VA Mid-Atlantic Health Care Network
Billing & Insurance
Private Health Insurance
VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare supplemental plans. Generally, VA does not bill Medicare or Medicaid for reimbursement; however, VA does bill other types of health insurance including Medicare Supplemental plans for covered services.
Note: A Veteran’s insurance coverage or lack of insurance coverage 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 policies of their spouses. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. However, Veterans may be responsible for a VA copayment depending on their assigned Priority Group.
Importance of Providing Health Insurance Information
- 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.
- Payments received from a Veteran’s private health insurance carrier are credited towards any applicable VA copayments, reducing all or part of the Veterans out-of-pocket expenses.
- Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse.
- Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. The funds are used to provide the best care possible to our Veterans.
Cancelling Private Health Insurance
Veterans who have private health insurance should consider a number of important factors before canceling their health insurance, such as:
- Impacts to Family Members. VA does not normally provide care for family members of Veterans enrolled in VA health care. If you cancel your private health insurance, they may have no health care coverage.
- Disenrollment in VA health care. 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 a Veteran with no health care coverage.
- Medicare Parts A and B. VA does not require a Veteran to have Medicare Part A or B to be enrolled in VA health care. However, Veterans should always consider their current and future health care needs before changing any insurance 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.
In most cases, if you don't sign up for Part B when you are first eligible, you'll have to pay a late enrollment penalty. You will have to pay this penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Coverage will start July 1 of that year.
For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance.