For treatment related to a Veteran’s nonservice-connected condition, VA may bill your health insurance for medical care, supplies, and prescriptions. Health insurance can be through a Veteran or a Veteran’s spouse that is provided by an employer or other non-federal source.
VA can bill a Veterans’ health insurance if medical care is received directly through VA or through a community provider. As a result, Veterans are required to provide information to VA about health insurance coverage, including coverage provided under your spouses’ policies.
You can use a High Deductible Health Plan (HDHP) for medical care and services for nonservice-connected conditions. HDHPs are usually linked to a Health Savings Account (HSA), which can be used to pay VA copayments. VA can bill your insurance company directly or can be reimbursed using a linked Health Reimbursement Account (HRA).
There are significant benefits of having private health insurance:
- May reduce or eliminate your copayments
- Does not affect your eligibility for VA care
- Allows VA to directly bill your insurance company for nonservice-connected care
- Charges associated with your VA health care may apply toward your annual deductible. (Contact your insurance company for more information.)
- VA cannot bill Medicare or Medicaid, but may bill Medicare supplemental health insurance for covered services related to nonservice-connected care.
- VA health care is not considered a health insurance plan.
Permission to Bill Health Insurance
As a result of the VA MISSION Act of 2018, VA no longer requires permission to bill health insurance carriers for health care related to a sensitive diagnosis. As outlined in 38 U.S.C. §7332, a sensitive diagnosis includes includes drug or alcohol abuse, alcoholism, HIV/HIV testing, and sickle cell anemia.
VA provided a one-time notification to Veterans who previously signed a release of information refusing to allow VA to bill encounters containing a sensitive diagnosis prior to submitting claims to a third-party health insurance carrier. The change has been published in the Federal Register and the one-time notifications are complete. VA has begun submitting claims to health insurance carriers for all nonservice-connected care with a sensitive diagnosis without a signature or written authorization to permit the disclosure of protected information on a claim(s) and/or in copies of Veteran’s medical records.
VA is required by Public Law 87–693; 42 U.S.C. 2651, commonly known as the Federal Medical Care Recovery Act, to bill the health insurance carrier that provides health care coverage for Veterans to include policies held by their spouse. The money collected goes back to VA medical centers to support health care costs provided to all Veterans.
Veterans have the right to submit a restriction request asking VA not to disclose their health information for billing purposes, but VA is not required to grant these requests. If Veterans would like to submit a restriction request, please contact the local VA facility’s privacy officer. Veterans can contact their VA facility’s billing office for more information.