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medicare coordination of benefits with va

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If you have other forms of health care coverage, such as a private insurance plan, Medicare, Medicaid or TRICARE, you can continue to use VA along with these plans.  Remember, it is always a good idea to inform your doctors if you are receiving care outside of VA so your health care can be coordinated.

Private Health Insurance

Veterans with private health insurance may choose to use these sources of coverage as a supplement to their VA health care benefits.  Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance.

VA is required, by law, to bill private health insurance providers for medical care, supplies and prescriptions provided for treatment of Veterans’ nonservice-connected conditions.  All Veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses.  Any payment received by VA may be used to offset “dollar for dollar” a Veteran’s VA copay responsibility.

Funds that VA receives from third party health insurance carriers go directly back to VA Medical Center’s operational budget.  That money can be used to hire more staff or buy medical equipment to improve Veterans health care.  Enrolled Veterans can provide or update their insurance information by:

Medicare Coverage

Creditable coverage.

Enrollment in the VA health care system is considered creditable coverage for Medicare Part D purposes.  This means VA prescription drug coverage is at least as good as the Medicare Part D coverage.  Since only Veterans can enroll in the VA health care system, dependents and family members do not receive credible coverage under the Veteran’s enrollment.

Under Medicare Part B, VA health care is NOT creditable coverage.  Creditable coverage under Medicare Part B can only be provided through an employer.  Although a Veteran may avoid the late enrollment penalty for Medicare Part D by citing VA health care enrollment, that enrollment would not help the Veteran avoid the late enrollment penalty for Part B.

VA does not recommend Veterans cancel or decline coverage in Medicare (or other health care or insurance programs) solely because they are enrolled in VA health care.  Unlike Medicare, which offers the same benefits for all enrollees, VA assigns enrollees to enrollment priority groups based on a variety of eligibility factors, such as service-connection and income.  There is no guarantee that in future years Congress will appropriate sufficient medical care funds for VA to provide care for all enrollment priority groups.  This could leave Veterans, especially those enrolled in one of the lower-priority groups, with no access to VA health care coverage.  For this reason, having a secondary source of coverage may be in Veterans’ best interest.

Enrolling in both VA and Medicare can provide Veterans flexibility.  For example, Veterans enrolled in both programs would have access to community physicians (under Medicare Part A or Part B) and can obtain prescription drugs not on the VA formulary if prescribed by community physicians and filled at their local retail pharmacies (under Medicare Part D).

For more information on Medicare coverage, visit the Health and Human Services Medicare website at www.medicare.gov .

Medicare Beneficiary Identifier

The Centers for Medicare and Medicaid Services (CMS) will issue new Medicare cards that use a Medicare Beneficiary Identifier (MBI) instead of a Social Security number to identify subscribers. Veterans should bring their new cards to their next VA appointment so the subscriber ID can be updated in the patient’s Medicare insurance file. For more information regarding the MBI, visit www.medicare.gov .

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1 (855) 665-9200, medicare & va benefits:how they work together.

Medicare & VA benefits: how they work together

The Department of Veteran’s Affairs (VA) and Medicare are two separate medical coverage programs. If you served in the military, you might have access to VA benefits and Medicare. How do the two types of coverage work together?

When You Use a VA Hospital

If you get medical care at a VA hospital, your VA benefits will generally cover the costs. This is because the VA uses providers who are covered under the plan, so you won’t necessarily need the institution to submit any claims to Medicare. However, Medicare can also cover services included with your VA medical benefits. In some cases, you can choose which provider to use.

It’s worth noting that you can’t use VA benefits and Medicare simultaneously . In other words, if the VA covers a treatment or office visit, Medicare can’t cover services rendered at the same time. The only exception occurs when you’re sent to a non-VA hospital by the VA. In that case, you can use your Medicare insurance plan to cover services that the VA won’t.

When You File Your Own Claim

Some disabled veterans don’t live near VA hospitals. In this case, they may receive fee-based identification cards . They can present these for treatment at a health care facility or doctor’s office. Be sure to call ahead before accepting an appointment since not all providers accept these cards.

The process varies depending on the provider’s preferences:

Try VA benefits drug plans

Unfortunately, many patients fail to enroll in a Medicare Part D plan on time. When this happens, they have to pay a penalty. If you have VA coverage, there is a good way to avoid the penalty.

To avoid paying penalties, make sure you enroll in a creditable drug plan by the due date. VA medical benefits offer a creditable drug plan that might prove more cost-effective than other options, such as Medicare or TRICARE.

Sometimes, paperwork gets lost or buried. If you’re sent a Part D penalty invoice, you can contest it by proving that you had a creditable drug plan within 63 days of applying for Medicare. It helps to keep all of your paperwork on hand. That way, you can prove when you signed up for your VA drug benefits.

Also Get Medicare

You might think that you don’t need Medicare if you qualify for VA medical benefits. However, Medicare can pick up the slack when the VA won’t cover the bill for certain services or at specific facilities. For instance, maybe you live around the block from a VA hospital, but you get sick or injured while traveling.

