More About Your Medical Benefits Package
We cover preventive care services, like:
- Health education
- Immunization against infectious diseases
- Counseling on genetic diseases
We cover inpatient hospital services, like:
- Kidney dialysis
- Specialized care
We cover urgent and emergency care services, like:
- Urgent or emergency care at some VA health facilities.
- Urgent care for injuries and illnesses that need attention right away, but arent life threatening, at urgent care locations that are part of our contracted network. This may include care at a VA-approved:
- Walk-in retail health clinic for minor illnesses like a sore throat or earache
- Urgent care facility for more pressing illnesses or injuries that require treatment like splinting, casting, or wound care
We cover other services and needs, like:
- Mental health services to treat certain issues like posttraumatic stress disorder , military sexual trauma , depression, and substance use problems.
We may cover services that your VA primary care provider concludes you need to support your treatment , like:
- Tests used to diagnose health conditions, including blood work, X-rays, and ultrasounds
- Therapy and rehabilitation services, including physical therapy, vision rehab, and therapy for traumatic brain injury
- Additional services, including prosthetic items, audiology , and radiation oncology
You may be able to get help with some non-medical services, like:
All of these must be true:
Yes.
Do I Need To Sign Up For Medicare If Im A Veteran With Va Health Care
En español | You arent required to sign up for Medicare if you have health care coverage through the U.S. Department of Veterans Affairs , but the VA encourages veterans to sign up for Medicare Part A and Part B during their initial enrollment period at 65, unless they also have group insurance from a current employer.
That way, youll have more options for care. VA health benefits provide coverage for care in VA clinics and hospitals but they generally dont cover other facilities and doctors.
Even if youre happy with your VA health care benefits now, your medical needs or the VA health systems costs and coverage could change. And you could end up with a late-enrollment penalty if you decide to sign up later for Medicare.
Once Im Enrolled Do I Need To Update My Income Information Every Year
This depends on your situation:
- If you completed a financial assessment to find out if you were eligible for cost-free medications or for beneficiary travel pay , youll need to provide updated income information each year.
- If we determine youre eligible for free VA health care because your household income is below our income limit, you dont have to provide updated income information each year.
Well receive your income information from the IRS and the SSA each year to confirm that youre still eligible for free VA health care. Well contact you only if this information changes your eligibility or copay requirements. If you disagree with the information, you can keep using VA health care services while we review your situation.
Note: Even when not required, we encourage you to report changes in your income. Its also important to let us know about changes to your personal information . You can do this any time by using our Health Benefits Update Form .
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Learn how VA health care works with other insurance .
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How Much Does Va Healthcare Cost
The VA will provide you free health care for conditions that are caused or made worse by your military service. If you have severe injuries or disabilities you may be eligible to receive all your medical care for free from the VA, not just that care related to your injuries. You can also receive more care from the VA if you have an income below certain limits.
If you are a 50% or greater disabled veteran or a former POW, all your medical care from the VA is free. There are other groups that may get some, or all VA medical care for free, see our VA Copay page for details.
Are Veterans’ Family Members Eligible For Va Health Care
Veterans’ family members are not eligible for enrollment in VA health care services. However, certain dependents and survivors may receive reimbursement from the VA for some medical expenses.
The Civilian Health and Medical Program of the Department of Veterans Affairs pays for health care services to dependents and survivors of certain veterans. It is primarily a fee-for-service program that provides reimbursement for most medical care that is provided by non-VA providers or facilities. On May 5, 2010, President Barack Obama signed into law the Caregivers and Veterans Omnibus Health Services Act of 2010 ” rel=”nofollow”> P.L. 111-163), which expanded the CHAMPVA program to include the primary family caregiver of an eligible veteran who has no other form of health insurance, including Medicare and Medicaid.26 Health care services provided include counseling, training, and mental health services for the primary family caregiver. For more information, see CRS Report RS22483, Health Care for Dependents and Survivors of Veterans, by Sidath Viranga Panangala.
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The Standard Va Health
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The VA will cover most of a fully qualifying veteran’s medical needs, including women’s health services.
But there are a few exceptions to coverage: abortions or abortion counseling, in-vitro fertilization, drugs not covered by the Food and Drug Administration , sex-reassignment surgeries, and memberships in spas and health clubs.
Dental care is provided, but it’s very limited. In most instances, veterans will only get dental care if they have a service-related dental condition or injury.
Does Va Verify The Information I Provide
This depends on your situation. If the information you provide shows that your income falls below our limits and qualifies you for free VA health care, medications, or both, were required by law to verify the information. We do this by confirming your information with the Internal Revenue Service and the Social Security Administration .
