This Act modifies the Department of Veterans Affairs' reimbursement rules for emergency medical care received outside VA facilities when a veteran has private insurance, clarifying what constitutes a copayment and expanding what costs are eligible for reimbursement claims.
Debbie Dingell
Representative
MI-6
The Veterans Emergency Care Reimbursement Act of 2025 modifies how the Department of Veterans Affairs (VA) reimburses veterans for emergency care received outside VA facilities when they have private insurance. This bill clarifies the definition of "copayment" for reimbursement purposes, explicitly excluding deductibles and coinsurance. It also broadens what counts as a reimbursement claim to include various out-of-pocket costs, applying these changes retroactively to claims filed since February 1, 2012.
VA Reimbursement Rules Retroactively Expanded to Cover Veteran Deductibles and Coinsurance Since 2012
If you’re a veteran with private insurance who has ever had to use a non-VA emergency room, this bill could mean getting a significant chunk of change back. The Veterans Emergency Care Reimbursement Act of 2025 is a technical but crucial fix to how the Department of Veterans Affairs (VA) pays back veterans for out-of-pocket costs related to emergency care they received outside the VA system.
The VA’s New Definition of 'Copayment'
This legislation updates a specific part of the law (38 U.S.C. § 1725) to clarify what the VA is required to reimburse when a veteran has private health insurance. Previously, the rules around what the VA would pay back—especially when it came to cost-sharing—were murky, leading to many denials. The bill strictly defines a “copayment” as only the fixed dollar amount paid for a specific service. Crucially, this definition now excludes money paid toward a deductible or coinsurance, which are often the biggest out-of-pocket costs after an emergency.
Clearing Up the Cost-Sharing Confusion
The real game-changer here is that the bill explicitly states that a reimbursement claim now includes requests for money spent on a copayment, deductible, coinsurance, or any other cost-sharing amount. This is a big deal because it closes the loophole that allowed the VA to deny claims for large deductibles or coinsurance payments, arguing they weren't covered under the existing, narrower definition of 'copayment.' For a veteran who had a major emergency, this could be the difference between getting reimbursed a few hundred dollars versus several thousand dollars.
Retroactive Relief for a Decade of Claims
Perhaps the most impactful provision is that these new rules apply retroactively to any reimbursement claim submitted for emergency treatment that happened on or after February 1, 2012. This isn't just about future claims; it means veterans who were previously denied reimbursement for their deductibles or coinsurance on emergency care over the past decade can now resubmit or have those claims reprocessed. This retroactive fix is specifically designed to provide relief to veterans caught up in legal battles over these denied claims, like those involved in the Wolfe v. McDonough lawsuit.
The Real-World Impact on Your Wallet
Think about a veteran who broke an arm in 2018 and went to the nearest hospital, not a VA facility. Their private insurance paid most of the bill, but they were left with a $3,000 deductible and $1,500 in coinsurance. Under the old rules, the VA likely denied that $4,500 claim. Under this new act, that veteran now has clear grounds to seek reimbursement for the full $4,500. While this is great news for veterans, the VA will need to handle a potentially massive influx of old claims, which could create significant administrative work and financial liabilities for the department. The benefit is clear: less financial stress on veterans who needed immediate care.