What Veterans Are Not Eligible For Va Health Care

Veterans Hiring Preference For Federal Jobs

Veterans with honorable discharges are offered hiring preference for federal jobs. Some family members may also be entitled to this preference depending on circumstances.

discusses something called Derived Preference which is a benefit for spouses, surviving spouses, and parents of a veteran who may be eligible to claim veterans preference when the veteran is unable to use it, adding that both parents and spouses may qualify for that preference at the same time under the right circumstances.

Who Does Not Qualify For Veterans Benefits

Most anticipate that this section deals with people who left military service with discharges not characterized as Honorable. Believe it or not, even those with Dishonorable discharges may qualify for certain VA benefits, but definitely not all.

There is only one category of military service that does NOT qualify for veteran benefits across the board. That category is made up of those who did not complete basic training, troops who washed out of advanced training, etc.

Sometimes those who make it a bit farther along in the process but are ultimately released from their military obligations due to issues such as failure to adapt to a military training environment, etc.

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In other words, those who do not make it past the initial training phase and wind up back in civilian life are not considered veterans and do not qualify for veteran benefits.

You must graduate basic training and meet the DoD standards for advanced training, OJT, or other requirements and be assigned to your first duty station as a permanent party member of that branch of service.

How Do You Find Out If You Qualify For Veterans Benefits

Service Records: Proving Your Eligibility For a veteran to show theyre eligible for benefits, they must first present the VA office with an official copy of their DD Form 214/215, or NGB 22/22A, which are some of the most significant documents issued by the military.

How long do you have to be in the military to get benefits for life?

Under BRS, youll get the traditional monthly retirement pay for life if you serve for 20 years or more and earn a full retirement from the military.

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What Should Policymakers Consider When Examining Changes To Purchased Care

Use of Purchased Care Has Been Growing

In recent years, VA has increased its purchases of care from private-sector providers to accommodate veterans whose needs cannot be met in-house. The Veterans Health Administration’s Chief Business Office estimated that VA purchased care costs in fiscal year 2014 totaled $5.6 billion after steady and significant increases year after year, as shown in Figure 8. The Veterans Choice Act added another $10 billion to VA’s budget to expand purchased care in 20152017.

If You Dont Have Veterans Coverage

If youâre a veteran who isnât enrolled in VA benefits or other veterans health coverage, you can get coverage through the Health Insurance Marketplace®.

Depending on your household size and income, you may be able to get lower costs on monthly premiums and out-of-pocket costs on private insurance. Or you may qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program .

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Figure 1 Despite A Shrinking Population Of Veterans The Number Of Veterans Who Use Va For Health Care Will Increase Until 2019 Then Level Off Or Decline

VA Serves Veterans with More-Complex Health Needs

Compared with non-veterans, veterans are disproportionately older, male, and less healthy. Veterans who use VA health careVA patientsare typically older than other veterans. More than half52 percentare over age 65, compared with 39 percent of veterans who are not VA patients. VA patients are also more likely than other veterans to have been deployed. Partly as a result of their older age and deployment experience, VA patients have a higher prevalence of chronic physical and mental health conditions than other veterans. For example, rates of cancer, diabetes, and mental health conditions are higher for VA patients than for veterans who do not use VA . These differences also reflect the eligibility criteria for enrolling in VA care, which depend in part on health status.

The relatively high rates of these conditions for VA patientscombined with otherwise rare conditions related to combat, such as limb loss, traumatic brain injury, blindness, and severe burnsmean that VA providers handle a patient mix that differs from what most community providers typically see.

Supply: What Is Va’s Capacity To Deliver Health Care And How Might This Impact Veterans’ Access

VA operates one of the most extensive health care systems in the country, with broad and deep resources and capabilities, including 144 hospitals, 700 outpatient clinics, and more than 55,000 employed clinicians. However, VA’s ability to harness these resources effectively to meet the health care needs of veterans has been called into question.

VA’s Capacity to Meet Demand

We assessed VA’s current capacity to meet demand based on measures of access and quality.

Most veterans live near a VA health care facility. Although veterans are highly dispersed throughout the United States, 93 percent of veterans live within 40 miles’ driving distance of a VA health care facility. However, geographic access to VA care varies by how access is measured and what services are needed . For example, veterans who rely on public transportation face a significant barrier to access: Only 25 percent of veterans live within a 60-minute transit time from a VA medical facility. Further, fewer veterans have geographic access to advanced and specialized services in VA facilities. For example, only 43 percent of veterans live within 40 miles of VA interventional cardiology services, and only 55 percent of veterans live within 40 miles of VA oncology services.

