InsuranceFAQs

va advised i qualified for free va care. why are they charging me on my private insurance

by Devyn Lehner Published 2 years ago Updated 1 year ago

How do VA health care charges apply to private insurance?

Your private insurer may apply your VA health care charges toward your annual deductible (the amount of money you pay toward your care each year before your insurance starts paying for care). Does my current health insurance status affect whether I can get VA health care benefits?

Can I get Free VA health care as a veteran?

Can I get free VA health care as a Veteran? You can get free VA health care for any illness or injury that we determine is related to your military service (called "service connected"). We also provide certain other services for free.

Do I need any other insurance if I have VA health care?

Being signed up for VA health care meets your Affordable Care Act health coverage requirement of having “minimum essential health coverage.” You don’t need any other insurance to meet this requirement. We’ll update this site if the ACA changes with new laws. Learn more about the ACA, VA, and you

Is VA health care covered under the Affordable Care Act?

Yes. Being signed up for VA health care meets your Affordable Care Act health coverage requirement of having “minimum essential health coverage.” You don’t need any other insurance to meet this requirement. We’ll update this site if the ACA changes with new laws.

How many priority groups are there for VA?

When you apply for VA health care, you’ll be assigned 1 of 8 priority groups. This system helps to make sure that Veterans who need immediate care can get signed up quickly. Your priority group may affect how soon we sign you up for health care benefits.

How many months of active duty do you have to serve?

If you enlisted after September 7, 1980, or entered active duty after October 16, 1981,you must have served 24 continuous months or the full period for which you were called to active duty, unless any of the descriptions below are true for you.

Can I get VA health care benefits if I served in the military?

Am I eligible for VA health care benefits? You may be eligible for VA health care benefits if you served in the active military, naval, or air service and didn’t receive a dishonorable discharge.

Does VA health care meet the ACA?

If I’m signed up for the VA health care program, does that mean I meet the requirements to have health care under the Affordable Care Act (ACA)? Yes. Being signed up for VA health care meets your Affordable Care Act health coverage requirement of having “minimum essential health coverage.”.

Can you request a restriction on VA health information?

You can submit a restriction request asking us not to disclose your health information for billing purposes, but we’re not required to grant your request. To submit a restriction request, please contact your nearest VA health facility and ask to talk with the privacy officer. You can also ask to talk with the billing office for more information.

Can HRAs reimburse you for non service connected conditions?

We may also accept reimbursement from HRAs for care we provide to treat your non-service-connected conditions.

Does VA pay deductible?

Your private insurer may apply your VA health care charges toward your annual deductible (the amount of money you pay toward your care each year before your insurance starts paying for care).

Do you have to bill your spouse's health insurance?

We’re required by law to bill your health insurance (including your spouse’s insurance if you’re covered under the policy). The money collected goes back to VA medical centers to support health care costs provided to all Veterans.

Do we bill Medicare or Medicaid?

We don’t bill Medicare or Medicaid, but we may bill Medicare supplemental health insurance for covered services.

What is VA approved walk in clinic?

This may include care at a VA-approved: Walk-in retail health clinic for minor illnesses like a sore throat or earache. Urgent care facility for more pressing (but not life-threatening) illnesses or injuries that require treatment like splinting, casting, or wound care.

What are the benefits of being a veteran?

Treat illnesses and injuries. Prevent future health problems. Improve your ability to function. Enhance your quality of life. All Veterans receive coverage for most care and services, but only some will qualify for added benefits like dental care. The full list of your covered benefits depends on:

Does VA health insurance meet the ACA?

You should also know that being signed up for VA health care meets your Affordable Care Act (ACA) health coverage requirement of having “minimum essential health coverage.” We’ll update this site if the ACA changes with new laws.

Do veterans need to complete a financial assessment?

This will depend on factors like your income level, disability rating, and military service history. Most Veterans need to complete a financial assessment when they enroll. This helps us determine if you qualify for free VA health care. Learn more about VA copays.

Do veterans get dental insurance?

All Veterans receive coverage for most care and services, but only some will qualify for added benefits like dental care. The full list of your covered benefits depends on:

Do you have to pay a VA copay if you live in Alaska?

You don't need us to approve (or "preauthorize") your care before you get treated, and. You don't need to pay a VA copay. If you live in A laska. You may be able to receive care through an Indian Health Service facility or Tribal Health facility even if you're not an eligible American Indian or Alaska Native Veteran.