Because of tax deadlines, we usually begin this process in July, the year after you report your income. So, for example, if you provide information for the year 2018, well verify it in July of 2019.
More about confirming your IRS and SSA information
What happens if the IRS and SSA information shows you have income above our limits
If the information we receive from the IRS and the SSA shows that you have income above our limits, well send a letter notifying you . Youll have the chance to dispute this information. You can also send documents showing you have additional deductible expenses that we should consider.
If you dont respond to our letter:
After 45 days, well send you a reminder letter.
After 75 days, well assume the information from the IRS and the SSA is correct. Well send you a letter to explain the changes in your eligibility or copay status. Well also explain how you can appeal our decision.
If you respond by disputing the information in our letter:
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Applying For Va Health Care Benefits
Once you have established your eligibility for VA health care benefits, you will need to fill out Form 10-10EZ or Form 10-10EZR to apply for benefits. These forms are also used to update your current information if anything has changed. There are several ways you can fill out or update the 10-10EZ: online, by phone, by mail, or in-person at a VA medical facility. Here is the info you need:
- Online:Visit this link and fill out the form.
- Phone: Call 1-877-222-VETS , Mon-Fri, 8:00 am 8:00 pm EST. A VA rep will send you a completed form via mail. You will need to verify and sign the form, then return it to the VA.
- Mail: Complete Form 10-10EZ or Form 10-10EZR and mail it to Health Eligibility Center, 2957 Clairmont Road, Suite 200, Atlanta, GA 30329-1647.
- In person: Visit any VA Medical Center or clinic. Here is the VA Directory.
Appendix Va Priority Groups And Their Eligibility Criteria
The VA classifies veterans into eight enrollment Priority Groups based on an array of factors including service-connected disabilities or exposures,71 prisoner of war status, receipt of a Purple Heart or Medal of Honor, and income. The criteria for each Priority Group are summarized in Table A-1.
The eight Priority Groups fall into two broad categories. The first group is composed of veterans with service-connected disabilities or with incomes below an established means test. These veterans are regarded by the VA as “high priority” veterans, and they are enrolled in Priority Groups 1-6. Veterans enrolled in Priority Groups 1-6 include the following:
- veterans in need of care for a service-connected disability
- veterans who have a compensable service-connected condition
- veterans whose discharge or release from active military, naval, or air service was for a compensable disability that was incurred or aggravated in the line of duty
- veterans who are former prisoners of war
- veterans awarded the Purple Heart
- veterans who have been determined by the VA to be catastrophically disabled
- veterans of World War I
- veterans who were exposed to hazardous agents while on active duty and
- veterans who have an annual income and net worth below a VA-established means test threshold.
Table A-2 provides information on income thresholds for VA health care benefits.
Table A-1. VA Priority Groups and Their Eligibility Criteria
|
Priority Group 1 |
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Percent Va Disability Pay Rate
70 VA Disability Pay
In 2020, a 70 percent VA disability rating is worth aminimum of $1,426.17 per month and is tax free at both the state and federallevels.
The 70% VA rating is often the tipping point for a higherVA rating, especially as disabled veterans become aware of the additionalbenefits available at the 100% VA rating.
According to VBA data reported to congress, 9.4% of disabled veterans or 447,330 out of 4,743,108 currently have a 70 percent VA disability rating.
A comprehensive 2020 70% VA disability pay chart is shownhere for quick reference:
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How To Establish Eligibility For Va Medical Benefits
VA health care eligibility is based upon active duty military service in the Air Force, Army, Marines, Navy, Coast Guard, or Merchant Marines .
Members of the National Guard and Reserves may be eligible for VA health care benefits if they were called to active duty on a Federal Executive Order . Other groups of servicemembers may also be eligible for VA medical care.
Misconceptions about VA health care eligibility: It is not a requirement to have served in combat or in a war zone. You do not need a service-connected disability rating. You did not need to be injured or wounded while in the service.
VA health care eligibility factors: VA health care eligibility is based on many issues, including active duty military service, type of military discharge, service-connected disabilities, medical conditions incurred while in the service, location of service, and more. You can be eligible based on your service dates, deployments you served on, or other criteria.
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How Does Va Determine Whether Ill Need To Pay Copays Based On My Income
If youre not already receiving VA disability compensation or pension payments, or dont have special eligibility factors , well ask for information about your income as part of our health care enrollment process. This is called an income assessment or financial assessment . Were required by law to collect this information.
We use your income information to help determine:
- If youre eligible for VA health care based on your income, and
- Whether youll need to pay copays for certain types of care or medications
Does The Va Provide Hearing Aids And Eyeglasses
Generally, the VA provides audiology and eye care services for all enrolled veterans. The VA does not provide hearing aids or eye glasses for normally occurring hearing or vision loss.
