Understanding The Va's Billing Practices: When Insurance Comes Into Play

The Department of Veterans Affairs (VA) is required by law to bill private health insurance carriers for medical care, supplies, and prescriptions provided for the treatment of veterans' non-service-connected conditions. This means that if you are a veteran with a non-service-connected condition, the VA will bill your private health insurance for any care, supplies, or medicine provided to treat that condition. This is done to supplement funds from Congress, with the money collected being used to purchase supplies and equipment to improve care for veterans. Importantly, veterans are not responsible for any unpaid balance that the insurance carrier does not pay, except for VA copayments which they may be required to pay depending on their assigned Priority Group.

Veterans are not responsible for any unpaid balance that the insurance carrier does not pay

Veterans are not responsible for any unpaid balance that their insurance carrier does not pay. However, they may be required to pay a VA copayment depending on their assigned Priority Group.

The VA is required by law to bill private health insurance carriers for medical care, supplies, and prescriptions provided for the treatment of veterans' non-service-connected conditions. This means that if a veteran has another form of health coverage, such as a private insurance plan, Medicare, Medicaid, or TRICARE, they can continue to use VA health care benefits alongside these plans.

The VA asks veterans to provide their health insurance information so that it can bill their private health insurance provider for any care, supplies, or medicine provided to treat non-service-connected conditions (illnesses or injuries that are not related to their military service).

Any payment received by the VA from a veteran's private health insurance carrier is credited towards any applicable VA copayments, reducing all or part of the veteran's out-of-pocket expenses. The money collected by the VA from private health insurance carriers is returned to the VA medical center providing the care. These funds are used to provide the best care possible to veterans.

Veterans may be responsible for a VA copayment depending on their assigned Priority Group

The Department of Veterans Affairs assigns every veteran an Enrollment Priority Group to ensure that certain groups of veterans can enrol in the VA health care program before others. There are eight priority groups, with Group 1 being the highest priority. The priority group is based on the veteran's military service history, disability rating, income level, Medicaid qualification, and other benefits they may be receiving.

Veterans in Groups 2 to 8 are required to pay for each 30-day or less supply of medication for the treatment of non-service-connected conditions (unless exempted). However, veterans are not responsible for any unpaid balance that the insurance carrier does not pay, except for VA copayments they may be required to pay, depending on their assigned Priority Group.

Each priority group has a different copay, so if a veteran is moved from one group to another, their copay could change. For example, veterans in Group 1 are not required to make a copay for inpatient care, outpatient care, outpatient medication, or extended care service. In contrast, veterans in Group 8 are required to make copayments for inpatient care, outpatient care, outpatient medication, and extended care services.

Veterans who have private health insurance should consider the impact on their family members before cancelling their plan. The VA does not typically provide care for family members, so cancelling private insurance could leave them without health coverage. Additionally, there is no guarantee that Congress will appropriate sufficient funds in future years to provide care for all Priority Groups. If funding is reduced, veterans in lower Priority Groups could lose their VA health care benefits and be left without coverage.

The money collected by VA stays within VA and can be used to purchase supplies and equipment

The VA is required by law to bill private health insurance carriers for medical care, supplies, and prescriptions provided for the treatment of veterans' non-service-connected conditions. This means that the VA bills insurance companies for any care, supplies, or medicine they provide to treat illnesses or injuries that are not related to a veteran's military service. This is done to supplement the funds from Congress. The money collected by the VA from private health insurance carriers is returned to the VA medical center providing the care. The funds are then used to purchase supplies and equipment to improve the care for veterans.

The VA does not bill Medicare or Medicaid for reimbursement. However, they do bill other types of health insurance, including Medicare Supplemental plans for covered services. 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.

Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under their spouses' policies. While veterans are not responsible for any unpaid balance that the insurance carrier does not pay, they may be required to pay a VA copayment depending on their assigned Priority Group. Payments received from a veteran's private health insurance carrier are credited toward any applicable VA copayments, reducing all or part of the veteran's out-of-pocket expenses.

Veterans are encouraged to keep their insurance to cover their family members' health

The Department of Veterans Affairs (VA) is committed to providing veterans with the best possible care. While VA health care benefits are available to those who served, it's important to note that VA health care coverage for family members is typically not provided. Therefore, it is strongly recommended that veterans maintain their private health insurance plans to ensure their family members remain covered.

• Impact on Family Members: The VA generally does not provide health care coverage for family members of veterans enrolled in VA health care. If a veteran cancels their private insurance plan, their family may be left without health coverage. This could lead to significant financial burden and stress for the family if they need to pay for health care services out-of-pocket.
• Uncertainty of Future Funding: There is no guarantee that Congress will appropriate sufficient funds in the future to cover all enrollment priority groups for VA health care. If a veteran is enrolled in one of the lower priority groups and relies solely on VA health care, they could lose their benefits in the future. Keeping private insurance ensures that veterans and their families have continuous health coverage, regardless of changes in VA funding or priority groups.
• Medicare Part B Reinstatement: If a veteran cancels their Medicare Part B coverage and later decides to reinstate it, they may face challenges. Reinstatement is only possible in January of the following year, and there may be penalties or increased premiums associated with this process.
• Late Enrollment Penalties: For Medicare Part B, if veterans do not sign up when they are first eligible, they will typically have to pay a late enrollment penalty. This penalty increases the longer they wait and will be added to their monthly premium for as long as they have Part B coverage.
• General Enrollment Period Wait: In addition to penalties, if veterans miss the initial enrollment period for Medicare Part B, they will usually have to wait until the General Enrollment Period (January 1 to March 31) to enroll. Their coverage will then start on July 1 of that year, leaving them without coverage for several months.
• Current and Future Health Needs: Veterans are advised to carefully consider their current and future health needs before making any changes to their insurance coverage. Keeping private insurance provides more options and flexibility in choosing health care providers and services, both within and outside the VA system.

While veterans can save money by dropping their private health insurance, the potential risks to themselves and their families can be significant. Therefore, the VA strongly encourages veterans to maintain their private insurance plans to ensure comprehensive health coverage for their loved ones.

Veterans are not required to have Medicare Part A or B to be enrolled in VA health care

VA health benefits provide coverage for care in VA clinics and hospitals, but this coverage generally does not extend to non-VA facilities and doctors. Medicare, on the other hand, covers care in non-VA facilities that accept Medicare coverage.

While Medicare Part A is typically premium-free for those who meet the eligibility requirements, Medicare Part B comes with an additional monthly premium. If you delay signing up for Medicare Part B, you may have to pay a late enrollment penalty. This penalty gets bigger each year you delay signing up, and you will have to pay it for as long as you have Part B.

Additionally, if you cancel your Medicare Part B coverage, you cannot be reinstated until January of the following year, and you may be penalized for reinstatement.

It is important to note that Medicare and VA benefits do not work together. Medicare does not pay for any care received at a VA facility, and VA benefits will not pay for Medicare cost-sharing (deductibles, copayments, coinsurance). However, if the VA authorizes services in a non-VA hospital but does not pay for all the services received, Medicare may pay for the Medicare-covered services that the VA does not.

Frequently asked questions