Chapter 9 VA Copayments and Insurance

Overview of Copayments

While many Veterans qualify for free healthcare services based on a VA compensable service-connected condition or other qualifying factor, most Veterans are asked to complete an annual financial assessment, to determine if they qualify for free services. Veterans whose income exceed the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA healthcare services.

Insurance and Other Third Party Payments:

Why Does VA Bill Insurance Companies?



Overview of VA Billing



Federal law requires VA to bill a private health insurance provider for medical care, supplies, and prescriptions for treatment of any Nonservice-connected condition. You are required to provide information on your health insurance coverage, including coverage provided under policies of your spouse. You are not responsible for paying any remaining balance of VA’s insurance claim that is not paid or covered by your health insurance. As applicable, any
payment received by VA may be used to offset “dollar for dollar” your VA copayment responsibility.



Does VA Bill for Service-Connected Conditions?


No. If you are Service-connected, VA will not bill your private health insurance carrier for treatment or services for any 
Service-connected condition.



Does VA Bill Medicare?

No. While VA does not bill Medicare, your Medicare supplemental health insurance may be billed for treatment of a 
Nonservice-connected condition.



Offsetting Your VA Copayments with Insurance Premiums


VA will apply payment from your private health insurance carrier “dollar for dollar” to your VA bill, which may eliminate
or reduce your VA copayment.

TRICARE

TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services,
their families and survivors. VA bills TRICARE for Nonservice-connected medical treatment. There are four options for
health care: TRICARE Prime, TRICARE Extra, TRICARE Standard and TRICARE for Life. Each of these options has specific
benefits, exclusions, co-pay and deductible requirements.



Do VA medical centers accept TRICARE?


Most VA medical centers accept TRICARE under certain conditions. Contact the local VA Enrollment Office or
 enrollment coordinator for more information.



Where can I get more information about TRICARE?

For more information about TRICARE, visit the TRICARE website at http://www.tricare.mil/ or call, toll-free,
1-877-874-2273.



How Do I Pay My VA Bill?


Any VA bills can be paid online by credit card or check. You may go to www.pay.gov and select Department of
 Veterans Affairs on the agency list. This service is available at no cost.
Bills can also be paid in person, by contacting the Agent Cashier office at the local VA health care facility. Bills can also
be paid by calling the number on the billing statement or a check or money order payable to “VA” can be sent to:
Department of Veteran Affairs

PO Box 530269
Atlanta, GA
30353-0269



Retroactive Award of Service-Connection or VA Pension Benefit



If you have recently received an award of a Service-connected condition, an increase in percentage of your Service-
connected rating, or a VA pension benefit, you may be eligible for reimbursement for VA copayments you have already
paid. For information, contact your local Revenue Office or call VA at 1-877-222-VETS (8387).

Enrolled Veterans may also be eligible for beneficiary travel payments back to the effective date of your award. You
must apply within 30 days of the date you became eligible for travel benefits. For more information, contact your local
 Enrollment Coordinator or call the VA at 1-877-222-VETS (8387)