Health Benefits

Private Health Insurance

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.

What’s in it for me for providing health insurance information?

• You will not be responsible to pay for any unpaid balance that your third party health insurance carrier does not cover.  Depending on your Priority Group however, you may be required to pay a VA copayment for non-service connected care.
• Payments made to VA by your private health insurance carrier may allow VA to offset part or all of your VA copayment.
• Many private health insurance companies apply VA healthcare charges toward your annual deductible. Contact your private health insurance carrier for specific details concerning your coverage. For billing questions about your VA patient statement, contact the number listed on your patient statement for billing inquiries.

Funds that VA receives from your third party health insurance carrier go directly back to your VA Medical Center’s operational budget. That money can be used to hire more staff or buy medical equipment to improve Veterans healthcare.

Insurance Coverage and Eligibility for VA Health Care

Your insurance coverage or lack of insurance coverage does not determine your eligibility for treatment at a VA health care facility.

Risks of Giving Up Your Private Insurance

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.

What about your non-Veteran family members?

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.

What would happen if you are disenrolled from VA’s health care program?

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.

What would happen if you drop your Medicare Part B 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

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

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

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.

Why VA Bills Your Health Insurance

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.

VA’s Financial Assessment (Means Test)

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.

Medication Copays and Income Screening

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.

Types of Copays

• Outpatient
• Inpatient
• Extended Care
• Medication Copay

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.