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Va Health Care Eligibility Questionnaire

Lets start by looking at some basic eligibility requirements, based on the VA health care eligibility questionnaire:

1. Are any of these statements true?

• You served in the active military, naval, or air service and were discharged or released with a rating of Honorable or General under Honorable Conditions
• You were/are a Reservist or National Guard member and you were called to active duty by a Federal Order and you completed the full call-up period

Veterans have the option of selecting yes or no.

If you answer yes, you will be taken to the following question: Are any of these statements true?

• You were discharged or separated for medical reasons, early out, or hardship
• You served in theater of combat operations within the past 5 years
• You were discharged from the military because of a disability
• You are a former Prisoner of War
• You receive VA pension or disability benefits
• You receive state Medicaid benefits
• Served in the Republic of Vietnam from January 9, 1962 to May 7, 1975
• Served in the Persian Gulf from August 2, 1990 to November 11, 1998

If you answer Yes to the second question, you most likely qualify for VA health care. You can skip to the section below, labeled Applying for VA Health Care Benefits.

Important note about household income:

The VA automatically determines the veterans income and deductible expenses by matching records with the Internal Revenue Service and Social Security Administration.

What Are Va Benefits

VA benefits are a set of assistance programs provided to service members specifically, those whove served either on active duty in the U.S. uniformed services, or on federally ordered, active duty in the National Guard or Reserves. Depending on your service record and whether you were injured in the line of duty, you might qualify for several programs, including disability income, life insurance benefits, education and career counseling, pension benefits, as well as VA medical benefits.

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Eligibility For Va Medical Care

You may be able to get VA health care benefits if you served in the active military and didnt receive a dishonorable discharge.

If you enlisted after Sept. 7, 1980, or entered active duty after Oct. 16, 1981, you must have served 24 continuous months or the full period for which you were called to active duty, unless you were:

• Discharged for a disability that was causedor made worseby your active-duty service, or
• Discharged for a hardship.

If youre a current or former member of the Reserves or National Guard, you must have been called to active duty by a federal order and completed the full period for which you were called or ordered to active duty. If you had or have active-duty status for training purposes only, you dont qualify for VA health care.

Figure 3 Va Patients Rely On Va For Only A Part Of Their Health Care

Demand for VA Care Will Evolve by 2024

This picture will change in the decade between 2014 and 2024, in the following ways.

The VA patient population will become less healthy. Owing partly to aging and the increasing share of Iraq and Afghanistan veterans, the future VA patient population will have a higher prevalence of chronic conditions and mental health conditions .

However, the overall health status of new veterans will improve over time because of the increase in the share of separating service members who did not face deployment-related health injuries. However, this will not be enough to offset the general downward trend in the health of the VA patient population as a whole.

Understanding future demand for health care among veterans who served in Iraq or Afghanistan is critical to meeting their needs. By 2024, about 19 percent of VA patients will have served in Iraq or Afghanistan . The long-term health impacts of deployment in these conflicts are not yet well understood, and therefore this cohort may pose new challenges for the VA health system.

A future conflict would increase demand for VA services. U.S. engagement in a military conflict in the next ten years would increase the number of newly eligible veterans, many of whom would have combat exposure. Across a range of conflict scenarios of different levels of scale and intensity, our analysis predicted that a future conflict would add between 500,000 and 925,000 new VA patients.

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Why Are Some Veterans Not Eligible For Va Health Care

If youre a current or former member of the Reserves or National Guard, you must have been called to active duty by a federal order and completed the full period for which you were called or ordered to active duty. If you had or have active-duty status for training purposes only, you dont qualify for VA health care.

Does The Va Pay For Health Care For Veterans Abroad

The VA may pay for hospital care and outpatient services related to a service-connected disability or rehabilitation to any eligible veteran outside of the United States, without regard to the veteran‘s citizenship.109

The VA provides limited health care benefits to veterans residing or traveling outside the United States through the Foreign Medical Program . Under current law, the VA is authorized to provide hospital care and medical services to an eligible veteran outside the United States only if the VA “determines that such care and services are needed for the treatment of a service-connected disability of the veteran or as part of a rehabilitation program under chapter 31 of this title .”110

Under the FMP, the VA pays the allowable amount for hospital and outpatient care. Veterans may generally select any health care provider. Claims for payment or reimbursement of services under the FMP must be submitted to the FMP office in Denver, CO. For care provided in Canada, claims must be submitted to Veterans Affairs Canada, Foreign Countries Operations Unit.111

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What Do Va Medical Benefits Cover

VA medical benefits cover preventative care, such as annual physical exams and immunizations. Inpatient treatments including surgeries, acute care, and kidney dialysis are also covered, along with emergency and walk-in services at some VA health facilities and VA-approved health clinics. Some veterans may additionally qualify for vision care, dental care, caregiver support, prescription drugs, some mental health services, help with transportation to and from medical appointments, and assisted living and home health care.

