VA Benefits and Medicare: Using Both Without Double Bills

If you have both Department of Veterans Affairs (VA) health benefits and Medicare, you can get care under either program, but Medicare and the VA can't pay for the same service. Medicare doesn't pay for care you get at a VA facility, and the VA pays for VA-authorized care at a VA or approved non-VA facility. Each time you get care, you choose which coverage to use, and that choice decides who gets the bill.

How do VA benefits and Medicare work together?

Medicare's booklet "How Medicare Works with Other Insurance" explains:

• If you have, or can get, both Medicare and veterans' benefits, you can get coverage under either program.
• Medicare doesn't pay for any care you get at a U.S. Department of Veterans Affairs (VA) facility.
• Medicare and the VA can't pay for the same items or services.
• Each time you get care, you'll choose which coverage to use.

Medicare.gov adds that Medicare pays for Medicare-covered items and services, and the VA pays for VA-authorized items or services in a VA or non-VA facility.

What if the VA sends me to a non-VA hospital?

Medicare.gov says if the VA authorizes services in a non-VA hospital but doesn't authorize all the services you get during the stay, Medicare may pay for the Medicare-covered services the VA didn't authorize.

Medicare's booklet also says that if a doctor takes you as a patient and bills the VA for VA-authorized services, the doctor must accept the VA's payment as payment in full. The doctor can't bill you or Medicare for those services.

Why did I get a bill when the VA was supposed to pay?

Common reasons include:

• The care wasn't authorized by the VA. If you went to a non-VA provider without VA approval, the bill may go to Medicare or to you.
• Only part of a stay was authorized. Medicare may cover the rest if it's Medicare-covered.
• The provider billed Medicare instead of the VA, or billed both.
• The provider billed you for VA-authorized care. Medicare's booklet says the doctor must accept the VA's payment as payment in full.

How do I check a bill when I have both?

1. Ask which program was billed. Call the provider: "Did you bill the VA or Medicare for this visit?"
2. Check your Medicare Summary Notice. If the visit was VA-authorized, it usually shouldn't appear on your MSN.
3. Get the VA authorization. If the VA approved the care, ask the provider to bill the VA and mention that it must accept the VA's payment as payment in full.
4. Look for double billing. The same service shouldn't be paid by both.
5. Call the VA if you have questions about a VA-authorized visit.

Should I keep Medicare if I have VA benefits?

The VA's own page on VA health care and other insurance answers this directly. Asked whether veterans with VA health care should still sign up for Medicare at 65, it says yes. Some reasons it and Medicare give:

• Care outside the VA. Medicare lets you see non-VA providers who take Medicare, without VA authorization.
• Emergencies. You may be closer to a non-VA hospital in an emergency.
• Changes in VA eligibility or priority. VA benefits depend on your eligibility and enrollment.
• Part B penalties. The VA says that if you delay Part B and need to sign up later, for example because you lose VA benefits or want more choice, you'll pay a penalty.
• Canceling Part B. The VA says if you cancel Part B, you won't be able to get it back until January of the following year.

A State Health Insurance Assistance Program (SHIP) counselor can walk you through the pros and cons for free.

What about drug coverage?

Medicare's booklet says you may be able to get drug coverage through the VA. You may also join a Medicare drug plan, but you can't use both types of coverage for the same drug at the same time. The VA notes that with a Medicare drug plan, you can fill prescriptions from non-VA doctors at a local pharmacy. If you rely on VA drug coverage instead, ask the VA whether it counts as creditable coverage so you can avoid a Part D late penalty.

What should I say to a billing office?

"I'm a veteran with VA benefits and Medicare. This visit was authorized by the VA on [date], authorization number [number]. Please bill the VA, not Medicare or me. Can you confirm that, and send a corrected statement?"

Frequently asked questions

Does Medicare pay for care at a VA hospital?

No. Medicare doesn't pay for care you get at a VA facility.

Can I use both VA benefits and Medicare?

Yes, but not for the same service. Each time you get care, you choose which program to use.

Can a non-VA doctor bill me for VA-authorized care?

Medicare's booklet says the doctor must accept the VA's payment as payment in full and can't bill you or Medicare for those services.

Will Medicare pay for services the VA didn't authorize?

Medicare may pay for Medicare-covered services the VA didn't authorize, such as part of a non-VA hospital stay.

Want help sorting VA and Medicare bills?

Bill Review Coach is a monthly medical bill review service for seniors and their families. Snap a photo of the bill and your Medicare notice, and we'll help you figure out who should have been billed and what to say when you call. You make the calls and write the emails; we help you know what to say.