Which Healthcare Facilities Don't Bill Medicare

Facilities That Don't Submit Medicare Claims

Some healthcare facilities are not required to bill Medicare, even when they treat Medicare beneficiaries. These facilities operate outside the Medicare billing system entirely. Understanding which ones they are helps you know what to expect when you receive care and what paperwork you might handle differently.

The main categories are Veterans Affairs (VA) medical centers, Indian Health Service (IHS) facilities, military treatment facilities, federal prisons, and certain state and local health departments. Each operates under its own funding structure and billing rules. Your out-of-pocket costs and how claims are processed depend on which type of facility treats you.

Key Takeaways

VA medical centers, Indian Health Service facilities, and military treatment facilities do not bill Medicare and operate on separate funding systems.
If you receive care at an exempt facility, Medicare does not pay the facility, but you typically do not owe the facility a bill either.
You should tell any healthcare provider upfront if you plan to use a VA or IHS facility so they do not expect a Medicare claim.
Some facilities are exempt only for certain services, so ask whether a specific treatment will be billed to Medicare or handled through another system.
If a facility bills you directly after saying it was exempt, contact your state's insurance commissioner or the facility's billing department to dispute the charge.

Veterans Affairs Medical Centers

VA medical centers do not bill Medicare for any care provided to veterans. Instead, the VA receives a separate federal appropriation to run its hospitals and clinics. If you are a veteran with Medicare, you can receive care at a VA facility, but the VA will not submit a claim to Medicare.

You do not owe the VA facility a bill for the care itself, though you may have small copayments depending on your VA disability rating and income. The VA and Medicare operate independently — having Medicare does not change your VA benefits, and using the VA does not affect your Medicare coverage elsewhere. If you need care and are unsure whether to go to the VA or a Medicare-participating provider, ask the VA facility whether they can treat your specific condition.

Indian Health Service Facilities

Indian Health Service (IHS) facilities, including tribal health centers and hospitals, do not bill Medicare. The IHS is a federal agency that provides healthcare to American Indian and Alaska Native people. Funding comes through the federal budget, not through Medicare claims.

If you are an enrolled member of a federally recognized tribe and have Medicare, you can receive care at an IHS facility without a Medicare claim being filed. You typically do not owe the facility a bill for the care. Some IHS facilities have agreements with Medicare to coordinate care, but they do not submit claims to Medicare for payment. If you receive care at an IHS facility and later receive a bill, contact the facility's billing office to clarify — you should not be charged.

Military Treatment Facilities

Military treatment facilities (MTFs) — hospitals and clinics run by the Department of Defense — do not bill Medicare. These facilities serve active-duty service members, retirees, and their families. Funding comes through the military budget.

If you are a military retiree or family member with Medicare, you can receive care at an MTF. The facility will not submit a claim to Medicare. You may owe a small copayment depending on your military status and the type of care. If you are may be able to access for both TRICARE (the military health insurance program) and Medicare, the facility will use TRICARE as the primary payer, not Medicare. Ask the MTF whether they can provide the specific care you need before scheduling an appointment.

Federal Prisons and Correctional Facilities

Federal Bureau of Prisons medical facilities do not bill Medicare. Healthcare for incarcerated individuals is funded through the prison system's budget. If you are incarcerated in a federal facility and have Medicare, the facility provides care without submitting a Medicare claim.

State and local correctional facilities vary in their billing practices. Some do not bill Medicare, while others may attempt to bill for certain services. If you are incarcerated and receive a bill after care, contact the facility's health services department to ask whether Medicare was billed and whether you owe payment.

State and Local Health Department Clinics

Some state and local health department clinics operate on a fee-for-service or grant-funded basis and do not bill Medicare. These clinics often provide preventive care, immunizations, and disease screening. However, not all health department clinics are exempt — some do bill Medicare.

Before receiving care at a health department clinic, ask whether they bill Medicare or use a different payment system. If they do not bill Medicare, ask what you will owe out of pocket. Some clinics use a sliding scale based on income. If you are unsure, contact the clinic's billing office directly.

What Happens When You Receive Care at an Exempt Facility

When you receive care at a facility that does not bill Medicare, the facility does not submit any claim to Medicare. Medicare does not pay the facility, and the facility does not bill you for the full cost of care. Instead, you may owe a copayment, coinsurance, or nothing at all, depending on the facility's rules.

Before your appointment, tell the facility that you have Medicare and ask what you will owe. Get this in writing if possible. After your visit, you should not receive an explanation of benefits (EOB) from Medicare for that care, because Medicare was never billed. If you do receive an EOB or a bill from the facility, contact the facility to clarify what happened.

What to Do If You Are Billed Unexpectedly

If a facility told you it was exempt from Medicare billing but then sends you a bill or you see a Medicare claim, contact the facility's billing department first. Explain that you were told the facility does not bill Medicare and ask them to correct the claim or bill.

If the facility does not resolve it, you can file a complaint with your state's insurance commissioner or with Medicare directly. Contact Medicare at 1-800-MEDICARE (1-800-633-4227) to report the issue. Keep copies of any bills, letters, or notes about what the facility told you. Your state insurance commissioner's office can also investigate whether the facility violated billing rules.

Frequently Asked Questions

If a facility does not bill Medicare, do I still have Medicare coverage?

Yes. Your Medicare coverage does not change based on where you receive care. However, some facilities choose not to bill Medicare even though they could. When a facility does not bill Medicare, it means that particular facility operates under a different funding system and handles payment differently.

Can I use my Medicare card at a VA or IHS facility?

You can bring your Medicare card, but the facility will not use it to bill Medicare. The VA and IHS have their own may be able to access systems. Bring your VA health identification card or proof of tribal enrollment instead. Having Medicare does not change your may be able to access at these facilities.

Will I owe more money if a facility does not bill Medicare?

Not necessarily. Facilities that do not bill Medicare typically charge less out of pocket than Medicare-participating providers. You may owe a small copayment or nothing at all. Ask the facility about costs before your appointment so you know what to expect.

What if I need a referral to a facility that does not bill Medicare?

Medicare does not require referrals for most care, so you do not need permission from Medicare to go to a VA, IHS, or military facility. However, tell your primary care doctor where you are going so they have a record. If the facility provides a summary of your visit, share it with your other doctors.

Can a facility be exempt from Medicare billing for some services but not others?

Yes. Some facilities may not bill Medicare for certain types of care but do bill for others. Always ask the facility whether the specific service you need will be billed to Medicare or handled through another system. Get the answer in writing if you can.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.