Beneficiaries Who Are Entitled to Both Medicare and Veteran's Administration Benefits
Published 01/04/2021
If the beneficiary is entitled to both Medicare and Veteran's Administration (VA) benefits, he or she may choose to receive treatment under either program.
For Patients Entitled to Both Medicare and VA Benefits
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Medicare cannot pay for services received from VA hospitals or other VA facilities (except for certain emergency hospital services)
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Medicare generally cannot pay if the VA pays for VA-authorized services that the beneficiary receives in a non-VA hospital or from a non-VA physician
Since July 1986, the VA has been charging coinsurance payments to some veterans who have non-service-connected conditions when treatment is received in a VA hospital or medical facility, or for VA-authorized treatment by non-VA sources. The VA charges coinsurance payments when the veteran's income exceeds a particular level.
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If the VA charges a coinsurance payment for VA-authorized care by a non-VA physician or hospital, Medicare may be able to reimburse the beneficiary, in part or in whole, from the VA coinsurance payment obligation
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To receive payment, submit a claim to Medicare with the explanation of benefits from the VA, showing how they processed it and the coinsurance charge
Note: Medicare cannot reimburse the beneficiary for VA coinsurance payments when VA hospitals and facilities furnish services, unless the services are emergency inpatient or outpatient hospital services.
CMS regulation references: Publication 100-05, Chapter 2 and Chapter 5.