What is a VA health card?

The VHIC safeguards your personal information – the member ID and card number have eliminated the need for your Social Security number to be on the card. Similar to a typical health insurance card, the VHIC signifies your enrollment in VA health care.

How long do you have to serve in the military to be eligible for the VA?

Most Veterans who enlisted after September 7, 1980, or entered active duty after October 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty to be eligible. This minimum duty requirement may not apply to Veterans who were discharged for a disability incurred or aggravated in the line of duty, were discharged for a hardship or received an “early out.” Since there are a number of other exceptions to the minimum duty requirements, VA encourages all Veterans to apply to determine their enrollment eligibility.

What is a VHIC card?

The VHIC is used as proof of identity and to check in for appointments at VA health care facilities. While the card is not required to receive health care, VA recommends all enrolled Veterans have one.

What is the VA handbook?

The handbook will detail your VA health care benefit information, based on your specific eligibility factors, in an organized, easy-to-read format. It also includes information on your preferred facility, copayment responsibilities, how to schedule appointments, ways to communicate treatment needs and more.

What does a notification letter mean for a veteran?

If the information provided assists in determining that the Veteran is eligible for enrollment, the Veteran will receive a notification letter indicating continued eligibility status. If the Veteran is determined not eligible for enrollment, the Veteran will receive a notification letter indicating the:

What can veterans expect from their Pact?

Veterans can expect their PACT to help them use health care services, including eHealth technologies , which are necessary to optimize their health and well-being. For more information, visit www.patientcare.va.gov/primarycare/PACT.asp or contact the enrollment coordinator at your local VA medical facility.

How long does it take for a VA to notify you of a disenrollment?

Enrolled Veterans who are receiving health care benefits and are later determined to not be eligible for enrollment will be notified via letter 60 days prior to disenrollment. This will give the Veteran adequate time to provide VA with the needed information to finalize the enrollment decision and, if necessary, transfer his or her medical care to the private sector or to seek other options for medical care.

What does priority 7 mean for VA?

If you are a Priority 7 veteran, providing us your insurance information will allow us to bill your insurance carrier, which will offset part or all of your co-payment. The law requires VAto bill private health insurance companies for all non service-connected care a veteran receives. VA’s budget and your future care could depend on the amount VA is able to collect from private health insurance carriers. By not giving us insurance information you may be limiting your future care and that of many other veterans.

Is the new health care law a different animal?

The new health care law is an entirely different animal, and it would reqire a discussion in politics to come to some kind of understanding.. and I am not going there.

Does the provider get free money?

The strange thing is that everyone loves it. The provider gets some "free" money. The insurer increases revenue (and therefore profits). The consultant gets another contract. And, the user pays nothing out-of-pocket--"the insurance pays it." However, that extra half-dollar comes from somewhere--premiums, taxes--and buys no more health care.

Can you recover a VA bill if you have private insurance?

Yes when you have private Insurance VA will bill them to recover any cost they can. You are not responsible for any Copay or deductible not paid. You are only responsible for bill from VA.

Can the VA get reimbursement from Medicare?

The VA is allowed to seek reimbursement from private insurance companies for conditions that are not service connected. They cannot get reimbursement from Medicare since it is just another government source.

Does IU back charge for SC?

It is my understanding they will not back charge your insurance for any SC issues but anything else is fair game, for instance if you have SC related heart issues they will not back charge blood work but if you a re SC for your back and they are doing a general physical, they will. I think at 100% or IU they don't back charge anything

Can VA bill insurance for non service connected conditions?

Of course VA can bill insurance companies for treatment for any condition that is not service connected regardless of the veteran's evaluation. The advantage to those veterans who have to pay a co-pay is that anything that is paid by insurance will go against the VA co-pay; but at the end of the day VA has every legal right in the world to bill insurance when it involves non -service connected conditions.

How to update VA health insurance?

Once you have established your eligibility for VA health care benefits, you will need to fill out Form 10-10EZ or Form 10-10EZR to apply for benefits. These forms are also used to update your current information if anything has changed. There are several ways you can fill out or update the 10-10EZ: online, by phone, by mail, or in-person at a VA medical facility. Here is the info you need: 1 Online: Visit this link and fill out the form. 2 Phone: Call 1-877-222-VETS (8387), Mon-Fri, 8:00 am – 8:00 pm EST. A VA rep will send you a completed form via mail. You will need to verify and sign the form, then return it to the VA. 3 Mail: Complete Form 10-10EZ or Form 10-10EZR and mail it to Health Eligibility Center, 2957 Clairmont Road, Suite 200, Atlanta, GA 30329-1647. 4 In person: Visit any VA Medical Center or clinic. Here is the VA Directory.