You’ll enjoy more flexibility if you have both Medicare and VA benefits. Additionally, the VA benefits program is subject to government oversight. The government can suspend or lower funding at any time, and you don’t want to find yourself without viable medical coverage.

Just remember that you can’t use both benefits at the same time. If you use Medicare to help pay for an MRI scan, for instance, the VA won’t pick up the rest of the cost. When you get treatment, try to determine which benefits will allow you to pay the least money out of pocket.

Deciphering your Medicare and VA benefits options can prove tricky, especially if you’re new to the process. Share this post with your community to help them understand how they might use their VA medical benefits in conjunction with Medicare.

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Do I need to sign up for Medicare if I’m a veteran with VA health care?

En español | You aren’t required to sign up for Medicare if you have health care coverage through the U.S. Department of Veterans Affairs (VA), but the VA encourages veterans to sign up for Medicare  Part A and Part B  during your  initial enrollment period  at 65, unless you also have  group insurance from a current employer.

That way, you’ll have more options for care. VA health benefits provide coverage for care in VA clinics and hospitals, but the coverage generally doesn't extend to non-VA facilities and doctors.

Even if you’re happy with your VA health care benefits, your medical needs or the VA health system’s costs and coverage could change. If you want to sign up for Medicare later, you may have to wait to enroll and pay a late penalty.

How does Medicare work with VA health benefits?

VA health benefits and Medicare are two separate systems. VA health benefits cover services at VA hospitals and other locations within its system. Medicare doesn’t pay for the care.

VA health benefits typically won’t cover hospitals, doctors and other providers that participate in Medicare, nor will they cover Medicare  deductibles, copayments and coinsurance . The rules are different for coordinating Medicare and  Tricare for Life coverage  for military retirees.

The VA occasionally pays for care from some providers not within its network, but only if you receive permission in advance. If the VA authorized only some services you need at a non-VA facility, Medicare can help with the additional costs.

Coverage varies.  When you  apply for VA health care,  you’re assigned to a  priority group  that determines your coverage and out-of-pocket costs within the VA system. The ratings are designed to ensure that veterans who need immediate care are assigned quickly.

The groups range from a priority of 1 — for  Medal of Honor recipients  and veterans with service-connected illnesses or injuries rated to be at least 50 percent disabling — down to 8 — for veterans whose gross income exceeds VA limits and don’t have a service-connected disability qualifying them for VA compensation.

Your priority level can affect your eligibility for certain VA services and treatments, such as dental care. If you have a lower priority level, you may need to make copayments for doctor’s visits, specialty tests such as MRIs, and inpatient hospital stays not related to your service-connected disability.

For more information about the different kinds of health benefits available for veterans, active-duty service members and military retirees and their families, see  AARP’s Veterans Health Benefits Navigator .

Think about the future.  Even if you’re happy with your VA coverage, financing for the VA health care system could change, especially for veterans at lower priority levels.

Your health care needs could change, too. You might move to another area farther from a VA facility or want to go to a doctor outside the VA system.

If you don’t sign up for Medicare during your initial enrollment period at age 65, you may have to wait until the next  general enrollment period  that runs Jan. 1 to March 31 each year, and you may have to pay a  late enrollment penalty . An exception: if you or your spouse is still working and you have health insurance from a current employer. In this case, you can choose to delay and not face a late enrollment penalty.

If I have VA drug coverage, do I need Medicare Part D?

You aren’t required to buy Medicare  Part D prescription drug coverage  if you have VA health benefits. VA prescription drug benefits are considered as good as or better than Medicare Part D, which the Centers for Medicare & Medicaid Services calls “creditable coverage.” You won’t have to pay a penalty if you decide to sign up for Part D later.

But VA health care only covers VA providers and pharmacies. Some people also sign up for Part D, so they can get prescriptions from doctors outside the VA and fill them at a nearby pharmacy.

Also, a Part D plan may cover different drugs than the VA and charge different copayments. VA copays for prescription drugs can vary by priority level. You can’t apply your VA and Part D benefits for the same expenses.

If you have VA drug benefits, you can sign up for a Part D plan without paying a  late enrollment penalty  any time after you enroll in Medicare Part A or Part B or within 63 days of losing VA drug benefits.

Keep in mind

Medicare has premiums, deductibles, copayments and other  out-of-pocket costs . If your income and assets fall below certain levels, you may qualify for help with some of these expenses from a  Medicare Savings Program . You also may be eligible for help with Medicare Part D premiums and copayments from the  Extra Help financial assistance program .

Updated February 23, 2023

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Medicare Secondary Payer

Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare. When Medicare began in 1966, it was the primary payer for all claims except for those covered by Workers' Compensation, Federal Black Lung benefits, and Veteran’s Administration (VA) benefits.

