H.R. 4077: GUARD Veterans’ Health Care Act
Sponsor
Lloyd Doggett
Democrat · TX-37
Bill Progress
Latest Action · Dec 3, 2025
Committee Hearings Held
Why it matters
Starting with plan years on or after January 1, 2026, the bill would require Medicare Advantage and prescription drug plans to reimburse the Department of Veterans Affairs for covered care the VA already delivers, potentially redirecting major health dollars into veterans’ care.
Enforcement is the muscle behind the bill. Third parties that fail or refuse to pay could face a civil penalty after 30-day notice and an opportunity to pay. For willful failure or refusal to pay, the penalty would be the higher of triple the claim amount or $50,000 per claim violation, with inflation adjustment. The United States would also get a cause of action for double the amount of the claim for failure to provide payment or reimbursement. On timing, the government generally would have 6 years from the last day care was furnished to bring proceedings, while tort-based money-damages cases would have to be filed within 3 years after the right of action accrues. The bill also blocks refund requests filed more than 18 months after the Department received payment and bars parties from distributing settlement or judgment proceeds before satisfying the VA’s claim.
What does H.R. 4077 do?
Medicare Advantage reimbursement starts January 1, 2026
The bill creates 38 U.S.C. § 1729C and requires Medicare Advantage plans, including MA-PD plans, and prescription drug plan sponsors to reimburse the Secretary of Veterans Affairs for Medicare-covered care the VA provides to enrolled individuals for plan years beginning on or after January 1, 2026.
Covers hospital care, drugs, labs, devices
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 settings provided by the Department of Veterans Affairs.
Plans get 45 days to pay clean claims
A third party must pay a 'clean claim' within 45 days or provide written notice refusing the claim or requesting more information; the VA then has 45 days to respond with additional information, and the third party has 15 days after receiving that information to pay or refuse the claim.
Willful nonpayment can cost $50,000
For a willful failure or refusal to pay, the civil penalty is the higher of triple the claim amount or $50,000 per claim violation, subject to inflation adjustment, after 30-day notice and an opportunity to pay.
Government gets 6 years to recover costs
General recovery proceedings are barred after 6 years from the last day care was furnished, while tort-based money-damages claims are barred unless the complaint is filed within 3 years after the right of action accrues.
Refund requests cut off after 18 months
Third parties cannot ask for refunds for payment errors more than 18 months after the date the Department received the payment, and they must report recipient identity and coordination-of-benefits information within 30 days after they know or should know the recipient received VA benefits.
Who benefits from H.R. 4077?
Veterans who use VA and Medicare Advantage
If they are enrolled in Medicare Advantage, including MA-PD plans, the VA could recover payment for covered services the veteran already receives from the VA, potentially increasing resources for outpatient care, inpatient care, prescription drugs, lab testing, medical devices, and post-acute or long-term care.
Department of Veterans Affairs
The VA gains a new statutory collection tool under 38 U.S.C. § 1729C, stronger enforcement rights, interest on late payments under 31 U.S.C. § 3717, and a requirement that recovered amounts be deposited into the Department of Veterans Affairs Medical Care Collections Fund.
Federal taxpayers
By requiring Medicare Advantage plans and prescription drug plan sponsors to reimburse the VA instead of leaving the federal health system to absorb those costs, the bill aims to recover more of the reasonable charges tied to veterans' care.
VA facilities and clinicians
Hospitals, clinics, and VA providers could see more reliable reimbursement because plans cannot deny payment based on extra documentation demands, utilization management, or other administrative requirements beyond what the bill allows.
Who is affected by H.R. 4077?
Medicare Advantage organizations
They would have to reimburse the VA for Medicare-covered services provided to their enrollees beginning with plan years on or after January 1, 2026, even if they would prefer prior authorization, extra documentation, or other utilization management rules.
Prescription drug plan sponsors
Stand-alone PDP sponsors would be required to reimburse the VA for covered prescription drugs provided to enrolled individuals and would be subject to the same deadlines, interest rules, and penalties for nonpayment.
Insurers and other third-party payers
For non-service-connected disability claims, they would face 45-day and 15-day payment deadlines, interest under 31 U.S.C. § 3717 for late payment, reporting duties within 30 days, and possible liability for double the amount of 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 or judgment proceeds before satisfying the Department’s claim, and tort-based money-damages cases would have to be filed within 3 years after the right of action accrues.
H.R. 4077 Common Questions
How much is the penalty if a Medicare Advantage plan willfully refuses to pay a VA claim?
Under the GUARD Veterans’ Health Care Act (SEC. 3), willful nonpayment can trigger a civil penalty of the greater of triple the claim amount or $50,000 per claim violation, adjusted for inflation, after 30 days' notice.
When do Medicare Advantage plans have to start reimbursing the VA under HR 4077?
According to HR4077 SEC. 2, Medicare Advantage, MA-PD, and Part D prescription drug plan sponsors must reimburse the VA for plan years beginning on or after January 1, 2026.
How long do Medicare Advantage plans have to pay a clean VA claim?
Under the GUARD Veterans’ Health Care Act (SEC. 3), a third party must pay a clean claim within 45 days or send written notice refusing the claim or requesting more information.
Can the VA charge interest if an insurer or plan pays a veteran care claim late?
Yes. Under HR4077 SEC. 3, late payment can trigger interest at the monthly rate set by the Treasury Secretary under 31 U.S.C. 3717.
What VA services must Medicare Advantage and Part D plans reimburse under the GUARD Veterans’ Health Care Act?
Under the GUARD Veterans’ Health Care Act (SEC. 2), reimbursement includes outpatient and inpatient care, prescription drugs, medical devices, lab testing, and post-acute or long-term care provided by the VA.
Can Medicare Advantage plans deny VA reimbursement because of prior authorization or plan paperwork rules?
No. According to HR4077 SEC. 2, plans must reimburse the VA regardless of plan administrative requirements, utilization management, or documentation rules.
How long does the government have to recover VA care costs from a third party?
Under the GUARD Veterans’ Health Care Act (SEC. 3), general recovery actions must be brought within 6 years from the last day the care or services were furnished.
How long do insurers have to ask the VA for a refund on a payment error?
According to HR4077 SEC. 3, a third party cannot request a refund or payment correction more than 18 months after the VA received the payment.
Does the bill let the government sue for double a VA clean claim that was not paid?
Yes. Under the GUARD Veterans’ Health Care Act (SEC. 3), the United States gets a cause of action for double the amount of a clean claim if payment or reimbursement is not provided.
Can an insurer distribute a settlement before paying the VA’s claim for veteran care?
No. According to HR4077 SEC. 3, a third party may not distribute settlement, judgment, or award proceeds until the Department’s claim has been satisfied.
Based on H.R. 4077 bill text
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 25 committee members cosponsored
Energy and Commerce Committee
2 of 54 committee members cosponsored
Ways and Means Committee
2 of 45 committee members cosponsored
52 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.
VA’s official community care and reimbursement hub is relevant because the bill expands VA recovery and payment collection from third-party health plans.
CMS’s Medicare Advantage information page is relevant because the bill applies to MA organizations and MA-PD plans.
CMS’s Part D page is relevant because the bill requires prescription drug plan sponsors to reimburse the VA for covered drugs.
Official U.S. Code page for 38 U.S.C. 1729, the core VA recovery statute that Section 3 of the bill amends.
Official U.S. Code page for 31 U.S.C. 3717, the Treasury interest provision the bill uses for late payments.
The Medicare Managed Care Manual provides official CMS guidance for Medicare Advantage plan operations, which helps contextualize the bill’s override of plan administrative requirements.
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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