How VA works with other health insurance!
Why VA Asks About Other Coverage’s
Why does VA require you to provide information on your health insurance coverage (including coverage under a spouse’s plan)?
They ask for this information because they have to bill your private health insurance provider for any care, supplies, or medicine we provide to treat your non-service-connected conditions (illnesses or injuries that aren’t related to your military service).
They don’t bill Medicare or Medicaid, but we may bill Medicare supplemental health insurance for covered services.
What if my health insurance provider doesn’t cover all the non-service-connected care that VA bills them for?
You won’t have to pay any unpaid balance not covered by your health insurance provider. But, depending on your eligibility priority group, you may have to pay a VA copayment for non-service-connected care.
Does it help me in any way to give VA my health insurance information?
Yes. Giving the VA your health insurance information helps you because:
- When your private health insurance provider pays them for your non-service-connected care, VA may be able to use the funds to offset part—or all—of your VA copayment.
- Your private insurer may apply your VA health care charges toward your annual deductible (the amount of money you pay toward your care each year before your insurance starts paying for care).
Does your current health insurance status affect whether you can get VA health care benefits?
No. Whether or not you have health insurance coverage doesn’t affect the VA health care benefits you can get.
Note: It’s always a good idea to let your VA doctor know if you’re receiving care outside VA. This helps your provider coordinate your care to help keep you safe and make sure you’re getting care that’s proven to work and that meets your specific needs.
If You Are Accepted Into VA Health Care Program
Should you give up my private health insurance or other insurance (like TRICARE or Medicare) if you’r 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. The VA encourages you to keep your insurance because:
- The VA doesn’t normally provide care for Veterans’ family members. So, if you drop your private insurance plan, your family may have no health coverage.
- The VA doesn’t know if Congress will provide enough funding in future years for it 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. And, if you don’t keep your private insurance, this would leave you with no 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. And, you may have to pay a penalty to get your coverage back.
Should You Signup For Medicare When You Turn 65
Yes. The VA encourages you to sign up for Medicare as soon as you can. This is because:
- The VA doesn’t know if Congress will provide enough funding in future years for it 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. But you should know that VA prescription drug coverage is better than Medicare coverage—and there’s no penalty for delaying Medicare Part D.
Having Both VA & Medicare
If you signed up for VA health care, and you 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 get care at a VA medical center or other VA location. The VA also covers your care if they 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 care setting, Medicare may pay for your care. Or, if the VA only authorizes 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.
Health Savings Account (HSA) And VA Care
Can you use your Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) to help pay for VA care for non-service-connected conditions?
Yes. The VA 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.
The VA may also accept reimbursement from HRAs for care the VA provides to treat your non-service-connected conditions.
Go to https://www.InsuredMeds.com for more information.