Medicare and Veterans

[LewB]

I have a client who has a Med Supp Plan and is also a veteran. He goes to the local VA hospital when he is town and bought the Med Supp to use when he is out of town.

He spent a few days in the VA hospital and shortly thereafter he received a letter from the VA stating that some of the test he received will paid by Medicare.

I have been under the impression that a veteran could use either VA or his Medicare plan and that there is no crossover.

Has anyone ever encountered a situation where Medicare paid for treatment received at a VA hospital?

 

[DS4]

I have a client who has a Med Supp Plan and is also a veteran. He goes to the local VA hospital when he is town and bought the Med Supp to use when he is out of town.

He spent a few days in the VA hospital and shortly thereafter he received a letter from the VA stating that some of the test he received will paid by Medicare.

I have been under the impression that a veteran could use either VA or his Medicare plan and that there is no crossover.

Has anyone ever encountered a situation where Medicare paid for treatment received at a VA hospital?

Medicare primary, supp secondary. VA is last

 

[LewB]

DS4, I copied the following from the Medicare publication "Who Pays First" page 19.

Medicare and Veterans’ Benefits

If you have or can get both Medicare and Veterans’ benefits, you can get treatment under either program. When you get health care, you must choose which benefits to use each time you see a doctor or get health care. Medicare can’t pay for the same service that was covered by Veterans’ benefits, and your Veterans’ benefits can’t pay for the same service that was covered by Medicare.

Note:To get the Department of Veterans Affairs (VA) to pay for services, you must go to a VA facility or have the VA authorize services in a non-VA facility.

Are there any situations when both Medicare and the VA may pay?

Yes. If the VA authorizes services in a non-VA hospital, but doesn’t pay for all of the services you get during your hospital stay, then Medicare may pay for the Medicare-covered part of the services the VA doesn’t pay for.

To me this is saying that you can either use VA benefits or Medicare but not both except as noted.

 

[LewB]

I have a booklet published by CMS titled “Who Pays First.” They have a 800 number if you have any questions on who pays first. I called them yesterday and asked them about a 65 year old veteran who also is covered under a med supp. I was told that a client can either use VA or his med supp plan but not both.

I then asked what happens if a person receives a bill for a copayment for medical test given at a VA hospital would Medicare pay. I was told that my client would be responsible for the copayment and that Medicare never approves any payments to VA. Yet that is exactly what happened. My client has a bill from VA for some medical test and on the bill it says paid by Medicare.

I told my client not to look a gift horse in the mouth.