What if a disabled veteran is not completely satisfied with the care through the VA?

1 answer | Last updated: Sep 16, 2016
A fellow caregiver asked...

If a disabled veteran is not completely satisfied with the care through the VA , Mr. Matthews stated" then paying for Medicare Part B would pay all or part of the co-payment if you receive care from a doctor or facility that is not actually part of the VA system". If that is true, then why are insurance companies trying to sell Medigap additional coverage to pay for the 20% co-payments that Medicare doesn't pay doctors and facilities? I am trying to decide if I should get this additional Medigap coverage or just go with Medicare Parts A&B? Your help in answering these questions will be appreciated.


Expert Answers

The VA health system and Medicare are two entirely separate, unrelated programs. If you are enrolled in both programs, you may choose to use one or the other to provide care or coverage for any particular medical service or procedure you have. But you may NOT use both programs for the same medical service or procedure. If you choose to receive coverage from the VA health system for a specific treatment, you may not also receive Medicare coverage for that treatment.

If you choose to go outside the VA system for a particular medical service or treatment, Medicare will pay a portion of the bill for medical care that it covers. However, for most types of outpatient medical care that it covers, Medicare pays only 80% of the amount it authorizes as payment for that care, and does not cover a large portion of many inpatient hospital or nursing facility stays. You are left to pay the remaining 20% for outpatient care, and large copayments for hospital or nursing facility stays, and you may NOT submit those bills to the VA. Because that extra outpatient 20% and inpatient copayments can amount to a lot of money for people who have frequent medical treatment or a long inpatient stay, many people buy extra insurance -- called Medigap insurance -- to supplement their Medicare coverage. This Medigap insurance is the extra coverage that the private insurance companies are trying to sell you.

Whether it's a good idea for you to buy Medigap insurance depends on how much you expect to use Medicare coverage instead of using the VA health system. If you plan on using the VA system for most of your medical care, and only rely on Medicare coverage occasionally, then there is less need to consider a Medigap policy. On the other hand, if you expect to use non-VA medical services for most of your medical care, and therefore rely heavily on Medicare coverage, then buying a supplemental Medigap policy makes much more sense.