Medicare Information for Veterans
If you have or can get both Medicare and veterans benefits, you may choose to get treatment under either program. But you have to choose one program or the other each time you need care. Medicare cannot pay for the same service paid for by the Department of Veterans Affairs (VA). Nor can the VA pay for the same service paid for by Medicare.
If You Choose to Use Your Veterans Benefits
If you choose to use your veterans benefits, Medicare generally cannot pay for services you get. Medicare cannot pay for the services you get from VA hospitals or other VA facilities. (There is an exception to this rule. There are cases where Medicare can pay for emergency inpatient and outpatient hospital services.) Medicare generally cannot pay if the VA pays for VA-authorized services that you get in a hospital that is not part of the VA system or from a doctor who is not affiliated with the VA.
If You Choose to Use Your Medicare Benefits
If you choose to use your Medicare benefits, Medicare can pay for Medicare-covered services you get from hospitals and doctors not affiliated with the VA, as long as the VA will not be paying for the same services.
When Covered Services are Different, Medicare and VA Each Help Pay
If the VA authorizes you to get hospital services in a hospital that is not a VA hospital, but does not pay for all the services you get during your stay, Medicare can pay for Medicare-covered services for which the VA does not pay. For example, if the VA authorizes a five-day stay and you remain in the hospital for 10 days, Medicare can pay for the Medicare-covered services you got during the five days not authorized by the VA.
Co-payments: Sometimes Medicare Can Pay or Help Pay
The VA charges co-payments to some veterans with non-service connected conditions. The co-payment is the veteran's share of the cost of treatment. The veterans who are charged co-payments are those at or above certain income. Sometimes, Medicare can pay part or all of this co-payment amount. Medicare cannot pay you for VA co-payments for services furnished by VA hospitals and facilities, unless the services are emergency inpatient or outpatient hospital services. Medicare can pay if the VA charges you a co-payment for VA-authorized care by a doctor or hospital not affiliated with VA. Medicare may be able to pay all or part of your VA co-payment.
Fee Basis Cards: Sometimes Medicare Can Help Pay
The VA issues "fee basis ID cards" to certain veterans. You may be issued a fee basis care because:
- You have a service connected disability.
- You will need medical services for an extended period of time; or there are no VA facilities in your area that can furnish the care you need.
If you have a fee basis card, you may choose any doctor you wish to treat you for the condition specified on the card. If the doctor accepts you as a patient and bills the VA for his or her services, the doctor must accept VA's payment as payment in full. The doctor may not bill you or Medicare for any charges not paid by the VA. If your doctor does not accept the fee basis card, you may file a claim with the VA yourself. The VA then pays the VA-approved amount, either to you or the doctor. If the VA payment is less than the Medicare-approved amount for the services, Medicare can pay benefits to supplement the VA payment. For this to happen, your doctor must bill Medicare for that portion of his or her charges not paid by the VA. Your doctor must attach a copy of the VA's explanation of benefits to the Medicare claim form. (The VA's explanation of benefits comes with the VA payment.) Medicare payment may be delayed in some cases. When you choose to get your services under the Medicare program and you are also eligible for VA fee basis benefits, your VA fee basis eligibility may delay processing of your Medicare claim. The delay occurs because the contractor that pays Medicare claims must contact your doctor to make sure that the VA is not being billed for the same services for which Medicare has been billed NOTE: If you have Medigap insurance, it may be required to pay for VA services as if they were Medicare-covered services.
Where to Get Help
If you have questions about whether the VA or Medicare should pay for your doctor services and other medical services, contact the contractor that pays your Medicare claims. If you have questions about whether the VA or Medicare should pay for hospital services or services furnished by other facilities, ask the provider of services to contact the Medicare intermediary.