In 1980, Congress passed legislation that made Medicare the secondary payer to certain primary plans in an effort to shift costs from Medicare to the appropriate private sources of payment. The MSP provisions have protected Medicare Trust Funds by ensuring that Medicare does not pay for items and services that certain health insurance or coverage is primarily responsible for paying. The MSP provisions apply to situations when Medicare is not the beneficiary’s primary health insurance coverage. Medicare statute and regulations require that all entities that bill Medicare for items or services rendered to Medicare beneficiaries must determine whether Medicare is the primary payer for those items or services.

Primary payers are those that have the primary responsibility for paying a claim. Medicare remains the primary payer for beneficiaries who are not covered by other types of health insurance or coverage. Medicare is also the primary payer in certain instances, provided several conditions are met.

CMS has made available a curriculum of computer-based training (CBT) courses that will assist you in understanding the fundamentals of MSP. You can access or download these CBTs from the Downloads section below. The first item listed is the MSP Curriculum document that contains a complete listing of the courses, their descriptions, and course lengths.

Common Situations of Primary vs. Secondary Payer Responsibility

The following list identifies some common situations when Medicare and other health insurance or coverage may be present, and which entity will be the primary or secondary payer.

1. Working Aged (Medicare beneficiaries age 65 or older) and Employer Group Health Plan (GHP):

2. Disability and Employer GHP:

3. End-Stage Renal Disease (ESRD) :

Please see the ESRD page for more information.

4. Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) – the law that provides continuing coverage of group health benefits to employees and their families upon the occurrence of certain qualifying events where such coverage would otherwise be terminated.

5. Retiree Health Plans

6. No-fault Insurance and Liability Insurance

7. Workers’ Compensation Insurance

Note: When there is evidence that the no-fault insurer, liability insurer, or workers’ compensation plan will not pay promptly, Medicare may make a conditional payment. A conditional payment is a payment Medicare makes for services another payer may be responsible for. Medicare makes this conditional payment so that the beneficiary won’t have to use his own money to pay the bill. The payment is “conditional” because it must be repaid to Medicare when a settlement, judgment, award or other payment is made.

Federal law takes precedence over state laws and private contracts. Even if an entity believes that it is the secondary payer to Medicare due to state law or the contents of its insurance policy, the MSP provisions would apply when billing for services.

Responsibilities of Beneficiaries Under MSP

As a beneficiary, we advise you to:

Please select Beneficiary Services in the Related Links section below for more information.

Responsibilities of Providers Under MSP

As a Part A institutional provider (i.e., hospitals), you should:

As a Part B provider (i.e., physicians and suppliers), you should:

Please select Provider Services in the Related Links section below for more information.

Responsibilities of Employers Under MSP

As an employer, you must:

Please select Employer Services in the Related Links section below for more information.

Statutory and regulatory provisions

The information above provides only a very high-level overview of the MSP provisions. See 42 U.S.C. 1395y(b) [section 1862(b) of the Social Security Act], and 42 C.F.R. Part 411, for the applicable statutory and regulatory provisions.

Related Links

Medicare Coordination of Benefits

Coordination of benefits determines who pays first for your health care costs. This comes into play if you have insurance plans in addition to Medicare. For example, your other health insurance, through an employer or other source, may have to pay for a portion of your care before Medicare kicks in.

Terry Turner, writer and researcher for RetireGuide

Terry Turner

Senior Financial Writer and Financial Wellness Facilitator

Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).

Matt Mauney, Senior Editor for RetireGuide

Matt Mauney

Financial Editor

Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.

Jerrad Prouty, Medicare Expert & RetireGuide Reviewer

Jerrad Prouty

Licensed Agent at Insuractive

Jerrad Prouty is a licensed agent at Insuractive with a specialization in selling Medicare insurance. He is licensed to sell insurance in more than 15 states.

A licensed insurance professional reviewed this page for accuracy and compliance with the CMS Medicare Communications and Marketing Guidelines (MCMGs) and Medicare Advantage (MA/MAPD) and/or Medicare Prescription Drug Plans (PDP) carriers’ guidelines.

APA Turner, T. (2023, February 27). Medicare Coordination of Benefits. RetireGuide.com. Retrieved March 4, 2023, from https://www.retireguide.com/medicare/basics/coordination-of-benefits/

MLA Turner, Terry. "Medicare Coordination of Benefits." RetireGuide.com , 27 Feb 2023, https://www.retireguide.com/medicare/basics/coordination-of-benefits/.

Chicago Turner, Terry. "Medicare Coordination of Benefits." RetireGuide.com. Last modified February 27, 2023. https://www.retireguide.com/medicare/basics/coordination-of-benefits/.

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How Does Medicare Work with Other Insurance?

If you have Medicare and some other type of health insurance, each plan is called a payer. Coordination of benefits (COB) sets the rules for which one pays first when you receive health care.

In some cases, Medicare may be the primary payer. But in other cases, your other insurance may be the primary payer.

Coordination of Benefits Process

Coordination of benefits allows insurers to know what their responsibilities are when it comes time to pay for your health care services.

The insurers know when they have to pay and what their share of payment will be if you are covered by more than one health care plan.

What Happens If Your Health Coverage Changes?

If your health coverage changes, your insurers have to report it to Medicare. But it can take a long time to be posted to Medicare’s records in some cases.

