If the beneficiary has or can get both Medicare and Veteran's Administration (VA) benefits, he/she may choose to get treatment under either program.

For patients entitled to both, Medicare and VA benefits, Medicare:

  • Cannot pay for services received from VA hospitals or other VA facilities (except for certain emergency hospital services)
  • 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.

  • 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
  • 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.

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