Health insurance coverage through Veteran or Veteran's spouse provided by employer, Veteran or other non-federal source.
VA is required to bill private health insurance providers for medical care, supplies and prescriptions provided for treatment of Veterans’ nonservice-connected conditions. Generally, VA cannot bill Medicare, but can bill Medicare supplemental health insurance for covered services.
All Veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance, and any payment received by VA may be used to offset "dollar for dollar" a Veteran’s VA copay responsibility.
Your insurance coverage or lack of insurance coverage does not determine your eligibility for treatment at a VA health care facility.
What should you do with your private health insurance if you are accepted into VA health care program? You could save a lot of money if you dropped the insurance, but there are some things you should consider.
VA does not normally provide care for family members of Veterans enrolled in VA’s health care program. If you drop your private health insurance, they may have no health care coverage.
There is no guarantee that in subsequent years Congress will appropriate sufficient funds for VA to provide care for all enrollment Priority Groups. This could happen if you are enrolled in one of the lower Priority Groups. This would leave you with no health care coverage.
If you cancel your Medicare Part B Coverage, you need to know that you cannot be reinstated until January of the following year, AND you may be penalized for reinstatement.
For these reasons, VA encourages you to keep your private health insurance.
TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. VA bills TRICARE for non-service connected medical treatment.
Medicare is a federally funded health insurance for people 65 or older, under 65 with certain disabilities and any age with End-Stage Renal disease.
Medicaid is a state administered health insurance provided to certain low income individuals and families who fit into an eligibility group that is recognized by federal and state law. Usually, Veterans who qualify for Medicaid will not pay copays for VA health care.
VA is required by law to bill any health insurance carrier that provides coverage for you, including policies held by your spouse. Only Veterans treated for non-service connected conditions should see their insurance company billed for their treatment. Veterans who are treated for service-connected conditions should not have their insurance company billed for treatment. VA does not bill Medicare or Medicaid.
VA may bill and accept reimbursement from High Deductible Health Plans (HDHPs) for medical care and services provided to Veterans for non-service connected conditions. (HDHPs are usually linked to a Health Savings Account, which can be used to make VA copayments.) VA may also accept reimbursement from Health Reimbursement Arrangements (HRAs) for care provided for non-service connected conditions.
Most non-service connected Veterans without a special eligibility such as a Purple Heart, are required to complete a financial assessment at the time of enrollment. A financial assessment consists of the Veteran’s household income (including spouse and dependents if applicable).
If your total gross household income is below VA income limits, you will not be charged a copay for medical services, however, you may be responsible for medication or extended care copays. If you have insurance VA will bill your insurance carrier for your non-service connected care.
If your total gross household income is over the VA income limits, VA will bill your health insurance carrier for your nonservice-connected medical services and you will be responsible for copays for nonservice-connected medical services, medications and extended care services that are not covered by your health insurance.
The Medication Copay applies to each prescription, including each 30-day supply or less of maintenance medications prescribed on an outpatient basis for nonservice-connected conditions. This copay may change annually.
Veterans who have a Service Connection rating of 40% or less and whose income is at or below the applicable pension thresholds may wish to complete a medication copay exemption test.
Billing Questions: If you receive a bill that you believe to be in error, please contact the toll free number that is listed on your billing statement.
You may be responsible for one or more of the federally mandated copays VA is required to charge. Veterans who are Service-Connected 10% or greater are not required to pay a copay for inpatient or outpatient care medical care.Health Savings Accounts (HSAs) can be used to make VA first party copayments.