VA health care and other insurance
If you have another form of health care (such as a private insurance plan, Medicare, Medicaid or TRICARE), you can take advantage of VA health care with these plans. Find out more about how VA works with other health insurance companies.
Why does VA require me to provide information about my health insurance (including spousal coverage)?
We require this information because we must pay your private health insurance company for any care, supplies or medications we provide to treat your non-service conditions (illness or injury. Not related to your military service).
We do not pay for Medicare or Medicaid, but we can pay for additional Medicare health insurance for the services being treated. What if my health insurance company doesn’t cover anyone who isn’t affiliated with the health service VA pays them?
You do not have to pay an outstanding balance that is not covered by your health insurance company. However, depending on your assigned priority group, you may have a non-service copy.
Has it helped me in any way to provide VA with its health insurance information?
Yes. By providing us with information about your health insurance, you will help because:
If your private health insurance company pays us for your non-service care, we may use these funds to reimburse part – or all – of your VA copy.
Your private insurance company can use your VA health care bills for your annual co-payment (the amount of money you pay each year for your health care before your insurance starts paying for health care).
Does my current health insurance status affect whether I can receive VA health care benefits?
No. Whether or not you have health insurance does not affect the benefits of the VA health care you receive.
Note: It is always a good idea to tell your VA doctor if you are receiving care outside of the VA. This will help your provider coordinate your care to keep you safe and provide you with the care that is proven to work and that meets your specific needs.
How VA Healthcare Works with Medicare and other Insurance
This is your decision. If you cancel private health insurance, you can save money, but there are risks. We recommend that you keep your insurance because:
We do not normally provide care to family members of veterans. So if you abandon the private insurance plan, your family will be without health insurance.
We do not know whether Congress will provide us with sufficient funding in the coming years to provide all veterans who enroll in VA health care. If you belong to one of the low priority groups, you may lose your VA health care benefits in the future. If you do not keep your private insurance, you will be left without health coverage.
If you have Medicare Part B (coverage for doctors and outpatient services) and cancel it, you will not be able to get it back until January next year. You may also have to pay a fine to get your coverage back (called reset coverage).
If I already have the benefits of VA health care, do I still have to register with Medicare when I reach the age of 65?
Yes. We recommend that you register for Medicare as soon as possible. This is because:
Medicare means you are insured when you need to go to a non-VA hospital or doctor – to have more options to choose from.
VA health care funding may change in the future. We encourage you to sign up for all the health care benefits you can have when you need it. If you postpone registration for Medicare Part B (coverage of doctors and outpatient services) and need to log in later because you will lose the benefits of VA health care or need more care options, you will pay a fine. This fine will increase every year you postpone registration – and you will pay it every year for the rest of your life.
If you sign up for Medicare Part D (prescription drugs), you can use it to get medication from doctors outside the VA and to fill out prescriptions at your local pharmacy instead of by courier service in the VA. There is no penalty for delaying Part D Medicare if you first register when you qualify, or within 63 days if you no longer have VA health care or other credible prescription drug coverage. For more information on how to avoid Part D fines, visit the Medicare website
If I apply for VA health care and I also have Medicare, what does each cover?
With each care, you need to choose which benefits you will enjoy.
To take advantage of VA, you must take care of yourself at a VA medical center rather than another VA. We will also cover your care if we authorize you in advance (that is, we give you prior permission) to receive services in a hospital outside of VA or in another state of care. Please note that you may be required to pay a copy of VA for non-service care.
If you go to a medical facility that is not a VA (or VA authorised), Medicare may pay for additional services you need during your stay. Or, if we only allow certain services on-site outside of VA, Medicare may pay for additional services you may need during your stay. Check your Medicare plan to see what places and health services you cover.
Find out more about Medicare
Can I use my Health Savings Account (HSA) or Health Reimbursement Agreement (HRA) to pay for VA care on terms unrelated to the service?
Yes. We may charge and receive highly deductible health plan (HDHP) payments for medical care and services to treat your non-service conditions. If you have HDHP connected to the HSA, you can use the HSA to pay for copies of the VA for the offline service.
We may also accept payments from the HRA for the care we provide in processing your Terms of Service.
Should the VA allow me to pay for my additional health insurance related to a sensitive diagnosis (such as alcohol or drug abuse or HIV)?
No. As a result of the VA MISSION of 2018, we no longer need permission to charge health insurance companies for care related to sensitive diagnoses (such as alcohol or drug abuse, alcoholism, HIV or HIV testing, sickle cell disease, etc.). Law 38 U.S.C. ยง7332 – protected information).
Prior to submitting any requests for sensitive diagnosis care, we will notify veterans of this change by sending a one-time notification to all veterans who have signed a declaration of refusal to pay for sensitive diagnosis care in the past. The federal registry also published the change.
Read the announcement on the Federal Register website
We have now applied to health insurance carriers for anything unrelated to health services, even if we do not have a signature or written consent that would allow us to disclose protected information about it.
We are required by law to pay for your health insurance (including your spouse’s insurance if you are covered by insurance). The money raised will be returned to VA medical centres to support the cost of health care for all veterans.
You can apply for a restriction that requires us not to disclose your health information for billing purposes, but we are not required to submit your request. To request a restriction, contact your nearest VA medical facility and ask for an interview with your Privacy Officer. You can also ask the billing office for more information.