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Health Benefits

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VA and Other Health Insurance

If you have other forms of health care coverage, such as a private insurance plan, Medicare, Medicaid or TRICARE, you can continue to use VA along with these plans.  Remember, it is always a good idea to inform your doctors if you are receiving care outside of VA so your health care can be coordinated.

Private Health Insurance

Veterans with private health insurance may choose to use these sources of coverage as a supplement to their VA health care benefits.  Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance.

VA is required, by law, to bill private health insurance providers for medical care, supplies and prescriptions provided for treatment of Veterans’ nonservice-connected conditions.  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.  Any payment received by VA may be used to offset “dollar for dollar” a Veteran’s VA copay responsibility.

Funds that VA receives from third party health insurance carriers go directly back to VA Medical Center’s operational budget.  That money can be used to hire more staff or buy medical equipment to improve Veterans health care.  Enrolled Veterans can provide or update their insurance information by:

  1. Using the online Health Benefits Renewal form (10-10-EZR) at www.vets.gov/healthcare/apply/
  2. Calling 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. ET.
  3. Presenting their health insurance card to the clinic clerk during check-in. VA health care is NOT considered a health insurance plan

Medicare Coverage

Creditable Coverage

Enrollment in the VA health care system is considered creditable coverage for Medicare Part D purposes.  This means VA prescription drug coverage is at least as good as the Medicare Part D coverage.  Since only Veterans can enroll in the VA health care system, dependents and family members do not receive credible coverage under the Veteran’s enrollment.

Under Medicare Part B, VA health care is NOT creditable coverage.  Creditable coverage under Medicare Part B can only be provided through an employer.  Although a Veteran may avoid the late enrollment penalty for Medicare Part D by citing VA health care enrollment, that enrollment would not help the Veteran avoid the late enrollment penalty for Part B.

VA does not recommend Veterans cancel or decline coverage in Medicare (or other health care or insurance programs) solely because they are enrolled in VA health care.  Unlike Medicare, which offers the same benefits for all enrollees, VA assigns enrollees to enrollment priority groups based on a variety of eligibility factors, such as service-connection and income.  There is no guarantee that in future years Congress will appropriate sufficient medical care funds for VA to provide care for all enrollment priority groups.  This could leave Veterans, especially those enrolled in one of the lower-priority groups, with no access to VA health care coverage.  For this reason, having a secondary source of coverage may be in Veterans’ best interest.

Enrolling in both VA and Medicare can provide Veterans flexibility.  For example, Veterans enrolled in both programs would have access to community physicians (under Medicare Part A or Part B) and can obtain prescription drugs not on the VA formulary if prescribed by community physicians and filled at their local retail pharmacies (under Medicare Part D).

For more information on Medicare coverage, visit the Health and Human Services Medicare website at www.medicare.gov.

Medicare Beneficiary Identifier

The Centers for Medicare and Medicaid Services (CMS) will issue new Medicare cards that use a Medicare Beneficiary Identifier (MBI) instead of a Social Security number to identify subscribers. Veterans should bring their new cards to their next VA appointment so the subscriber ID can be updated in the patient’s Medicare insurance file. For more information regarding the MBI, visit www.medicare.gov.