How VA health care works with Medicare and other insurance

Should I give up my private health insurance or other insurance (like TRICARE or Medicare) if I’m accepted into the VA health care program?

This is your decision. You can save money if you drop your private health insurance, but there are risks. We…

This is your decision. You can save money if you drop your private health insurance, but there are risks. We encourage you to keep your insurance because:

  • We don’t normally provide care for Veterans’ family members. So, if you drop your private insurance plan, your family may not have health coverage.
  • We don’t know if Congress will provide enough funding in future years for us to care for all Veterans who are signed up for VA health care. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future. If you don’t keep your private insurance, this would leave you without health coverage.
  • If you have Medicare Part B (coverage for doctors and outpatient services) and you cancel it, you won’t be able to get it back until January of the following year. You may also have to pay a penalty to get your coverage back (called reinstating your coverage).
Posted 11 months agoby Kristijan

If I already have VA health care benefits, should I still sign up for Medicare when I turn 65?

Yes. We encourage you to sign up for Medicare as soon as you can. This is because: We don’t know…

Yes. We encourage you to sign up for Medicare as soon as you can. This is because:

  • We don’t know if Congress will provide enough funding in future years for us to provide care for all Veterans who are signed up for VA health care. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future.
  • Having Medicare means you’re covered if you need to go to a non-VA hospital or doctor—so you have more options to choose from.
  • If you delay signing up for Medicare Part B (coverage for doctors and outpatient services) and then need to sign up later because you lose your VA health care benefits or need more choice in care options, you’ll pay a penalty. This penalty gets bigger each year you delay signing up—and you’ll pay it every year for the rest of your life.
  • If you sign up for Medicare Part D (coverage for prescription drugs), you’ll be able to use it to get medicine from non-VA doctors and fill your prescriptions at your local pharmacy instead of through the VA mail-order service. There’s no penalty for delaying Medicare Part D.
Posted 11 months agoby Kristijan

If I’m signed up for VA health care, and I also have Medicare, what’s covered by each?

You’ll need to choose which benefits to use each time you receive care. To use VA benefits, you’ll need to…

You’ll need to choose which benefits to use each time you receive care.

To use VA benefits, you’ll need to get care at a VA medical center or other VA location. We’ll also cover your care if we pre-authorize you (meaning we give you permission ahead of time) to get services in a non-VA hospital or other care setting. Keep in mind that you may need to pay a VA copayment for non-service-connected care.

If you go to a non-VA (or VA authorized) care facility, Medicare may pay for other services you may need during your stay. Or, if we only authorize some services in a non-VA location, then Medicare may pay for other services you may need during your stay. Check your Medicare plan, so you know which care locations and services you’re covered for.
Learn more about Medicare

Posted 11 months agoby Kristijan

Can I use my Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) to help pay for VA care for non-service-connected conditions?

Yes. We may bill and accept reimbursement from High Deductible Health Plans (HDHPs) for medical care and services to treat…

Yes. We may bill and accept reimbursement from High Deductible Health Plans (HDHPs) for medical care and services to treat your non-service-connected conditions. If you have an HDHP linked to an HSA, you can use your HSA to pay your VA copayments for non-service-connected care.

We may also accept reimbursement from HRAs for care we provide to treat your non-service-connected conditions.

Posted 11 months agoby Kristijan

Does VA need my permission to bill my other health insurance for care related to a sensitive diagnosis (like alcohol or drug abuse or HIV)?

No. As a result of the VA MISSION Act of 2018, we no longer need permission to bill health insurance…

No. As a result of the VA MISSION Act of 2018, we no longer need permission to bill health insurance providers for care related to a sensitive diagnosis (like alcohol or drug abuse, alcoholism, HIV or HIV testing, sickle cell anemia, or other diagnoses included in Public Law 38 U.S.C. §7332-protected information).

Before submitting any claims for care related to a sensitive diagnosis, we notified Veterans of this change by sending a one-time notice to all Veterans who had signed a release of information refusing to allow us to bill for care related to a sensitive diagnosis in the past. The Federal Register also published this change.

Read the notice on the Federal Register website

We’re now submitting claims to health insurance carriers for all non-service-connected care, even if we don’t have a signature or written authorization permitting us to disclose protected information on these claims or in Veterans’ medical records.

We’re required by law to bill your health insurance (including your spouse’s insurance if you’re covered under the policy). The money collected goes back to VA medical centers to support health care costs provided to all Veterans.

You can submit a restriction request asking us not to disclose your health information for billing purposes, but we’re not required to grant your request. To submit a restriction request, please contact your nearest VA health facility and ask to talk with the privacy officer. You can also ask to talk with the billing office for more information.

Find your nearest VA health facility

Posted 11 months agoby Kristijan