To avoid problems, you should call the Benefits Coordination & Recovery Center (BCRC) toll-free at 1-855-798-2627 (TTY users: 1-855-797-2627) as soon as your health coverage changes.

You should also let your doctor and other health care providers you use know that your coverage has changed.

Finally, call your insurer and make sure they reported the changes to Medicare so that your records are up to date and there won’t be problems with your claims.

Frequently Asked Questions About Medicare's Coordination of Benefits

Employers and unions often offer health insurance to employees or retirees. If you already have Medicare and are offered group coverage through your employer or union, you can choose whether you want to pay for it or reject the coverage.

If you choose to take it, or are insured through your spouse’s employer’s plan, the insurer will coordinate with Medicare to pay part of your health care costs.

If you are dual enrolled in both Medicare and Medicaid , Medicare will always pay first on any health care claim. In rare cases where you might have another insurance plan, that plan would also pay before Medicaid kicks in.

If you qualify for both Medicare and Veterans’ benefits , you can receive treatment through either federal program. But each time you receive health care or go to the doctor, you have to choose which program — Medicare or VA benefits — will pay for the service or visit. You cannot have both pay for the same service and Medicare will never be the secondary payer for a service provided under Veterans’ benefits.

You should also remember that to have the VA pay for medical services, you must go to a VA hospital or other facility or have the VA approve medical services in a non-VA hospital or other facility.

Visit Medicare.gov to view or print out publications such as “Who Pays First?” that explains more about coordination of benefits. You can also call 1-800-MEDICARE (TTY users: 1-8770486-2048) to see if Medicare will mail a copy to you.

Or contact your State Health Insurance Assistance Program (SHIP) for free, personalized health insurance counseling and related help. You can find your state’s SHIP phone number at shiptacenter.org.

Terry Turner, writer and researcher for RetireGuide

Matt Mauney, Senior Editor for RetireGuide

5 Cited Research Articles

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You can have both Medicare and Veterans Affairs (VA) benefits , but Medicare and VA benefits do not work together. Medicare does not pay for any care that you receive at a VA facility.

Note: If the VA authorizes services in a non-VA hospital, but does not pay for all the services you get during your hospital stay, Medicare may pay for Medicare-covered services the VA does not pay for.

If you chose not to enroll in Medicare and to keep your VA coverage, you will not have health insurance for facilities outside the VA health system. Some choose to enroll in Medicare Part A because it’s premium -free but turn down Part B because of the additional monthly premium. If you want to enroll in Medicare in the future, you may face penalties and would likely have to wait to enroll during the General Enrollment Period (GEP) . You will not be eligible for the Part B Special Enrollment Period (SEP) if you delay Medicare enrollment .

If you decide to enroll in Part B, you should do so during your Initial Enrollment Period (IEP) . Enrolling in Part B provides you with the flexibility of getting health care outside the VA system. Also, you may qualify for programs to help pay the Part B premium and Medicare cost-sharing. Remember that you can keep your VA health benefits to get coverage for health care services and items not covered by Medicare, such as over-the-counter medications, annual physical exams, and hearing aids. Also be sure to think over your drug coverage options when deciding whether or not to delay Medicare enrollment.

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medicare coordination of benefits with va

Medicare COB: Does Medicare Work Alongside Other Insurance?

Individuals who have Medicare and other insurance coverage may need to be aware of Medicare COB. The COB stands for coordination of benefits, which simply means the coordination of which insurance benefits pay first on any claim. Find out more about insurance COB below to understand when Medicare might pay as primary or secondary.

Understanding Primary vs. Secondary Payer

The primary payer is the insurance company or entity that pays first on a health care claim . When an insurance company or Medicare is the primary payer, it processes the claim normally. That typically means:

However, if you have a second insurance policy or other coverage, that payer will kick in as the secondary payer. That means there's a good chance it will pay all or some of the "patient responsibility" left over by the primary insurance.

What's left, if any, after the secondary insurance has processed the claim may be your actual out-of-pocket cost for the services. 

Is Medicare a Primary or Secondary Payer?

Medicare can be either a primary or secondary payer, depending on what other insurance you have and the situation involved in the claim. For those who have Medicare, here are some of the situations when Medicare might be the secondary payer:

There's a potential exception to the rules about coverage through employer-sponsored plans. If the employer has joined with others in a union to create a multi-employer health care plan, Medicare will pay secondary if  any of the employers in the plan have more than the required employees. 

In most other cases, Medicare pays as the primary insurance and your other coverage kicks in as secondary. Note that if you have coverage through an employer-sponsored plan that wouldn't pay as primary, you typically have to have Medicare Part B coverage for the employer plan to kick in as secondary.

Does Medicare Work Together With Medicaid?

Yes, but Medicaid will always pay as the payer of last resort. This means if you have Medicare and Medicaid, Medicare will pay as primary and Medicaid as secondary. If you have Medicare, another insurance, and Medicaid, Medicaid will only pay after Medicare and the other insurance company have processed the claim.

