H.R. 4077: GUARD Veterans’ Health Care Act
Sponsor
Lloyd Doggett
Democrat · TX-37
Bill Progress
Latest Action · Dec 3, 2025
Committee Hearings Held
Make Medicare plans pay the VA back
Why it matters
When a veteran enrolled in a private Medicare Advantage or drug plan gets treated at the VA, that plan often never reimburses the government, and the federal health system absorbs the cost. H.R. 4077 would require those plans to pay the VA back for covered care starting with plan years on or after January 1, 2026, and back it with penalties of up to triple the claim or $50,000 for willfully refusing to pay.
H.R. 4077, the GUARD Veterans' Health Care Act, targets a quiet gap in how veterans' care gets paid for. When the VA treats a veteran who is also enrolled in a private Medicare Advantage or Part D drug plan, that plan currently has little obligation to reimburse the government. The bill flips that, requiring the plans to pay the VA back for covered care starting with plan years on or after January 1, 2026.
The reimbursement is not limited to one kind of care. It covers outpatient and inpatient treatment, prescription drugs, medical devices, lab work, and post-acute and long-term care the VA provides. And plans cannot dodge payment by demanding prior authorization or extra paperwork the bill does not require.
The second half of the bill sharpens the VA's existing power to collect from insurers and other third parties for care tied to non-service-connected conditions. Plans get 45 days to pay a clean claim or explain in writing why they will not. Miss the deadline and interest starts running.
The bill also adds penalties for nonpayment. A plan that willfully refuses to pay a clean claim can owe the higher of triple the claim amount or $50,000 per violation. The government gets the right to sue for double the amount of an unpaid clean claim, and a plan cannot distribute settlement money before the VA's claim is satisfied.
Everything the VA collects under the new authority goes into its Medical Care Collections Fund, which helps pay for veterans' care.
H.R. 4077 Bill Summary
What H.R. 4077 actually does.
Medicare plans must reimburse the VA
Medicare Advantage plans, including MA-PD plans, and Part D prescription drug plan sponsors would have to reimburse the VA for Medicare-covered care it delivers to their enrolled veterans, starting with plan years beginning on or after January 1, 2026.
Covers everything from drugs to long-term care
Reimbursement is not limited to one setting. It explicitly includes outpatient care, inpatient care, prescription drugs, medical devices, lab testing, and post-acute and long-term care the VA provides.
Plans get 45 days to pay a clean claim
A plan must pay a clean claim within 45 days or send written notice refusing it or requesting more information. The VA then has 45 days to respond, and the plan has 15 days after that to pay or refuse. Late payment accrues interest.
Willful nonpayment can cost triple or $50,000
A plan that willfully fails or refuses to pay a clean claim can owe the higher of triple the claim amount or $50,000 per violation, subject to inflation adjustment, after 30 days' notice and a chance to pay.
The government gets six years to collect
General recovery proceedings are barred after six years from the last day care was furnished. Tort-based money-damages claims are barred unless the complaint is filed within three years after the right to sue first accrues.
Refund requests cut off after 18 months
A third party cannot ask for a refund to correct a payment error more than 18 months after the VA received the payment, and it must report a recipient's identity and coordination-of-benefits information within 30 days of learning they received VA benefits.
Who benefits from H.R. 4077?
Veterans who use both the VA and Medicare Advantage
Veterans enrolled in a Medicare Advantage or MA-PD plan keep getting care from the VA exactly as they do now. The bill changes who pays for it behind the scenes, with the goal of steering more money back toward veterans' outpatient, inpatient, drug, lab, device, and long-term care.
The Department of Veterans Affairs
The VA gains a new tool to collect from Medicare plans, stronger enforcement rights against insurers, interest on late payments, and a requirement that recovered money flow into its Medical Care Collections Fund, which pays for veterans' care.
Federal taxpayers
When private Medicare plans do not pay for care the VA delivers, the federal health system eats the cost. By forcing those plans to reimburse the VA, the bill aims to recover charges that taxpayers currently absorb.
VA hospitals and clinicians
VA facilities could see more reliable reimbursement, because plans could not deny payment based on extra documentation demands, utilization management, or other administrative rules the bill does not allow.
Who is affected by H.R. 4077?
Medicare Advantage organizations
They would have to reimburse the VA for Medicare-covered care delivered to their enrollees starting with plan years on or after January 1, 2026, even where they would normally require prior authorization, extra documentation, or other utilization management.
Part D prescription drug plan sponsors
Stand-alone drug plan sponsors would have to reimburse the VA for covered prescription drugs it provides to enrolled veterans, under the same deadlines, interest rules, and penalties for nonpayment.
