Health Care Insurance

Private Health Insurance

Health insurance coverage through Veteran or Veteran's spouse provided by employer, Veteran or other non-federal source.

VA health care is NOT considered a health insurance plan.

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 for any unpaid balance that the insurance carrier does not pay except for VA copay.
Payments from your private health insurance carrier may allow us to offset part or all of your copay.
Many private health insurance companies will apply VA health care charges toward the satisfaction of your annual deductible.

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 that 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 nonservice-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 does not bill High Deductible Health Plans (which are usually linked to a Health Savings Account).

VA’s Financial Assessment (Means Test)

Most nonservice-connected Veterans are required to complete an annual financial assessment. A financial assessment consists of your family’s income and assets; this includes your spouse’s income and dependent children’s too.

If your income and assets fall below the income thresholds: You will not be charged a copay for medical treatment, but VA will bill your insurance carrier for your nonservice-connected care. You may also be responsible for medication or extended care copays.

If your income and assets exceed the income thresholds: VA will bill your insurance carrier for your nonservice-connected medical treatment and for medications. You will be responsible for copays for nonservice-connected medical treatment, medications and extended care services that are not covered by your health insurance payments to VA.

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.

Medication copays are charged for all over-the-counter medications such as aspirin, cough syrup, vitamins, etc., that are dispensed from a VA pharmacy. Therefore, you may want to consider purchasing over-the-counter medications on your own.

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.

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.

Health Savings Accounts (HSA) cannot be utilized to make VA copays.

Because copay rates may change annually, they are published separately. Current year rates can be obtained at any VA health care facility or at our website:
www.va.gov/healthbenefits/cost/copays.asp.

You are not responsible for the balance of your insurance company's bills, deductibles or cost shares.