at 65

At 65, Medicare can add premiums, enrollment deadlines, and plan decisions to your monthly budget. Veterans do not all face the same bill. VA health care, VA prescription coverage, TRICARE For Life, income, work coverage, and the Medicare plan you choose each follow different rules. This guide separates six common costs and explains what to verify before delaying coverage or choosing a plan.

1. The Medicare Part B premium

The standard Medicare Part B premium is $202.90 per month in 2026. Some people pay more because of income-related adjustments or a late-enrollment penalty. Most beneficiaries have the premium deducted from Social Security; if you are not receiving Social Security, Medicare can bill you, often every three months.^[1][7][2]

Part B enrollment is not a universal legal requirement, but delaying it can have serious consequences. VA health care does not substitute for Part B. If you or your spouse are actively working and covered by a group health plan based on current employment, you may be able to delay Part B without a late-enrollment penalty. The rules depend on the employment and employer circumstances; COBRA, retiree coverage, VA coverage, and individual coverage generally are not current-employment coverage for this Special Enrollment Period. Confirm with Social Security or Medicare before delaying Part B.^[8][3]

2. The Part D prescription-drug premium

Medicare Part D plans have their own premiums, and the amount depends on the plan and where you live. VA prescription coverage is generally considered creditable drug coverage. That can allow you to delay Part D while you keep that coverage, provided you enroll within the applicable window if the coverage ends.^[4][3]

VA and Part D are separate systems. You generally choose whether to use VA or Part D for a prescription rather than expecting both programs to pay for the same drug. Compare formularies, pharmacies, premiums, and out-of-pocket costs if you are considering Part D.^[4][10]

3. The Part D late-enrollment penalty

If you go without Part D or other creditable prescription coverage for 63 days or more after becoming eligible, a late-enrollment penalty may apply when you later join a plan. VA and TRICARE prescription coverage are examples of creditable coverage, but keep the coverage notice and confirm your dates.^[4]

4. The Part B late-enrollment penalty

The Part B Initial Enrollment Period lasts seven months: the three months before your 65th-birthday month, your birthday month, and the three months after. If you delay without a qualifying Special Enrollment Period, the penalty is generally 10% for each full 12-month period you could have had Part B, usually for as long as you have Part B.^[8][11]

VA health care is not current-employment group coverage for the usual Part B Special Enrollment Period. VA encourages eligible veterans to sign up for Medicare, and says delaying Part B can lead to a penalty for the rest of your life. Before you decline or delay Part B, ask Social Security, Medicare, VA, or a SHIP counselor to review your specific coverage.^[3][11]

5. IRMAA and other income-related costs

The Income-Related Monthly Adjustment Amount, or IRMAA, can add a surcharge to Part B and Part D premiums when your modified adjusted gross income is above the applicable threshold. For 2026, Social Security generally uses information from your 2024 tax return, with exceptions when a more recent return is needed. The complete 2026 schedule depends on filing status and includes multiple income brackets, so check the current SSA premium table rather than relying on a shortened chart.^[12][13]

VA disability benefits are generally excluded from gross income under federal tax rules. Other income and tax-exempt interest can still affect the modified adjusted gross income used for IRMAA, so do not assume a VA disability payment is the only fact that matters.^[14][12]

6. The Part A premium

Most people pay no monthly Part A premium because they or a qualifying spouse paid Medicare taxes for enough work quarters, generally 40 quarters. Premium-free Part A is based on the applicable work record—not simply on being a veteran. Some active-duty military earnings received special Social Security wage credits for specified periods and under limited conditions, so check your Social Security earnings record or Medicare eligibility.^[2]

What Medicare Advantage can change

Medicare Advantage (Part C) requires both Part A and Part B. A plan may have a $0 monthly plan premium, but you still generally pay Part B, and deductibles, copayments, drug costs, networks, prior authorization, and the plan's annual out-of-pocket limit still apply.^[15][2][6]

Some Medicare Advantage plans may help pay all or part of your Part B premium through a plan-specific Part B premium reduction. It depends on the plan, county, year, and eligibility; many plans do not offer it. The reduction is not a refund, check, or cash payment, and you should compare the entire plan rather than choosing based only on this feature.^{[6][16][17][18]}

Enrolling in Medicare Advantage does not by itself cancel VA eligibility, but it is separate coverage with its own network, authorization, claims, premiums, copayments, and out-of-pocket rules. Check the specific plan before using it for non-VA care; do not assume it will cover a service denied by VA or cover it without cost or delay. VA community care must generally be authorized before non-emergency care from a community provider.^[3][19][2]

A real example is not a promise

My dad Wallace is an 82-year-old Vietnam-era veteran. In his county, his particular Medicare Advantage plan reported a $0 plan premium and a $185 Part B premium reduction, leaving $17.90 of the 2026 standard Part B premium. That is one plan, in one county, for one year—not a result to expect everywhere. Deductibles, copayments, drug costs, networks, authorizations, and the plan's annual out-of-pocket limit still apply. Verify current plan documents before enrolling.

How Medicare, VA, and TRICARE pay

Medicare and VA generally do not pay for the same item or service together. Each time you receive care, you generally choose which benefits to use: VA pays VA-authorized care, while Medicare pays Medicare-covered care under Original Medicare or your Medicare plan. For non-VA emergency care, VA rules include using an emergency department and notifying VA within 72 hours, along with other requirements.^[10][3][20]

For TRICARE For Life, Medicare generally pays first for services both programs cover and TRICARE pays last. If a TFL beneficiary joins Medicare Advantage, non-emergency care generally must come through the plan's network; copayments may apply, and paper claims to TRICARE may be needed. Part C and Part D are optional for TFL, but Parts A and B are required.^[5][9]

A simple checklist before you turn 65

1. Identify your coverage Write down VA health care, VA prescriptions, TRICARE For Life, CHAMPVA, current-employment group coverage, retiree coverage, and COBRA separately. Their rules are not interchangeable.^[5][21][8]
2. Mark your enrollment window Use the seven-month Initial Enrollment Period and ask whether a qualifying Special Enrollment Period applies before delaying Part B.^[8][11]
3. Compare the whole plan If considering Medicare Advantage or Part D, review networks, covered drugs, premiums, deductibles, copayments, authorization rules, and out-of-pocket costs—not just a premium line.^[15][2]
4. Get a second look You can book a call with Veterans Advantage Financial®, or contact Medicare.gov and 1-800-MEDICARE for all available options. There is no cost to you for our help; if you enroll, we are paid by the insurance company. We do not offer every plan available in your area.^[2]

For more education, read the VA health care and Medicare guide, the TRICARE For Life guide, and the Veterans Medicare FAQ. Veterans Advantage Financial® is independent and is not affiliated with or endorsed by Medicare, CMS, Social Security, VA, TRICARE, or any government agency.

This is general education, not personal advice, and it isn’t a recommendation of any specific plan. Veterans Advantage Financial® is a licensed insurance agency, not affiliated with or endorsed by Medicare, Social Security, VA, TRICARE or any government agency. Plan availability, costs and benefits vary by plan, county and year. Check your own situation with the agency or plan before making changes.

About the author

Christopher Duncan

Certified Medicare Insurance Planner™ · Retirement Income Certified Professional®

Christopher founded Veterans Advantage Financial® and has helped people with Medicare since 2006. He is a licensed insurance agent in all 50 states and DC (NPN 8613503). His dad, Wallace, is a Vietnam-era veteran.

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