VA and Medicare Co-Pays?


Hi Jim, I am a 100% Totally & Permanently disabled veteran having Medicare coverage. I know as a Priority 1, I can use the VA, but have doctors that I want to remain with. My question is: If I use private doctors/hospitals not associated with the VA, will the VA pay the amount that Medicare does not pay? Thank you.

Jim's Reply:


No. Neither VA nor Medicare act as a second payer to each other. Many of us are in a similar situation and getting the right balance requires some thought. Using the VA Community Care program I've kept my civilian doctors for the most part and I have no copays, VA picks up the entire tab as TriWest Insurance.

My VA primary care doctor sees all the reports and helps coordinate the visits to specialists. The Community Care Program doesn't particularly like to pay for a primary care doctor as the VA primary care provider is also the 'gatekeeper' to coordinate specialty visits, pharmacy and so on.

I'm fortunate that I like my VA primary care doc and I have a second primary care doc, a civilian, who is much more convenient and who bills my Medicare Part B.

The rules to allow us to use civilian doctors are largely based on the miles between you and comparable VA care. Read through that info very carefully and begin to inquire how you can get set up with the doctors you prefer. prepared to appeal the VA mileage determination. At first pass they said I lived 8 miles from my VA health care clinic so I wasn't eligible. That would be true if I were a crow because there's a huge body of water between me and my clinic...about 8 miles across in a straight line.

Driving there takes 1 + hours, 50 miles or so...I'm eligible. You're also pre-authorized to use select urgent care clinics. There are the usual hoops and more hoops to jump through but once you're hooked up, it works well.

Good luck.