Medicare and Veteran’s Benefits
Dual Coverage – Who Pays First?
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Frequently Asked Questions (FAQs)
How long do I have to wait to get into the hospital or see a doctor?
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Question: I have Medicare and Veteran’s benefits. Who pays first?
Answer: If you have or can get both Medicare and Veterans benefits, you can get treatment under either program. When you get health care, you must choose which benefits you are going to use. You must make this choice each time you see a doctor or get health care, like in a hospital. Medicare cannot pay for the same service that was covered by Veterans benefits, and your Veterans benefits cannot pay for the same service that was covered by Medicare. You do not have to go to a Department of Veterans Affairs (VA) hospital or to a doctor who works with the VA for Medicare to pay for the service. However, to get services paid by VA, you must go to a VA facility or have the VA authorize services in a non-VA facility.
Question: Are there any situations when both Medicare and VA can pay?
Answer: Yes. If the VA authorizes services in a non-VA hospital, but doesn’t pay for all of the services you get during your hospital stay, then Medicare may pay for the Medicare-covered part of the services that the VA does not pay for.
Example: John, a veteran, goes to a non-VA hospital for a service that is authorized by the VA. While at the non-VA hospital, John gets other non-VA authorized services that the VA refuses to pay for. Some of these services are Medicare-covered services. Medicare may pay for some of the non-VA authorized services that John received. John will have to pay for services that are not covered by Medicare or the VA.
Question: Can Medicare help pay my VA co-payment?
Answer: Sometimes. The VA charges a co-payment to some veterans. The co-payment is your share of the cost of your treatment, and is based on income. Medicare may be able to pay all or part of your co-payment if you are billed for VA-authorized care by a doctor or hospital that is not part of the VA.
Question: I have a VA fee basis ID card. Who pays first?
Answer: The VA gives fee basis ID cards to certain veterans. You may be given a fee basis card if: •You have a service connected disability; •You will need medical services for an extended period of time; or •There are no VA hospitals in your area.
If you have a fee basis ID card, you may choose any doctor that is listed on your card to treat you for the condition. If the doctor accepts you as a patient and bills the VA for services, the doctor must accept the VA’s payment as payment in full. The doctor may not bill either you or Medicare for any charges. If your doctor doesn’t accept the fee basis ID card, you will need to file a claim with the VA yourself. The VA will pay the approved amount to either you or your doctor.
Question: Where can I get more information?
Answer: You can get more information on Veterans’ benefits by calling your local VA office, or the national VA information number 1-800-827-1000 . Or, you can use a computer to look on the Internet at www.va.gov. If you do not have a computer, your local library or senior center may be able to help you get this information using their computer.
Question: If I have additional question on my Medicare coverage, who do I call?
Resources & Links
VHA’s enrollment system one year ago had roughly 867,000 “pending” records. VA’s OIG found that about 35% of the pending claims were for veterans who investigators determined were deceased (Muchmore, Modern Healthcare, 9/2) CA Health Line 9.3.2015
38 U.S. Code Chapter 17 – HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
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