If not completely satisfied with VA, will Medicare Part B provide full coverage?

1 answer | Last updated: Sep 14, 2017
A fellow caregiver asked...

If you are 100% disabled veteran, and paying for Medicare Part B coverage. And you prefer to see a private doctor, get a second opinion, or a more timely manner for a procedure. At this point, does Medicare Part B become your primary provider, and if so, does it pay 100% of the cost or is it shared with the VA? For example, does Medicare Part B pay 80% and the VA pay 20% Copay, etc??

Expert Answers

If you are covered by the VA's medical program and also are enrolled in Medicare Part B, you have a choice about which program will cover any particular medical service or treatment. However, you cannot use both programs for the save service or treatment. that's because they work in completely separate ways. The VA actually provides medical care, while Medicare provides a kind of insurance coverage -- kind of apples and oranges. So, if you use VA medical providers for a particular treatment, they will pay for the entire cost. You may not receive Medicare coverage for treatment you receive from the VA system.

On the other hand, if you want to receive care outside the VA system, you can do so with any provider who participates in Medicare (meaning just about any non-VA provider). The provider will submit its bill to Medicare Part B, and Medicare will pay its share of the bill (usually 80%, though 100% of some outpatient costs). If there is a portion of the bill that Medicare B does not pay (either your 20% coinsurance amount, an amount the provider charges above what Medicare will pay, or some service Medicare does not pay for at all), the VA will NOT pay any of that amount. Instead, you must pay for it yourself, either through Medigap or other supplemental private insurance, through Medicaid or other government health insurance program if you are eligible for it, or out of your pocket.

To learn more details about how Medicare and VA medical benefits work in tandem, take a look at the Medicare online booklet Medicare and Other Health Benefits: Your Guide to Who Pays First[medicare.gov].