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If you are eligible for Veterans Administration (VA) health insurance and you have another form of health care coverage, such as a private insurance plan, Medicare, Medicaid or TRICARE, you can continue to use VA along with these plans. It is always a good idea to inform your VA doctors if you are receiving care outside of VA so your health care can be coordinated.

Private Health Insurance

Veterans with private health insurance may choose to use these sources of coverage as a supplement to their VA health care benefits.  Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance.

VA is required, by law, to bill private health insurance providers for medical care, supplies and prescriptions provided for treatment of Veterans’ nonservice-connected conditions.  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.  Any payment received by VA may be used to offset “dollar for dollar” a Veteran’s VA copay responsibility.

Funds that VA receives from third party health insurance carriers go directly back to VA Medical Center’s operational budget.  That money can be used to hire more staff or buy medical equipment to improve Veterans health care.  Enrolled Veterans can provide or update their insurance information by:

• Using the online Health Benefits Renewal form (10-10-EZR) at www.vets.gov/healthcare/apply/
• Calling 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. ET.
• Presenting their health insurance card to the clinic clerk during check-in. VA health care is NOT considered a health insurance plan

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.

Under Medicare Part B, VA health care is NOT creditable coverage.  Creditable coverage under Medicare Part B can only be provided through an employer.  Although a Veteran may avoid the late enrollment penalty for Medicare Part D by citing VA health care enrollment, that enrollment would not help the Veteran avoid the late enrollment penalty for Part B.

VA does not recommend Veterans cancel or decline coverage in Medicare (or other health care or insurance programs) solely because they are enrolled in VA health care.  Unlike Medicare, which offers the same benefits for all enrollees, VA assigns enrollees to enrollment priority groups based on a variety of eligibility factors, such as service-connection and income.  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 Veterans’ best interest.
Enrolling in both VA and Medicare can provide Veterans flexibility.  For example, Veterans enrolled in both programs would have access to community physicians (under Medicare Part A or Part B) and can obtain prescription drugs not on the VA formulary if prescribed by community physicians and filled at their local retail pharmacies (under Medicare Part D).

CHAMPVA benefits

If you are the spouse or child of a veteran with disabilities or a veteran who has died, you may be eligible for health benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). This program is for people who do not qualify for TRICARE, which is for active duty and retired military personnel and their family members.

You may qualify for CHAMPVA benefits if you do not qualify for TRICARE and you meet at least one of the following conditions:

• You are the spouse or child of a veteran with a service-connected disability
• You are the surviving spouse or child of a veteran who died from a service-connected disability, or who was at the time of death permanently disabled from a service-connected disability
• You are the surviving spouse or child of a service member who died in the line of duty, not due to misconduct

Note: A service-connected disability is a disability that the U.S. Department of Veterans Affairs (VA) concluded was caused—or made worse—by the veteran’s active-duty service. A permanent disability is one that is not expected to improve.

If you have both Medicare and CHAMPVA, they will work together to cover your health care costs. Medicare will pay first, and CHAMPVA is always the secondary payer. CHAMPVA will help pay out-of-pocket costs, such as deductibles and coinsurances.

Keep in mind that CHAMPVA beneficiaries with Medicare cannot receive Medicare-covered care at a VA Medical Center, because Medicare does not pay for any care that you receive at a VA facility.

CHAMPVA benefits offer creditable drug coverage. This means that if you are enrolled in CHAMPVA drug coverage, you can delay Medicare Part D enrollment without incurring a late enrollment penalty (LEP).