Information on Veteran’s Health Insurance and Copays at VA
Why VA Bills Your Health Insurance
VA is required by law to bill any health insurance carrier that provides coverage for you, including policies held by your spouse. Veterans who are treated for a nonserviceconnected condition can expect to see their insurance company billed for their treatment. VA does not bill Medicare or Medicaid.
Please NOTE: VA is not authorized to bill VA copays to a High Deductible Health Plan (which are usually linked to a Health Savings Account).
Where the Money Goes
Money collected from health insurance reimbursements are returned to the medical centers and used to enhance the health care services provided to Veterans.
For this to happen, information must be obtained regarding your health insurance coverage. VA staff may call you at home to obtain this information or they may ask you for it when you check in for an appointment at the medical center. Always bring your insurance card with you when you come to VA. This will provide the facility with your current insurance information.
Insurance Coverage and Eligibility for VA Health Care
Your insurance coverage or lack of insurance coverage does not determine your eligibility for treatment at a VA health care facility.
VA’s Financial Assessment (Means Test)
Most nonservice-connected Veterans are required to complete an annual fi nancial assessment. A fi nancial assessment consists of your family’s income and assets; this includes your spouse’s income and dependent children’s too.
If your income and assets fall below the income thresholds: You will not be charged a copay for medical treatment, but VA will bill your insurance carrier for your nonservice-connected care. You may also be responsible for medication or extended care copays.
If your income and assets exceed the income thresholds: VA will bill your insurance carrier for your nonserviceconnected medical treatment and for medications. You will be responsible for copays for nonservice-connected medical treatment, medications and extended care services.
The Medication Copay applies to each prescription, including each 30-day supply or less of maintenance medications prescribed on an outpatient basis for nonservice-connected conditions. This copay may change annually.
Please note: Medication copays are charged for all over-the-counter medications such as aspirin, cough syrup, vitamins, etc., that are dispensed from a VA pharmacy. Therefore, you may want to consider purchasing over-the-counter medications on your own.
Veterans who have a Service Connection rating of 40% or less and whose income is at or below the applicable pension thresholds (which can be found at: www.va.gov/healtheligibility) may wish to complete a medication copay exemption test.
- Outpatient
- Inpatient
- Extended Care
- Medication Copay
You may be responsible for one or more of the federally mandated copays VA is required to charge.
Health Savings Accounts (HSA) cannot be utilized to make VA copays.
Please NOTE: Because copay rates may change annually, they are published separately. Current year rates can be obtained at any VA health care facility or at our Web site: www.va.gov/healtheligibility/costs.
For more information regarding health insurance billing and copays, call the toll free number that is listed on your statement or call the Health Revenue Center at: 1-866-393-4074.
Q. If I am required to make a copay and can’t, will VA withhold my treatment or medications?
A. No. VA will not withhold any treatment or medication. An account is automatically established when you are required to make a copay. However, if you are having fi nancial difficulties and unable to pay assessed copay charges, you may apply for a hardship, waiver, compromise, or repayment plan.
Q. I am presently covered by my spouse’s insurance policy. Do I need to tell VA this when I register?
A. Yes. VA is required by law to bill your spouse’s insurance company, provided you are covered under your spouse’s insurance policy, for nonservice-connected medical care.
Q. Will my health insurance cover my copay charge?
A. In most cases yes. Reimbursements received from insurance carriers will be used to offset or eliminate your copay on a dollar for dollar basis. The unpaid VA copay balance remains your payment responsibility.
Please NOTE: You are not responsible for the balance of your insurance company’s bills, deductibles or cost shares.
Federal Benefits for Veterans and Dependents
VA National Income Thresholds |
VA National Geographic Income Thresholds
For questions about Health Care Eligibility, please visit the VA inquiry website.
|
