Veterans
Benefits
The following
overview is for eligible veterans who elect to receive care from a Veterans
Administration (VA) facility for a non-service related condition. This
information explains how this plan’s benefits are affected in these
circumstances.
Non-Medicare
Eligible Veterans
If an individual
chooses to use veterans benefits for a non-service related condition that
requires inpatient hospitalization, this plan will review the inpatient stay for
medical necessity and appropriate length of stay, since it is obligated to
reimburse the Veterans Administration for non-service related treatment at a VA
facility. The individual should contact this plan’s medical review agency
for preadmission certification of the inpatient hospitalization to a VA hospital
(please see Preadmission Certification).
Preadmission certification verifies the medical necessity of an inpatient
admission and the appropriate length of that admission before the individual is
admitted.
Medicare
Eligible Veterans
If an individual
has or can receive both Medicare and veterans benefits for a non-service related
condition, he or she may choose to receive treatment under either program. But
the individual must choose one program or the other each time he or she needs
care. Medicare cannot pay for the same service paid for by the Department of
Veterans Affairs (VA). Nor can the VA pay for the same service paid for by
Medicare. If the
individual is eligible to receive benefits from Medicare and chooses to use
veterans benefits for a non-service related condition, the amount of benefits
that would have been payable by Medicare will be subtracted from this
plan’s payable benefits.
The individual
does not always have to go to a VA hospital or to a physician who is affiliated
with the VA for the VA to pay for the
care. If the
individual chooses to use veterans benefits, Medicare generally cannot pay for
the following services:
- Services
received from VA hospitals or other VA facilities. (There is an exception to
this rule. There are cases where Medicare can pay for emergency inpatient and
outpatient hospital services.)
- Services
when the VA authorizes services in a hospital that is not part of the VA system
or from a physician who is not affiliated with the
VA.
If
the individual chooses to use Medicare benefits, Medicare can pay for
Medicare-covered services received from hospitals and physicians not affiliated
with the VA, as long as the VA will not be paying for the same
services. If the
VA authorizes the individual to receive hospital services in a hospital that is
not a VA hospital, but does not pay for all the services received during the
stay, Medicare can pay for Medicare-covered services for which the VA does not
pay. For example, if the VA authorizes a five-day stay and the individual
remains in the hospital for ten days, Medicare can pay for the Medicare-covered
services received during the five days not authorized by the
VA. The VA charges
copayments to some veterans with non-service related conditions. The copayment
is the veteran’s share of the cost of treatment. The veterans who are
charged copayments are those at or above a certain income. Sometimes, Medicare
can pay part or all of this copayment amount:
- Medicare
cannot pay VA copayments for services furnished by VA hospitals and facilities,
unless the services are emergency inpatient or outpatient hospital
services.
- Medicare
may be able to pay all or part of the individual’s copayment if the VA
charges the individual a copayment for VA-authorized care by a physician or
hospital not affiliated with
VA.
Questions
about Veterans Adminstration (VA) benefits should be directed to the Veterans
Administration.
|
|
|
