The short answer
You have to tell VA about any other health insurance before VA authorizes Community Care, and report changes within 60 days. VA may bill your private insurance for care that isn't for a service-connected condition, but you don't pay the insurer's deductible or copay. Medicare, Medicaid, and TRICARE work differently, and VA can't bill Medicare.
Do I have to tell VA about other insurance?
Yes. 38 CFR 17.4010(c) requires you to tell VA about any other health insurance before VA authorizes Community Care, and to report changes within 60 days. Missing insurance information can hold up a referral.
You can update your insurance on VA.gov, by calling 877-222-8387, or at your VA facility.
What counts as other health insurance?
The Community Care rule uses the term "other health-care plan contract" in 38 CFR 17.4005. It means an insurance policy or similar arrangement not run by VA, like an employer plan or a plan through your spouse.
It specifically leaves out Medicare, Medicaid, and TRICARE, which have their own rules.
Will VA bill my insurance?
It may, for care that isn't related to a service-connected condition. Federal law lets VA recover the cost from your insurer under 38 U.S.C. 1729, and the details are in 38 CFR 17.100 through 17.106.
What that means for you:
- You don't pay the insurer's deductible or copay to VA.
- Your VA benefits don't shrink because you have insurance. VA says having other insurance doesn't reduce your VA health care benefits.
- You may still owe VA's own copay if your priority group requires one.
- Care for service-connected conditions isn't billed to your insurer.
Will the community provider bill my insurance?
For VA-authorized care, the provider should bill VA or VA's network administrator, not your insurer. Give the provider your VA authorization number so they don't send the claim to your private plan by mistake. VA handles any recovery from your insurer.
What about Medicare?
VA can't bill Medicare, and Medicare generally doesn't pay for care VA authorizes. If you have both, you choose for each visit: use VA (including Community Care) or use Medicare with a Medicare provider. You can't make both pay for the same visit.
What about Medicaid and TRICARE?
They're left out of the "other health-care plan" definition for Community Care. If you have TRICARE as a military retiree, VA may bill TRICARE for care that isn't service connected. If you have Medicaid, VA is usually the payer for VA-authorized care. Ask your VA facility's billing office how it handles your specific coverage.
What about emergency care?
Insurance matters more there. For emergency care VA didn't authorize, VA may cover amounts your insurance didn't, but it can't reimburse your insurer's copays or pay costs from missing your insurer's deadlines or appeals. See Non-VA Emergency Care.
Should I keep my private insurance?
That's your call. Many Veterans keep it for family coverage or care outside VA. See VA Health Care vs. Private Insurance.