Does Medicare COB Work With VA Benefits?

No, those who have coverage through both programs must choose a benefit to use each time they seek care. To use VA benefits, you must also go to a VA facility or get preapproval to use VA benefits at a non-VA facility.

How Does Coordination of Benefits Work?

When you seek medical care, ensure you provide all of your insurance information. Claims billing specialists with your doctor's office typically work to ensure they bill claims in the right order according to Medicare COB. 

However, you should also keep Medicare apprised of your benefits status. When you sign up for Medicare, you typically provide some information about your coverage so that Medicare knows how to coordinate your benefits. If your benefits change, you should call the Benefits Coordination & Recovery Center at 1-855-798-2627 to update your information.

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CHAMPVA and Medicare: Can I Have Both?

medicare coordination of benefits with va

CHAMPVA is a cost-sharing health coverage program for some military families who don’t qualify for TRICARE. You can use CHAMPVA with Medicare when you’re eligible for both programs.

CHAMPA will be the secondary payer to Medicare and will pay most of your out-of-pocket costs.

Since there are no additional premiums if you qualify for CHAMPVA, using it alongside Medicare can significantly lower your healthcare costs. Let’s take a look at what CHAMPVA is, who may qualify, and how it works together with Medicare.

medicare coordination of benefits with va

What is CHAMPVA?

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a healthcare plan for certain dependents of veterans. CHAMPVA is a different program than TRICARE , which also services military members, veterans, and their families.

TRICARE eligibility is open to people who are:

You can’t use CHAMPVA if you have or are eligible for TRICARE. CHAMPVA helps cover dependents who aren’t eligible for TRICARE.

For example, service members who leave active duty under certain conditions might not qualify for TRICARE. However, if they have a disability caused by their service, their family may be able to enroll in CHAMPVA.

What services does CHAMPVA cover?

CHAMPVA is a cost-sharing health insurance program. This means that it will pay a portion of the cost of health services you receive, and you’ll pay the remaining amount.

You won’t pay a premium for CHAMPVA, but there is a deductible of $50 before CHAMPA coverage kicks in.

After you pay your deductible, CHAMPVA will pay what’s known as the “allowable amount” for all covered services. Generally, CHAMPVA will pay 75 percent of the allowable amount, and you’ll pay the other 25 percent.

Covered services include:

There are two other completely covered benefits. Hospice care from any provider is 100 percent covered under CHAMPVA. You can also get prescription coverage at no cost to you if you use the Department of Veteran Affairs (VA) Meds by Mail program.

Coverage works differently if you use CHAMPVA alongside another health insurance plan, including Medicare. When you use CHAMPVA with another insurance plan, CHAMPVA becomes what’s called a secondary payer.

This means your other insurance plan will be billed first, and CHAMPVA will then pay the remaining cost. This can save you a lot of money on out-of-pocket medical expenses like copayments or coinsurance amounts.

Am I eligible for CHAMPVA?

You’re eligible for CHAMPVA if you’re the dependent child or the current or widowed spouse of a veteran who meets one of these conditions:

There is no premium cost for CHAMPVA coverage.

You can apply for CHAMPVA at any time. You’ll need to send in an application along with documents that prove your eligibility. Depending on your circumstances, these might include:

You’ll also need to send in information about any other insurance plan you currently have.

It generally takes between 3 and 6 weeks for your application to be processed. You’ll receive a CHAMPVA card in the mail if your application is approved. You can start using CHAMPVA coverage as soon as your card arrives.

How does CHAMPVA work with Medicare?

Since 2001, CHAMPVA beneficiaries have been able to use their coverage after turning age 65. This means CHAMPVA can be used alongside Medicare.

You’ll need to be enrolled in Medicare to keep your CHAMPVA coverage. Here are the rules for how that works:

For example, let’s say you turned 65 years old in 1999 and enrolled in Medicare parts A and B. You won’t be able to drop your Part B coverage and keep your CHAMPVA coverage. However, if you turned age 65 in 1999 and enrolled in only Part A, you wouldn’t need to sign up for Part B to keep your CHAMPVA coverage.

You can use CHAMPVA alongside:

It’s important to note that CHAMPVA won’t pay for the cost of your Part B premium .

You should also know that you can no longer use VA healthcare facilities or healthcare providers once you’re enrolled in Medicare.

Who pays first for healthcare costs?

Medicare is the primary payer when you use it with CHAMPVA. This means Medicare will be the first to pay the cost of any service you receive, then CHAMPVA will pay the rest.

You’ll have very few out-of-pocket costs using CHAMPVA and Medicare together, since CHAMPVA will generally pay any copayments or coinsurance amounts.

You can expect to pay:

The same rules apply to Medicare Part D. CHAMPVA will pick up your copayments on all covered prescriptions. It will also pay 75 percent of the cost of prescriptions that your Medicare Part D plan doesn’t cover.

Present both your Medicare Part D plan card and your CHAMPVA ID card at your pharmacy for coverage.

Getting your coverage questions answered

If you’re not sure who will pay for a service, you can check ahead of time by:

What about Medicare Advantage?

