The short answer
VA health care is care VA provides or pays for, not an insurance plan. Community Care is part of it: VA approves and pays for certain care from outside providers. Private insurance is separate, and you can keep it. VA may bill it for care not related to your service-connected conditions, but you won't owe more because of it.
How are the three different?
They're three separate things that can work together.
| VA health care | VA Community Care | Private insurance | |
|---|---|---|---|
| What it is | Care from VA, based on enrollment and eligibility | VA-paid care from outside providers, inside your VA benefit | A plan you or an employer buys |
| Who decides what's covered | VA | VA, through a referral and authorization | The insurance company |
| Where you go | VA medical centers and clinics | Community providers VA approves | The plan's network |
| Family coverage | No, Veterans only | No, Veterans only | Often yes |
| Monthly premium | No | No | Usually yes |
Is VA health care insurance?
No. VA health care is a benefit, not an insurance policy. VA enrolls you, assigns a priority group, and then provides or pays for care in its medical benefits package. There's no premium or annual deductible. Depending on your priority group and the type of care, you may owe copays. See VA copay rates.
VA health care also counts as qualifying health coverage under the Affordable Care Act, so you don't need another plan just to meet that rule.
Where does Community Care fit?
Community Care is part of VA health care. It isn't a separate plan. When you qualify under one of VA's eligibility rules, VA can approve care from an outside provider and pay that provider directly.
It doesn't work like a PPO. You can't book with any civilian provider and send VA the bill. For routine care, VA has to approve the specific care first, and the provider has to be in VA's network or have an agreement with VA. See What Is VA Community Care?
Can I keep private insurance with VA health care?
Yes. VA says having other insurance doesn't reduce your VA benefits. Many Veterans keep employer or spouse coverage, especially when it covers family members.
What happens with the insurance:
- VA may bill your insurer for care that isn't for a service-connected condition. Federal law allows this under 38 U.S.C. 1729.
- You don't pay the insurer's deductible or copay to VA. You're only responsible for any VA copay you'd owe anyway.
- VA can't bill Medicare, and Medicare generally doesn't pay for care VA provides.
- You need to tell VA about your insurance before Community Care is authorized, and tell VA about changes within 60 days, under 38 CFR 17.4010(c).
More detail is in How Other Health Insurance Works With Community Care.
Does VA cover my spouse or kids?
No. VA health care covers the Veteran. Family members need their own coverage. Some qualify for CHAMPVA, a separate VA program for certain spouses and children. See What Is CHAMPVA?
This is the most common reason Veterans keep employer coverage: the family depends on it.
Should I drop my private insurance?
That depends on your situation. Before you cancel anything, think through:
- Family. Would anyone lose coverage?
- Access. How long does your local VA take to see you for the care you use most?
- Your doctors. Are your current specialists in VA's community network, and would you qualify to keep seeing them?
- Travel. VA care away from home is limited. Your plan may cover you better when you travel.
- Prescriptions. VA uses its own formulary. Check whether your medications are on it.
A practical approach: enroll in VA health care, keep your current plan for a while, and see how VA and Community Care work for you before making a change you can't easily undo.
Common misconceptions
- "If I use VA, I have to drop my insurance." No. You can have both.
- "VA will send me bills my insurance didn't pay." No. You only owe VA copays that apply to you.
- "Community Care means I can see anyone." No. VA approves the care and the provider.
- "My VA covers my family." No. Look at CHAMPVA or other coverage for them.