Why Congress Is Looking at Veteran Medicare Advantage Plans

Last reviewed: 2026-08-11

If you follow veteran healthcare news at all, you may have seen headlines about Medicare Advantage plans, VA care, and billions of dollars. This is a real, active policy conversation, and it is worth understanding in plain terms, separate from any plan you might be considering. Nothing here is a reason to avoid or rush into anything. It is context.

The core issue: two systems that don’t bill each other

The Department of Veterans Affairs (VA) is generally prohibited by law from billing Medicare for care it provides to veterans. That rule predates Medicare Advantage. When Medicare Advantage, the privately administered version of Medicare, expanded in the years since, it created a gap: the federal government pays a Medicare Advantage insurer a fixed monthly amount for each enrolled veteran, whether or not that veteran ever uses the plan, while the VA separately pays for the same veteran’s care out of its own budget when that veteran gets treated at a VA facility instead. Neither side reimburses the other.

What researchers found

A study published in Health Affairs in 2024 examined Medicare Advantage plans with unusually high numbers of veteran enrollees, plans where veterans make up a large share of the membership. The researchers found that in 2020, the Centers for Medicare & Medicaid Services (CMS) paid more than $1.32 billion to Medicare Advantage plans nationwide for VA enrollees who did not use any Medicare services that year. About 19.1 percent of that, roughly $252 million, went specifically to the high-veteran plans the study focused on. Within those plans, roughly one in five VA enrollees incurred no Medicare-paid services in a given year, a notably higher share than among other Medicare Advantage enrollees generally.

What a Wall Street Journal analysis reported

Reporting from the Wall Street Journal, published in December 2024, examined billing and enrollment data for Medicare Advantage plans marketed heavily toward veterans. According to that analysis, as summarized in a subsequent policy brief from the Center for Medicare Advocacy, the federal government paid insurers an estimated $44 billion between 2018 and 2021 to cover veterans dually enrolled in VA care and Medicare Advantage plans generally, while the VA spent an additional $46 billion on the same group’s care over the same period. Within that total, the analysis found insurers collected about $1.7 billion in 2021 specifically through veteran-majority plans, plans where most members are dually enrolled veterans. The analysis also found that members of veteran-majority plans used substantially fewer Medicare-covered services than members of other Medicare Advantage plans, including fewer surgeries, fewer doctor visits, and fewer hospital days, while on a per-member basis, insurers were paid about 77 percent as much for veteran-majority plan members as for members of other plans in the same geographic areas.

The legislative response

A bipartisan, bicameral bill called the GUARD Veterans’ Health Care Act, short for the Guarantee Utilization of All Reimbursements for Delivery of Veterans’ Health Care Act, was introduced on June 23, 2025: in the House by Representative Lloyd Doggett with Republican and Democratic cosponsors, and in the Senate the same day, where Senator Richard Blumenthal is among the cosponsors. The bill would amend federal law to let the VA recover costs from Medicare Advantage and Medicare Part D prescription drug plans when the VA provides care or medication that would otherwise have been covered under a veteran’s Medicare Advantage or Part D plan. As of this writing, the bill has been introduced and referred to committee. It has not been enacted.

A parallel administrative step

Separately from any legislation, the VA and CMS announced in July 2025 that they had set up a data-matching partnership between the two agencies to identify cases where a provider had billed both VA and Medicare for the same episode of care. That partnership identified and began recovering $106 million in duplicate billing accumulated over a six-year period, out of roughly 5.9 million veterans who are enrolled in both systems. This step targets duplicate provider billing directly, and is distinct from the capitated-payment issue the Health Affairs study and the GUARD Act address.

What this means if you’re choosing coverage today

None of this changes anything about your coverage today. Medicare Advantage plans marketed to veterans remain fully legal, and enrolling in one is a legitimate choice for veterans for whom it fits. The policy conversation described above is about federal spending patterns and program design, not about whether any individual veteran’s enrollment is proper.

It is also fair to say this category of plan could look different in the future if the GUARD Act or similar legislation passes. That is a reason to stay generally informed, not a reason to make a coverage decision out of fear of a bill that has not become law. The right way to choose coverage remains the same regardless of how this policy debate resolves: base the decision on your own doctors, your own use of care, and your own comfort with plan networks and paperwork, not on speculation about what Congress might do next.

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