Hearing aids and eyeglasses are provided to the following veterans:35
- Veterans with any compensable service-connected disability.
- Veterans who are former prisoners of war .
- Veterans who were awarded a Purple Heart.
- Veterans receiving compensation for an injury, or an aggravation of an injury, that occurred as the result of VA treatment.
- Veterans in receipt of an increased pension based on being permanently housebound and in need of regular aid and attendance.
- Veterans with hearing or vision impairment resulting from diseases or the existence of another medical condition for which the veteran is receiving care or services from VA, or which resulted from treatment of that medical condition .
- Veterans with significant functional or cognitive impairment evidenced by deficiencies in the ability to perform activities of daily living.36
- Veterans who have hearing and/or vision impairment severe enough that it interferes with their ability to participate actively in their own medical treatment and to reduce the impact of dual sensory impairment .
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What Is Project Arch
Project ARCH is a five-year pilot program to evaluate how to improve access to health care for rural and highly rural veterans by providing these services closer to where they live through contractual agreements with non-VA medical providers.
The Project ARCH pilot provides a range of specified health care services to eligible veterans in Veterans Integrated Service Networks 1, 6, 15, 18, and 19. Eligibility for Project ARCH is based on statutory language. Specifically, eligible individuals include veterans who are enrolled in VA for health care services as of the date of the commencement of the pilot program and meet the statutory definition of covered veterans. Veterans may also participate in the pilot program if they are eligible to enroll under Section 1710 of Title 38 of the U.S.C. This includes Operation Enduring Freedom /Operation Iraqi Freedom veterans and veterans who served on active duty in a theater of combat operations or in combat against a hostile force during a period of hostilities after November 11, 1998.
Covered veterans are defined as those veterans residing in a pilot VISN:
- More than 60 minutes away from the nearest VA health care facility providing primary care services,
- More than 120 minutes away from the nearest VA health care facility providing acute hospital care, or
- More than 240 minutes away from the nearest VA health care facility providing tertiary care.
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What The Recruiter Never Told You About Medical Care
Medical and dental expenses and health insurance costs are a concern for many people, but what do you get if you join the military? If the recruiter promises free health care for life, its not the whole truth.
Up until the mid-1980s, recruiters touted the free health care for life benefits of military service. Your medical care was covered while on active duty and benefits extended into retirement. Any military retiree and their immediate family could get care at any military medical facility. That law hasnt really changed. What has changed is the space availability of health care.
As a result of downsizing, there are fewer military hospitals in the United States than existed back then. Slowly, but steadily, military retirees, their families, and many active duty family members were forced to seek medical care off-base, with only partial reimbursement from a program called CHAMPUS . Those who could still receive care through the military medical facilities found that even urgent care appointments were taking a long time to obtain.
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Retired National Guard Or Reserve Members
Your healthcare benefits as a retired member of the National Guard or Reserve depend on your age.
Under Age 60
If you are under the age of 60, you and members of your family may qualify to purchase TRICARE Retired Reserve.
If you purchase TRICARE Retired Reserve and you have adult children who “age out” at 21 , they may qualify to purchase TRICARE Young Adult.
You may be eligible for dental coverage through the Federal Employees Dental and Vision Insurance Program .
If you don’t purchase TRICARE Retired Reserve, you will not be eligible for any other TRICARE plan until you turn 60.
Age 60 and Older
When you reach 60, you and your family are eligible for the same benefits available to active-duty retired service members, which vary based on where you live.
If you live in the United States, you can enroll in:
- TRICARE For Life
If you live outside of the United States, your choices include:
- TRICARE Select Overseas
- TRICARE For Life
No matter where you live:
- Your adult children who “age out” at 21 may qualify to purchase TRICARE Young Adult.
- You may be eligible for dental coverage through the Federal Employees Dental and Vision Insurance Program .
Is Enrollment Different For Returning Combat Veterans
Veterans returning from combat operations are eligible to enroll in VA health care for five years from the date of their most recent discharge without having to demonstrate a service-connected disability or satisfy an income requirement. Veterans who enroll under this extended enrollment authority continue to be enrolled even after the five-year eligibility period ends.
This special period of enrollment eligibility for VA health care was first established in 1998 and was expanded in 2007. In 1998, Congress, responding to the growing concerns of Persian Gulf War veterans’ undiagnosed illnesses, passed the Veterans Programs Enhancement Act of 1998 ” rel=”nofollow”> P.L. 105-368), entitling a veteran who served on active duty in a theater of combat operations during a period of war after the Persian Gulf War to be eligible to enroll in VA health care during a two-year period following the date of discharge.
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