You can use your CHAMPVA coverage with a Medicare Advantage plan. Since Medicare Advantage plans replace Medicare parts A and B, having an Advantage plan still meets the requirement to be enrolled in Medicare to keep CHAMPVA once you’re age 65.

Your Medicare Advantage plan will be the primary payer, just like when you have original Medicare. CHAMPVA will pay your copayments and other out-of-pocket costs.

Your bill will go to your Medicare Advantage plan first and then to CHAMPVA. In most cases, you won’t have any out-of-pocket costs to pay.

Many Medicare Advantage plans also include Part D coverage. When you use a Medicare Advantage plan that includes Part D along with CHAMPVA, your CHAMPVA benefits will pick up the cost of your prescription copayments.

Medicare Advantage plans often have networks. The network includes all the providers that your Medicare Advantage plan will cover healthcare services from. In many cases, you’ll need to pay out of pocket for any services you receive from an out-of-network provider.

However, when you use CHAMPVA along with your Medicare Advantage plan, you can often get 75 percent of the cost of out-of-network service covered.

How do I choose the right coverage options for me?

You need to enroll in original Medicare (parts A and B) to keep your CHAMPVA coverage. You can also choose to enroll in additional Medicare parts, such as:

The best option for you will depend on your personal needs and budget.

Medicare Advantage, Medigap, and Medicare Part D plans have their own premiums, deductibles, and other costs. CHAMPVA can pick up some of these costs — but not your premiums.

You might not even need additional Medicare parts if you’re using CHAMPVA.

For example, Medigap plans are designed to cover the out-of-pocket costs of Medicare parts A and B. However, since CHAMPVA already does this when you use it alongside Medicare, you might not need a Medigap plan.

Here are some other common scenarios to consider:

Original Medicare + CHAMPVA

Let’s say you have CHAMPVA and Medicare parts A and B, and you choose to not enroll in any other Medicare plans.

You’d pay the Medicare B premium, and Medicare would be your primary payer for all covered services. You could get prescriptions for 25 percent of the allowable amount at a pharmacy or completely covered if you use the Meds by Mail program using only CHAMPVA.

Original Medicare + Part D + CHAMPVA

You have CHAMPVA, Medicare parts A and B, and a Part D plan. You’d pay the Medicare Part B premium and the premium for your Part D plan.

Medicare would be the primary payer for services and prescriptions, and CHAMPVA would pick up your copayments and coinsurance amounts.

Medicare Advantage + CHAMPVA

You have CHAMPVA and a Medicare Advantage plan that includes Part D coverage. You’d pay the Medicare Part B premium plus the premium for your Medicare Advantage plan.

Medicare would be the primary payer for your services and prescriptions, and CHAMPVA would pick up your copayments and coinsurance amounts.

Ways to save on Medicare coverage

It’s worth noting that you may be able to find Medicare Advantage or Medigap plans in your area with $0 premiums .

You can shop for plans in your area on the Medicare website and compare prices, networks, and covered services before you commit to a plan.

You can also look for savings on your Medicare coverage. You might qualify for programs to help lower your costs if you have a limited income. These programs include:

Ultimately, the right plan for you depends on your needs and your budget. You’ll want to select a plan that includes:

You can also search for premiums in your price range and those with out-of-pocket costs you can manage.

The takeaway

Last medically reviewed on November 10, 2020

How we reviewed this article:

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Coordination of benefits: Benefits of having two health insurance plans

Nupur Gambhir

Nupur Gambhir is a content editor and licensed life, health, and disability insurance expert. She has extensive experience bringing brands to life and has built award-nominated campaigns for travel and tech. Her insurance expertise has been featured in Bloomberg News, Forbes Advisor, CNET, Fortune, Slate, Real Simple, Lifehacker, The Financial Gym, and the end-of-life planning service.

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John is the editorial director for CarInsurance.com, Insurance.com and Insure.com. Before joining QuinStreet, John was a deputy editor at The Wall Street Journal and had been an editor and reporter at a number of other media outlets where he covered insurance, personal finance, and technology.

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Some people are covered by two health insurance plans, which is called coordination of benefits (COB). If you have two plans, one will be primary and one will be secondary. 

Coordination of benefits (COB) allows you to have multiple health insurance plans . COB allows insurers to determine which insurance company will be the primary payer and which will be the secondary if you have two separate plans . It also makes sure insurance companies don’t duplicate payments or reimburse for more than the health care services cost.

Key Takeaways

Coordination of benefits creates a framework for the two insurance companies to coordinate benefits so they pay their fair share when both plans pay. COB decides which is the primary insurance plan and which one is secondary insurance. You can think of the secondary payer as supplemental coverage to help you pay for out-of-pocket costs.

If you are using coordination of benefits for their health insurance, the primary insurance pays its share of your health care costs first. Then, the secondary insurance plan will pay up to 100% of the total cost of health care, as long as it’s covered under the plan. Neither plan will pay more than 100% of the total health care costs, so you’re not going to get double the benefits if you have multiple health insurance plans.