What are the eligibility factors for VA health care?

VA health care eligibility factors: VA health care eligibility is based on many issues, including active duty military service, type of military discharge, service-connected disabilities, medical conditions incurred while in the service, location of service, and more. You can be eligible based on your service dates, deployments you served on, ...

How does the VA determine a veteran's income?

The VA automatically determines the veteran’s income and deductible expenses by matching records with the Internal Revenue Service and Social Security Administration.

Do veterans have to establish eligibility each year?

However, some veterans will need to establish eligibility each year to maintain their enrollment priority. This is generally the case for veterans who qualify for VA medical care based on their income or other information that can change from year to year.

Can military veterans receive medical care?

Many military veterans aren't aware they are eligible to receive medical care through the VA. This guide shows you how to determine if you are eligible and learn how to enroll in VA health care.

Can you get VA health care if you are on active duty?

Members of the National Guard and Reserves may be eligible for VA health care benefits if they were called to active duty on a Federal Executive Order (this generally excludes active duty for training purposes). Other groups of servicemembers may also be eligible for VA medical care.

Can you visit a VA clinic?

Each case is unique, and final benefits decisions rest with the VA. VA health care eligibility only means you can visit VA medical centers and clinics for health care. It does not necessarily mean all health care is 100% free (some medical care may be free, however, many veterans may be required to pay a co-pay).

Why are veterans not eligible for VA health care?

But because of rules that changed in 2003, veterans are no longer eligible for VA Health Care because of their veteran status . The reason for this is rather straightforward: budget cuts. In 2003, Congress passed a budget that included a freeze on veterans qualifying for benefits, what the VA calls Priority 8.

How many priority groups does the VA have?

The VA has eight priority groups that it uses to qualify veterans for VA-funded health care. The highest priority groups are reserved for those veterans with “service connected” disability ratings, or veterans in special groups such as: Former POWs; Those exposed to Agent Orange; Recipients of the Medal of Honor; and. Recipients of a Purple Heart.

What is the result of the VA cuts?

The result of these cuts was that the VA no longer could accept new veterans into Priority Group 8, and veterans who do not qualify for one of the higher-priority groups are no longer eligible for VA-funded health care.

Can veterans be grandfathered into priority 8?

Veterans already enrolled in Priority 8 were grandfathered in and allowed to continue receiving VA health care in that priority group.

Do veterans qualify for VA health insurance?

Many veterans are stunned to hear that they do not qualify for VA Health Care simply because they are veterans. Most veterans who have private health insurance with significant co-pays – especially for expensive treatments like chemotherapy – are looking for alternatives to get their treatments paid for by the VA.

Is the VA getting worse?

Unfortunately, the VA guidelines are probably going to get worse before they get better. As recently as last year, the House of Representatives proposed a plan to cut VA Health Care for those in Priority Groups based on income, specifically those who have incomes above the national threshold (currently $36,554 per year for a veteran and one dependent) but who are below the geographic threshold.

Can you file asbestos claims with the VA?

Our Veterans Department can help you or a loved one file asbestos-related VA claims and access potential benefits.

Basic Eligibility For VA Health Care

  • If you served in the active military, naval or air service and are separated under any condition other than dishonorable, you may qualify for VA health care benefits. Current and former members of the Reserves or National Guard who were called to active duty (other than for training only) by a federal order and completed the full period for which t...
See more on va.gov

Minimum Duty Requirements

  • Most Veterans who enlisted after September 7, 1980, or entered active duty after October 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty to be eligible. This minimum duty requirement may not apply to Veterans who were discharged for a disability incurred or aggravated in the line of duty, were discharged for a hards…
See more on va.gov

Enrolled, But Later Determined Ineligible

  • Enrolled Veterans who are receiving health care benefits and are later determined to not be eligible for enrollment will be notified via letter 60 days prior to disenrollment. This will give the Veteran adequate time to provide VA with the needed information to finalize the enrollment decision and, if necessary, transfer his or her medical care to the private sector or to seek other …
See more on va.gov

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