WHAT YOU SHOULD KNOW ABOUT VETERANS & MEDICARE
VA & OTHER HEALTH INSURANCE
If you have health coverage other than what is offered through VA, you can continue to use those services through the plan you subscribe to. It is a good idea to inform your VA health care provider if you are receiving care outside of VA as well, so your health care can be coordinated with other providers.
VETERANS & MEDICARE COVERAGE
Creditable Coverage Enrollment in the VA health care system is considered creditable coverage for Medicare Part D purposes. This means VA prescription drug coverage is at least as good as the Medicare Part D coverage. Since only Veterans can enroll in the VA health care system, dependents and family members do not receive credible coverage under the Veteran’s enrollment. VA does not recommend Veterans cancel or decline coverage in Medicare (or other health care plans) solely because they are enrolled in VA health care. VA does not normally provide care for Veterans’ dependents and family members. In addition, Veterans who elect to cancel their Medicare Part B coverage, would not be able to obtain coverage until January of the following year. There is no guarantee that in future years Congress will appropriate sufficient medical care funds for VA to provide care for all enrollment priority groups. This could leave Veterans, especially those enrolled in one of the lower-priority groups, with no access to VA health care coverage. For this reason, having a secondary source of coverage may be in the Veterans’ best interest.
ENROLLING IN BOTH VA & MEDICARE CAN PROVIDE VETERANS FLEXIBILITY
Selecting Medicare Part A coverage comes at no added cost, whereas Part B comes with a monthly premium. Some Veterans may choose to delay enrollment in Part B if they already have other (mainly employer) coverage; however, if a Veteran delays Part B enrollment initially but decides to enroll at a later date, then they would have to pay a monthly penalty to Medicare. In other words, VA health coverage does not protect against having to pay a penalty for Part B, like it does for Part D. Having VA health care does not qualify as “other” coverage for Part B. Veterans should bring their Medicare cards to their next VA appointment to update their private health insurance information.
PRIVATE HEALTH INSURANCE
When Veterans have VA health care and other health plans, community health care providers may not bill any other health plan for non-emergent care authorized by VA. If you have both VA and another health plan and receive emergency care at a community facility for the treatment of a service-connected condition, please indicate to bill the VA. The VA will consider the bill under your Veteran benefits package. Your health insurance should not be billed for service-connected care. If a Veteran wishes to use their VA benefit in the community, only VA should be billed. VA will bill your OHI, if appropriate, for reimbursement. There are limitations on VA’s ability to provide coverage for emergency care at a community facility when you have other health insurance. If you have other health insurance but the insurance does not fully cover the cost of treatment, VA may pay certain costs for which you are personally liable, unless payment by your insurance provider was denied because you or your medical provider failed to comply with the provisions of your health plan contract or third-party payer; for example, failure to submit a bill or medical records within specified time limits, or failure to exhaust appeals of the denial of payment. VA is required to bill other health plans for medical care, supplies and prescriptions provided for the treatment of Veterans’ nonservice-connected conditions. All Veterans applying for VA health care are required to provide information on their health plan coverage, including coverage provided under health plan policies of their spouses, if applicable. The VA health care benefit is NOT considered a health insurance plan. Enrolled Veterans can provide or update their insurance information by: • Using the VA Form 10-10EZR (Health Benefits Update Form) at www.va.gov/health-care/update-health information/. • Calling 877-222-VETS (877-222-8387) Monday through Friday between 8:00 a.m. and 8:00 p.m. ET. • Presenting their health insurance card to the clinic clerk during check-in.