GUARD Veterans’ Health Care Act
The GUARD Veterans’ Health Care Act would expand how the Department of Veterans Affairs (VA) recovers costs for care it provides to veterans. First, it creates a new mechanism to bill Medicare Advantage (MA) plans and Medicare prescription drug (Part D) plans for VA-provided items and services that would be covered by those Medicare plans, requiring plans to pay the VA to the full extent of what their plan covers. Second, it broadens the VA’s authority to recover reasonable charges for care or services provided to veterans with non-service-connected disabilities by pursuing subrogation against third parties (such as tortfeasors or other payers) and by strengthening collection procedures, penalties for nonpayment, and enforcement tools. The bill would deposits any recovered funds into the VA Medical Care Collections Fund. It also adjusts related Medicare and Social Security Act provisions to align with these changes and would take effect for MA and Part D plan years beginning in 2026. Potential impact: The bill could increase VA-revenue through new cost-recovery channels (MA/Part D plans and third-party recoveries), reduce costs borne by the VA or by Medicare in some scenarios, and strengthen VA leverage to pursue reimbursements. It would also impose new administrative responsibilities on MA/PDP sponsors and third-party payers, and could affect veterans’ interactions with their health-care benefits and with third-party insurers or tort matters.
Key Points
- 1New cost-recovery from Medicare Advantage and Medicare prescription drug plans
- 2- VA may bill MA or PDP plans for care the VA provides that would be covered by those Medicare plans, and plans must reimburse the VA to the extent their plan covers the item or service, regardless of the plan’s usual administration or documentation requirements.
- 3- Recovered amounts go to the VA Medical Care Collections Fund.
- 4- Applies to MA and PDP plan years beginning on or after January 1, 2026.
- 5Medicare conforming amendments
- 6- The Social Security Act is amended so Medicare Parts A (hospital/medical) and B (other services) coordinate with the new VA recovery (1729C), and to update exclusions when VA reimbursement under 1729C applies.
- 7Expanded authority to recover reasonable charges for non-service-connected care
- 8- The United States gains the right to recover reasonable charges for care or services VA must furnish for non-service-connected disabilities, including amounts payable under third-party plans or tort arrangements.
- 9- The recovery rights extend to subrogation from third parties and to all related claims, such as tort actions, insurance plans, and other payers.
- 10- New and enhanced enforcement tools include deadlines for third-party responses, interest for late payments, penalties for noncompliance, and a possible civil remedy for double damages in some cases.
- 11Procedural and enforcement details
- 12- If a third party fails to pay a “clean claim” within specified timeframes, interest accrues and penalties may apply.
- 13- The term “clean claim” means a claim that can be processed without additional information.
- 14- The bill sets time limits (e.g., a six-year window to bring actions after care is furnished; a three-year window for tort-based actions under certain conditions) and requires coordination of benefits reporting to the VA.
- 15- The Secretary may implement these provisions through regulations or program instructions.
- 16Definitions and clarifications
- 17- The bill defines “non-service-connected disability” broadly, including aggravations of service-connected conditions and other health-care needs.
- 18- It clarifies that recovered amounts are not limited to non-VA providers or to non-VA fee schedules.