Insurers and other third-party payers
For care tied to non-service-connected conditions, they would face 45-day and 15-day payment deadlines, interest on late payment, reporting duties within 30 days, and possible liability for double the claim, or the higher of triple damages or $50,000 for willful refusal to pay.
Parties in settlements and tort cases
They could not distribute settlement, judgment, or award proceeds before satisfying the VA's claim, and tort-based money-damages cases would have to be filed within three years after the right to sue first accrues.
HR4077 Legislative Journey
House: Committee Action
Dec 3, 2025
Committee Hearings Held
House: Committee Action
Jun 23, 2025
Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Ways and Means, and Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
About the Sponsor
Lloyd Doggett
Democrat, Texas's 37th congressional district · 31 years in Congress
Committees: Ways and Means, the Budget, Joint Committee on Taxation
View full profile →
Cosponsors (5)
This bill has 5 cosponsors: 2 Democrats, 3 Republicans, reflecting bipartisan support. Cosponsors represent 5 states: Arizona, California, North Carolina, and 2 more.
Committee Sponsors
Veterans' Affairs Committee
2 of 24 committee members cosponsored
Energy and Commerce Committee
2 of 54 committee members cosponsored
Ways and Means Committee
2 of 45 committee members cosponsored
51 Democrats across these committees haven't cosponsored yet. Mobilize their constituents
What laws does H.R. 4077 change?
3 changes
Sections Amended
Section 1729A of this title.''. (2) Clerical amendment.--The table of sections at the beginning of such chapter
inserting after the item relating to section 1729B the following new item: ``1729C
Section 1814(c) of Social Security Act (42 U.S.C. 1395f(c))
inserting ``and section 1729C of title 38, United States Code'' after ``section 1880''
Section 1835(d) of Social Security Act (42 U.S.C. 1395n(d))
inserting ``and section 1729C of title 38, United States Code'' after ``section 1880''
H.R. 4077 Quick Facts
- Committee
- Veterans' Affairs
- Chamber
- House
- Policy
- Armed Forces and National Security
- Introduced
- Jun 23, 2025
Committee Hearings Held
Dec 3, 2025
Official Sources
Official bill page with text, actions, sponsors, and status for the GUARD Veterans’ Health Care Act.
The core VA recovery statute that Section 3 of the bill amends to add 45-day payment deadlines, interest, and nonpayment penalties.
The Treasury fund where the bill directs all amounts recovered from Medicare plans to be deposited to help pay for veterans' care.
The Treasury interest provision the bill applies when a third party misses the 45-day deadline to pay a clean claim.
VA’s official community care and third-party reimbursement hub, relevant because the bill expands VA recovery and payment collection from health plans.
CMS’s Medicare Advantage resources page, relevant because the bill requires MA organizations and MA-PD plans to reimburse the VA.
CMS’s Part D general information page, relevant because the bill requires prescription drug plan sponsors to reimburse the VA for covered drugs.
H.R. 4077 Common Questions
Does H.R. 4077 cost veterans anything out of pocket?
No. The bill moves money between private Medicare plans and the VA, not the veteran. It requires Medicare Advantage and drug plans to reimburse the VA for care it already provides. Your benefits and out-of-pocket costs do not change.
When do Medicare plans have to start reimbursing the VA under H.R. 4077?
Medicare Advantage plans, MA-PD plans, and Part D drug plan sponsors must reimburse the VA for covered care starting with plan years that begin on or after January 1, 2026.
What's the penalty if a Medicare plan willfully refuses to pay the VA?
A plan that willfully fails or refuses to pay a clean claim can owe the higher of triple the claim amount or $50,000 per violation, adjusted for inflation. The VA first gives 30 days' notice and a chance to pay.
What VA care must Medicare and drug plans reimburse?
Reimbursement covers outpatient and inpatient care, prescription drugs, medical devices, lab testing, and post-acute or long-term care the VA provides to enrolled veterans.
Can a Medicare plan deny VA reimbursement over prior authorization or paperwork?
No. Plans have to reimburse the VA regardless of prior authorization, utilization management, or extra documentation rules they would normally apply.
How long does a Medicare plan have to pay a clean VA claim?
A plan has 45 days to pay a clean claim or send written notice refusing it or asking for more information. Miss the deadline and interest starts running on the unpaid amount.
How long does the government have to collect VA care costs from an insurer?
Generally six years from the last day the VA furnished the care. Tort-based claims for money damages have a shorter window, three years after the right to sue first accrues.
Based on H.R. 4077 bill text
H.R. 4077 Bill Text
“To amend title 38, United States Code, and the Social Security Act to permit recovery from the Department of Veterans Affairs of costs from Medicare Advantage and Medicare prescription drug plans and to modify the authority for recovery by the United States of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities, and for other purposes.”
Source: U.S. Government Publishing Office
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