COB rules vary for each individual and depend on the size and type of your plans, as well as what state you live in, as many states also have different laws in place. Additionally, large employers may have their own COB rules for medical claims.

Here’s an example of how the process works:

That sounds great, right? Well, having two health plans also means that you’ll likely need to pay two premiums and deal with deductibles for two health plans. But, couples may choose to have two plans if they are both employer-sponsored.

There are various situations when two health insurers need to coordinate on medical claims. You and your spouse may be eligible for two different policies from your jobs. Your spouse might be on Medicare and you have your own health plan. You might be under 26 and have your employer’s coverage and a parent’s insurance.

Here is a list of situations and which plan would likely serve as primary insurer and which ones would probably be secondary:

Coordination of benefits can sometimes get complicated — especially if the healthcare plan is for a child or dependent. Here are just a few examples of how coordination of benefits works for dependents:

Coordination of benefits is not one size fits all — there are a few different types of COB coverages: 

You should discuss your best options and what your coordination of benefits offers with your benefits administrator or health insurance company. 

Can you have two health insurances?

Yes, you can have more than one health plan.

Having two health plans may mean having to pay two premiums. However, two health plans may also help reduce out-of-pocket expenses when you need health care.

What is secondary insurance?

Secondary insurance is the health plan that pays second as part of the COB process.

The health plan that pays first and which one pays second depends on the type of plans and the situation. Check the table earlier on the page to see some of the scenarios.

How do I update my Medicare coordination of benefits?

There are a few different ways to update your Medicare coordination of benefits. For starters, reach out to your employer or union benefits administrator to update your benefits. If you still need help, try calling the benefits coordination hotline at 1-855-798-2627. 

How does coordination of benefits work in health insurance?

COB is a process that decides which health plan pays first when you have multiple health insurance plans. These plans are called primary and secondary plans.

Who is responsible for coordination of benefits?

The health insurance plans handle the COB. The health plans use a framework to figure out which plan pays first — and that they don’t pay more than 100% of the medical bill combined.

The plan type guides a COB. Factors that play a part in deciding which plan pays first are based on the state and size and type of the type of plan. Large employer plans can create their own rules.

What is coordination of benefits in medical billing?

COB helps insurance companies with the medical claims billing process.

After you receive health care services, the provider bills the insurance company or companies. The primary insurance company reviews the claims first and decides what it owes. Then, the secondary plan reviews what’s left of the bill and provides its payment.

Once the payers handle their parts of the medical claim, the patient receives a bill from the provider for the rest of the medical costs.

Medicare.gov. “ Coordination of Benefits. “Accessed June 2022.

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Coordination of benefits is a way to figure out who pays first when 2 or more health insurance plans are responsible for paying the same insurance claim.

Using coordination of benefits when processing insurance claims help identify the primary payer’s obligations as well as deciding the secondary payer’s portion. 

It is important to collect and verify the secondary and primary insurer information at each visit to reduce coordination of benefits worries.

It is also essential to be familiar with payer guidelines and payment plans before sending the claims to the primary payer.

NOTE: The secondary payer often requires a copy of the primary payer’s ‘Explanation of Benefits’ before processing and settling a claim.

Thankfully, H. J. Ross Company is the expert with over 40 years of experience in dealing with a wide range of chiropractic billing issues.

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Manchin on Social Security, Medicare: ‘Is there a better program?’

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Sen. Joe Manchin (D-W.Va.) on Thursday emphasized that he’s not going to discuss cutting Social Security and Medicare but suggested that Congress may have to look at whether there is a “better program” to use to make the benefits sustainable for future generations.

“Is there a better program?” Manchin said in an interview with Fox Business. “Is there a better way younger people can invest and have something for retirement? I don’t know.”

“Only thing I’m telling you I’m not going to discuss is cutting Social Security and Medicare for those people that are receiving and have been depending on it, that have worked hard and earned it,” he added. “Now with that, you have to look at everything. How do you sustain what you have?”

Manchin noted that if Congress doesn’t do anything to make the entitlement programs solvent, and they “sit back with our hands in our pockets and say we can’t get involved,” recipients will face automatic cuts.

Social Security is set to start running a shortfall in 2032, which could result in a more than 20 percent reduction in benefits, according to updated estimates from the Congressional Budget Office. The Medicare trustees suggested last year that the program’s trust fund will remain solvent through 2028.

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IMAGES

  1. Medicare for Veterans: A Comprehensive Guide

    medicare coordination of benefits with va

  2. Understanding Medicare Coordination of Benefits

    medicare coordination of benefits with va

  3. Do the VA And Medicare Work Together?

    medicare coordination of benefits with va

  4. VA or Medicare? Do you need both?

    medicare coordination of benefits with va

  5. Blockchain & Group Benefit Coordination: Learnings & Wrap Up

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  6. VA and Medicare: Are The Extra Costs Worth It?

