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VA Palo Alto Health Care System

 

Billing & Insurance

While many Veterans qualify for enrollment and cost-free health care services based on a compensable service-connected condition or other qualifying factors, certain Veterans will be asked to complete a financial assessment to determine their eligibility for cost-free medical services, medications and travel benefits. Otherwise known as the Means Test, this financial information may be used to determine the applicant’s enrollment priority group and whether he/she is eligible for cost-free VA health care. Higher-income Veterans may be required to share in the expense of their care by paying copays.

Income threshold information

Where the Money Goes

Money collected from health insurance reimbursements is returned directly 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.

For questions regarding your bill, please contact the Health Resource Center at (866) 347-2353.

Private Health Insurance

Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by employer, Veteran or other non-federal source.

VA health care is not considered a health insurance plan.

VA is required to bill private health insurance providers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. Generally, VA cannot bill Medicare, but can bill Medicare supplemental health insurance for covered services.

All Veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Veterans are not responsible for paying any remaining balance of VA's insurance claim not paid or covered by their health insurance, and any payment received by VA may be used to offset "dollar for dollar" a Veteran's VA copay responsibility.

What's in it for me for providing health insurance information?

  • You will not be responsible for any unpaid balance that the insurance carrier does not pay except for VA copay.
  • Payments from your private health insurance carrier may allow us to offset part or all of your copay.
  • Many private health insurance companies will apply VA health care charges toward the satisfaction of your annual deductible.

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.

Risks of Giving Up Your Private Insurance

What should you do with your private health insurance if you are accepted into VA health care? You could save of money if you dropped the insurance, but there are some things you should consider.

  • What about your non-Veteran family members?
  • VA does not normally provide care for family members of Veterans enrolled in VA's health care program. If you drop your private health insurance, they may have no health care coverage.

  • What would happen if you are disenrolled from VA's health care program?
  • There is no guarantee that in subsequent years Congress will appropriate sufficient funds for VA to provide care for all enrollment Priority Groups. This could happen if you are enrolled in one of the lower Priority Groups. This would leave you with no health care coverage.

  • Do I still need Medicare Parts A and B if I receive my health care from VA?
  • VA does not require a Veteran to have Medicare Part A or B to be enrolled in VA health care. However, a Veteran may want to consider their total health care needs before changing any insurance coverage.

  • What would happen if you drop your Medicare Part B coverage?
  • If you cancel your Medicare Part B Coverage, you need to know that you cannot be reinstated until January of the following year, and you may be penalized for reinstatement.

For these reasons, VA encourages you to keep your private health insurance.