Orlando Harmon
Veterans in the United States with private health insurance may choose to use it as a supplement to their VA health care benefits. By law, the VA is required to bill private health insurance providers for medical care, supplies, and prescriptions provided for the treatment of non-service-connected conditions. This means that veterans are not responsible for any remaining balance that their insurance carrier does not pay, except for VA copayments, which may be required depending on their assigned priority group.
| Characteristics | Values |
|---|---|
| VA's Billing of Private Insurance | Required by law to bill private health insurance providers for non-service-connected conditions |
| Who Does This Apply To? | Veterans applying for and using VA medical care |
| What Information is Required? | Health insurance coverage, including coverage under a spouse's plan |
| Who is Responsible for Remaining Balance? | Veterans are not responsible for any unpaid balance not covered by their health insurance provider |
| Copayments | Depending on the assigned priority group, there may be a copayment for non-service-connected care |
| Benefits of Providing Insurance Information | Private insurance payments may offset VA copayments; insurance charges may count towards a veteran's annual deductible |
| VA Billing of Medicare and Medicaid | VA does not bill Medicare or Medicaid, but may bill Medicare supplemental health insurance for covered services |
| Impact on Eligibility | Having health insurance does not affect VA health care benefits |
What You'll Learn
Veterans are not responsible for any unpaid balance not covered by their health insurance provider
By law, the VA is required to bill private health insurance providers for non-service-connected care. The VA asks veterans for their private health insurance information when they are being treated for a non-service-connected condition. The funds received from third-party health insurance carriers go directly back into the VA Medical Center's operational budget to improve care for all veterans.
Veterans are encouraged to keep their private health insurance, as it can be used to supplement their VA health care benefits. Additionally, having private health insurance can provide veterans with more options and flexibility in their health care. For example, veterans with both VA and Medicare coverage can access community physicians and obtain prescription drugs not on the VA formulary.
It is important to note that a veteran's insurance coverage or lack thereof does not determine their eligibility for treatment at a VA health care facility.
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VA health care is not considered a health insurance plan
VA is required by law to bill private health insurance providers for medical care, supplies, and prescriptions provided for the treatment of veterans' non-service-connected conditions. All veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage under their spouse's plan. Any payment received by the VA may be used to offset the veteran's VA copayment responsibility.
The funds that the VA receives from third-party health insurance carriers go directly back to the VA Medical Center's operational budget. This money can be used to hire more staff or buy medical equipment to improve veterans' health care.
Veterans can provide or update their insurance information by using the online Health Benefits Renewal form (10-10-EZR) at www.vets.gov/healthcare/apply/, calling 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. ET, or presenting their health insurance card to the clinic clerk during check-in.
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VA health care and Medicare
Veterans can have both Medicare and VA health care benefits. However, Medicare and VA benefits do not work together. Medicare does not pay for any care that veterans receive at a VA facility. For VA coverage to cover care, veterans must generally receive health care services at a VA facility. For Medicare to cover care, veterans must receive care at a Medicare-certified facility that works with their Medicare coverage.
Veterans do not have to pay 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 the treatment of veterans' non-service-connected conditions. All veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under their spouses' policies.
Any payment received by the VA may be used to offset the veteran's VA copay responsibility. Funds that the VA receives from third-party health insurance carriers go directly back to the VA Medical Center's operational budget. This money can be used to hire more staff or buy medical equipment to improve veterans' health care.
Veterans enrolled in both VA and Medicare have more coverage choices and options for medical and hospital care, as well as for prescription drug services if they also enroll in a Part D plan.
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VA health care and private insurance
The VA asks veterans for their private health insurance information when they are being treated for a non-service-connected condition. This is because, by law, the VA must bill private health insurance providers for any non-service-connected care, supplies, or medicine provided to veterans. This includes non-service-connected conditions, which are illnesses or injuries that are not related to the patient's military service. The VA is also required to bill the insurance of a veteran's spouse if they are covered under their policy.
Veterans are not responsible for paying any balance left unpaid by their health insurance provider. However, depending on their assigned priority group, they may have a copay for non-service-connected care. When a private health insurance provider pays the VA for non-service-connected care, this may offset part or all of the veteran's VA copayment. Additionally, the veteran's private insurer may apply their VA health care charges toward their annual deductible.
It is important to note that having VA health care coverage does not affect a veteran's eligibility for other health benefits or insurance programs. The VA encourages veterans to keep their private insurance, as funding for VA health care may change in the future, and there is no guarantee that Congress will appropriate sufficient funds to cover all enrollment priority groups. Therefore, having a secondary source of coverage may be in the veteran's best interest.
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VA health care and family members
If you are a family member or dependent of a service member or veteran, you may be eligible for VA benefits. These include health care, life insurance, or money for school. Surviving family members may also qualify for added benefits, such as help with burial costs and survivor compensation.
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health insurance program for current or surviving spouses and children of veterans with disabilities or service members who died in the line of duty. Through this program, the VA covers the cost of some health care services and supplies through cost sharing.
The Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers support and services for family caregivers of eligible veterans who were seriously injured in the line of duty and meet other eligibility requirements. Services for eligible participants may include a financial stipend, access to health insurance, mental health counselling, caregiver training, and respite care.
The Camp Lejeune Family Member Program is for those who lived at U.S. Marine Corps Base Camp Lejeune or Marine Corps Air Station (MCAS) in North Carolina with an active-duty veteran who was their spouse or parent. If you lived in either of these places for at least 30 cumulative days between August 1953 and December 1987, you may have had contact with contaminants in the drinking water. Scientific and medical evidence has shown a link between exposure to these contaminants and the development of certain diseases later on. If you now have one of the related conditions, you may qualify for health care benefits through the VA.
The Spina Bifida Health Care Benefits Program is for the biological children of Korean or Vietnam War veterans who have been diagnosed with spina bifida. If eligible, you may qualify for disability benefits, including health care benefits.
The Children of Women Vietnam Veterans (CWVV) Health Care Benefits Program is for the biological children of women Vietnam War veterans who have been diagnosed with certain birth defects. If eligible, you may qualify for VA health care benefits to help pay for services needed to treat your covered birth defect and related medical conditions.
If you qualify for CHAMPVA or the Spina Bifida or Children of Women Vietnam Veterans programs, you can get prescription benefits through your local pharmacy or through the VA's Meds by Mail program.
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Frequently asked questions
Yes, the VA is required by law to bill private health insurance providers for medical care, supplies, and prescriptions provided for the treatment of non-service-connected conditions.
Non-service-connected conditions refer to illnesses or injuries that are not related to your military service.
You are not responsible for any unpaid balance not covered by your private insurance. However, depending on your assigned priority group, you may have a VA copayment for non-service-connected care.
The VA asks for private insurance information to bill your insurance provider for any non-service-connected care you receive. This helps support and improve VA healthcare services for all veterans.