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COMMENTS

  1. VA Health Care And Other Insurance

    To use VA benefits, you'll need to get care at a VA medical center or other VA location. We'll also cover your care if we pre-authorize you (meaning we give you permission ahead of time) to get services in a non-VA hospital or other care setting. Keep in mind that you may need to pay a VA copayment for non-service-connected care.

  2. Coordination of Benefits

    Coordination of benefits (COB) allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities (i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more …

  3. PDF Coordination of Benefits.

    Coordination of Benefits G E T T I N G S T A R T E D Learn how Medicare works with other health or drug coverage and who should pay your bills first. ... "Medicare and Other Health Benefits: Your Guide to Who Pays First," or call 1-800-MEDICARE (1-800-633-4227) to find out if a

  4. PDF Your guide to who pays first.

    Coordination of benefits If you have Medicare and other health coverage, you may have questions about how Medicare works with your other insurance and who pays your bills first . Each type of coverage is called a "payer ." When there's more than one payer, "coordination of benefits" rules decide who pays first .

  5. VA and Other Health Insurance

    Using the online Health Benefits Renewal form (10-10-EZR) at www.vets.gov/healthcare/apply/ Calling 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. ET. Presenting their health insurance card to the clinic clerk during check-in. VA health care is NOT considered a health insurance plan Medicare Coverage Creditable Coverage

  6. Medicare and VA Benefits

    In most cases, VA benefits and Medicare can't pay for the same services. The VA pays for VA-authorized health care services or items while Medicare pays for Medicare-approved health care. You generally have to choose which to use. There is no coordination of benefits between the two health care programs.

  7. Medicare & VA benefits: how they work together

    VA medical benefits offer a creditable drug plan that might prove more cost-effective than other options, such as Medicare or TRICARE. Sometimes, paperwork gets lost or buried. If you're sent a Part D penalty invoice, you can contest it by proving that you had a creditable drug plan within 63 days of applying for Medicare.

  8. Do You Need Medicare if You Have Veterans' Health Care?

    VA health benefits cover services at VA hospitals and other locations within its system. Medicare doesn't pay for the care. VA health benefits typically won't cover hospitals, doctors and other providers that participate in Medicare, nor will they cover Medicare deductibles, copayments and coinsurance.

  9. Medicare Secondary Payer

    Individual has ESRD, is covered by COBRA and is in the first 30 months of eligibility or entitlement to Medicare COBRA pays Primary, Medicare pays secondary during 30-month coordination period for ESRD Individual is age 65 years or older and covered by Medicare & COBRA: Medicare pays Primary, COBRA pays secondary

  10. Medicare Coordination of Benefits

    To avoid problems, you should call the Benefits Coordination & Recovery Center (BCRC) toll-free at 1-855-798-2627 (TTY users: 1-855-797-2627) as soon as your health coverage changes. Information to Have Ready When Calling the BCRC Your name The name and address of your health insurance plan Your policy number

  11. Making Part B enrollment decisions with VA benefits

    Enrolling in Part B provides you with the flexibility of getting health care outside the VA system. Also, you may qualify for programs to help pay the Part B premium and Medicare cost-sharing. Remember that you can keep your VA health benefits to get coverage for health care services and items not covered by Medicare, such as over-the-counter ...

  12. Medicare Coordination of Benefits (COB)

    However, you should also keep Medicare apprised of your benefits status. When you sign up for Medicare, you typically provide some information about your coverage so that Medicare knows how to coordinate your benefits. If your benefits change, you should call the Benefits Coordination & Recovery Center at 1-855-798-2627 to update your information.

  13. How CHAMPVA and Medicare Work Together

    calling Medicare's Benefits Coordination & Recovery Center at 855-798-2627 (TTY: 855-787-2627) calling CHAMPVA customer care at 800-733-8387, Monday through Friday from 8:05 a.m. to 7:30 p.m....

  14. Health insurance: How coordination of benefits works

    Some people are covered by two health insurance plans, which is called coordination of benefits (COB). If you have two plans, one will be primary and one will be secondary. Coordination of benefits (COB) allows you to have multiple health insurance plans.

  15. Billing & Coding: Coordination of Benefits

    Coordination of benefits is a way to figure out who pays first when 2 or more health insurance plans are responsible for paying the same insurance claim. Using coordination of benefits when processing insurance claims help identify the primary payer's obligations as well as deciding the secondary payer's portion. It is important to collect ...

  16. PDF Coordination of Benefits and Third Party Liability (COB/TPL) In

    FBDE (Medicare) Full Benefit Dual Eligible FEMA Federal Emergency Management Agency FMAP Federal Medical Assistance Percentage ... D. Department of Veterans Affairs (VA)..... 74 1. COB: General Rule ... Coordination of Benefits (COB): Primary and Last Payers ...

  17. Manchin on Social Security, Medicare: 'Is there a better program?'

    Sen. Joe Manchin (D-W.Va.) on Thursday emphasized that he's not going to discuss cutting Social Security and Medicare but suggested that Congress may have to look at whether there is a "better program" to use to make the benefits sustainable for future generations. "Is there a better program?" Manchin said in an interview with Fox […]