VA medical centers can bill Medicare Advantage plans (supplemental Medicare), as these are private insurance policies purchased through a third party. By law, however, the VA cannot bill traditional Medicare (Medicare Part A Part B) plans issued by the federal government.
VA medical centers may bill a patient’s Medicare Advantage plan for services not covered by their VA benefits. These are considered non-service-connected conditions and are billed to the private insurance policy. If the plan holder’s supplemental Medicare plan doesn’t cover certain services, then the patient may have to pay out-of-pocket for care.
Individuals eligible for VA medical benefits may still be eligible to enroll in a supplemental Medicare plan for services not covered by the VA. Supplemental Medicare plans can include dental care, certain medications, vision care and preventative care, such as gym memberships and healthy food purchases. Enrollment in Medicare Part B is a requirement for eligibility in Medicare Advantage plans.
Enrolling in both Medicare Advantage and VA health benefits allows more flexibility for treatment, giving the patient more options for health care providers. Those who sign up for Medicare Part D, the plan that covers prescription medications, can have their prescriptions filled at a local pharmacy, instead of going through the VA mail-order plan.
It’s generally best to inform the VA doctor about any care provided outside of the VA health care network, as they can help coordinate patient care.
Individuals with dual health care enrollment must decide which coverage they wish to use before seeking treatment. To use VA benefits, treatment must be from a VA medical center or other location. Individuals may also receive services from a non-VA hospital or care setting if they obtain pre-authorization from the VA. In these cases, there may be a VA co-pay for non-service-connected care.
Each supplemental Medicare plan is different, designed to cover a specific range of services. An individual may have two or three supplemental plans to cover general medical care, prescriptions, health care coverage while traveling and dental or optometric services. If the policyholder receives these types of services from a VA medical center, then the VA can bill whichever plans cover those services.
For specific questions about which insurance pays first, or if plan coverage changes, enrollees are encouraged to call the customer service department of the supplemental Medicare provider.