Closer look at private insurance, VA benefits


By Harold B. Wolford - Veterans Corner



VA health care works with Medicare and other insurance. If you have other forms of health care coverage (like a private insurance plan, Medicare, Medicaid, or TRICARE), you can use VA health care benefits along with these plans.

Why does VA require me to provide information on my health insurance coverage (including coverage under a spouse’s plan)? VA asks for this information because we have to bill your private health insurance provider for any care, supplies, or medicine we provide to treat your non-service-connected conditions (illnesses or injuries that aren’t related to your military service). VA doesn’t bill Medicare or Medicaid, but we may bill Medicare supplemental health insurance for covered services.

What if my health insurance provider doesn’t cover all the non-service-connected care that the VA bills them for? You won’t have to pay any unpaid balance not covered by your health insurance provider. But, depending on your assigned priority group, you may have a copay for non-service-connected care. Learn more about eligibility priority groups.

Does it help me in any way to give the VA my health insurance information? Yes. Giving the VA your health insurance information helps you because of the following. When your private health insurance provider pays the VA for your non-service-connected care, they may be able to use the funds to offset part — or all — of your VA copayment. Your private insurer may apply your VA health care charges toward your annual deductible (the amount of money you pay toward your care each year before your insurance starts paying for care).

Does my current health insurance status affect whether I can get VA health care benefits? No. Whether or not you have health insurance coverage doesn’t affect the VA health care benefits you can get.

If I’m signed up for the VA health care program, does that mean I meet the requirements to have health care under the Affordable Care Act (ACA)? Yes. Being signed up for VA health care meets your Affordable Care Act health coverage requirement of having “minimum essential health coverage.” You don’t need any other insurance to meet this requirement. You can learn more about the ACA, VA, and you on VA.gov.

Note: It’s always a good idea to let your VA doctor know if you’re receiving care outside VA. This helps your provider coordinate your care to help keep you safe and make sure you’re getting care that’s proven to work and that meets your specific needs.

Should I give up my private insurance or other insurance (like TRICARE or Medicare) if I’m accepted into the VA health care program? This is your decision. You can save money if you drop your private health insurance, but there are risks. VA encourages you to keep your insurance because:

• VA doesn’t normally provide care for veterans’ family members. So, if you drop your private insurance plan, your family may not have health coverage.

• VA doesn’t know if Congress will provide enough funding in future years for VA to care for all veterans who are signed up for VA health care. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future. If you don’t keep your private insurance, this would leave you without health coverage.

• If you have Medicare Part B (coverage for doctors and outpatient services) and you cancel it, you won’t be able to get it back until January of the following year. You may also have to pay a penalty to get your coverage back (called reinstating your coverage).

If I already have VA health care benefits, should I still sign up for Medicare when I turn 65? Yes. VA encourages you to sign up for Medicare as soon as you can. This is because:

• VA doesn’t know if Congress will provide enough funding in future years for us to provide care for all veterans who are signed up for VA health care. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future.

• Having Medicare means you’re covered if you need to go to a non-VA hospital or doctor, so you have more options to choose from.

• If you delay signing up for Medicare Part B (coverage for doctors and outpatient services) and then need to sign up later because you lose your VA health care benefits or need more choice in care options, you’ll pay a penalty. This penalty gets bigger each year you delay signing up — and you’ll pay it every year for the rest of your life.

• If you sign up for Medicare Part D (coverage for prescription drugs), you’ll be able to use it to get medicine from non-VA doctors and fill your prescriptions at your local pharmacy instead of through the VA mail-order service. There’s no penalty for delaying Medicare Part D.

If I’m signed up for VA health care, and I also have Medicare, what’s covered by each? You’ll need to choose which benefits to use each time you receive care. To use VA benefits, you’ll need to get care at a VA medical center or other VA location. VA will also cover your care if they preauthorize you (meaning they give you permission ahead of time) to get services in a non-VA hospital or other care setting.

Keep in mind that you may need to pay a VA copayment for non-service-connected care. If you go to a non-VA (or VA authorized) care facility, Medicare may pay for other services you may need during your stay. Or, if VA only authorizes some services in a non-VA location, then Medicare may pay for other services you may need during your stay. Check your Medicare plan so you know which care locations and services you’re covered for.

Can I use my Health Savings Account (HAS) or Health Reimbursement Arrangement (HRA) to help pay for VA care for non-service-connected conditions? Yes. VA may bill and accept reimbursement from High Deductible Health Plans (HDHPs) for medical care and services to treat your non-service-connected conditions. If you have an HDHP linked to an HSA, you can use your HSA to pay your VA copayments for non-service-connected care. VA may also accept reimbursement from HRAs for care they provide to treat your non-service-connected conditions.

Does VA need my permission to bill my other health insurance for care related to a sensitive diagnosis (like alcohol or drug abuse or HIV)? No. As a result of the VA MISSION Act of 2018, VA no longer needs permission to bill health insurance providers for care related to a sensitive diagnosis (like alcohol or drug abuse, alcoholism, HIV or HIV testing, sickle cell anemia, or other diagnoses included in Public Law 38 U.S.C. §7332-protected information).

VA is now submitting claims to health insurance carriers for all non-service-connected care, even if VA doesn’t have a signature or written authorization permitting VA to disclose protected information on these claims or in Veterans’ medical records. VA is required by law to bill your health insurance (including your spouse’s insurance if you’re covered under the policy). The money collected goes back to VA medical centers to support health care costs provided to all veterans.

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By Harold B. Wolford

Veterans Corner

Harold B. Wolford is president of the Vietnam Veterans of America Chapter 1095. He served in the United States Army from 1970 to 1973. Wolford can be reached via email at harold@wolfordhome.com.

Harold B. Wolford is president of the Vietnam Veterans of America Chapter 1095. He served in the United States Army from 1970 to 1973. Wolford can be reached via email at harold@wolfordhome.com.