Can A Dishonorable Discharge Make You Ineligible For Va Benefits

Dishonorable discharge makes a veteran ineligible for all VA benefits. A character of service determination remains on your military record unless a discharge review board modifies the character. However, this board may only modify, correct, or change characters of service not imposed by a court-martial.

Can a person get an honorable discharge from the military?

For those who separate or retire from the military after doing well during their time in service can expect an honorable discharge. Following a career of faithful military service, the member is almost always given an honorable discharge. How do you get an Honorable Discharge?

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Keep Your Personal Information Updated With All Va Organizations

While you are enrolled, it is important to update or report changes to your address, phone number, name, health insurance or financial information. The three VA organizations , Veteran Benefits Administration and National Cemetery Administration ) computer databases are not connected therefore, you will need to notify each VA organization of your demographic and personal information changes. Keeping your information accurate allows VA to better inform you of updates to benefits and services. To update your information with VHA, complete VA Form 10-10EZR online at va.gov/health-care/apply/application/introduction call 1-877-222-VETS Monday through Friday between 8 a.m. and 8 p.m. ET. or contact the enrollment coordinator at your local medical facility. Self-service kiosks also are available at most VA health care facilities for use in updating your personal information. For more information, see Self-Service Kiosks on page 29.

Why Was I Denied Access To Va Health Care

Several MOAA members have asked why they were denied enrollment in VA health care by the Veterans Health Administration.

Typically, these members have not been denied enrollment their situation usually comes down to not understanding VHA Priority Group protocols. You can learn more about these groups here.

Basic VHA eligibility entails individuals who served in the active military, or qualified Reserve or National Guard members, who were discharged or released under conditions other than dishonorable. Typical minimum service requirements are 24 continuous months or the full period for which they were called to active duty.

Once eligibility has been established, the VA assigns the veteran one of eight VA Health Care Priority Groups . The full breakdown is available here:

When a member asks about being denied VHA enrollment, my first question is always, Do you have a VA disability compensation rating? Almost universally, the answer is No.

The bottom line for these members: They are enrolled in VHA, but they are assigned PG8 and therefore will not be afforded access to VHA.

You can check your income levels against VHA limits, adjusted for geography, at

Lets examine the criteria for each VHA Priority Group:

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Figure 5 Nearly All Veterans Live Within A 40

VA Usually, but Not Always, Provides Timely Care

According to VA data, most veterans get care within two weeks of their preferred appointment date , as shown in Figure 6, and the vast majority complete their appointments with their primary care providers within the VA timeliness standard of 30 days from the preferred date. This pattern persists for specialty care as well, with access to mental health care slightly better.

Figure 8 Cost And Demand For Purchased Care Have Increased Almost Three

The Veterans Choice Act also expanded eligibility for veterans who are already eligible for VA health care to purchase care outside of VA. Veterans can obtain an appointment with an outside provider under the Choice program if they live far from the health care they need or if they are unable to schedule an appointment at a VA hospital or other VA facility within VA’s 30-day standard.

VA’s Purchased Care System Is Complex

At the time of our analysis, VA purchased outside care through various mechanisms, each guided by different structures, policies, and procedures, as shown in Figure 9. We found that decisions about which purchased care mechanism to use for a particular circumstance relied on the complex judgment of VA administratorswith priority given to VA partner facilities overseen by other federal agencies or affiliated academic institutions. Beyond that, referral decisions took into account other factors, such as payment levels and provider qualifications.

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The Camp Lejeune Family Member Program

Those who lived on U.S. Marine Corps Base Camp Lejeune or Marine Corps Air Station with an active-duty spouse or parent for at least 30 cumulative days from August 1953 through December 1987 may qualify for medical conditions related to contaminated drinking water in those areas.

If you have a medical condition associated with this contaminated water issue, you may qualify for VA health care benefits.

How Does The Va Process Applications

The VA processes health benefits applications through either a VA medical facility orHealth Eligibility Center .

Veterans designate which VA medical center or outpatient clinic they prefer to have their applications processed through, with the exception of four medical facilities.73 If veterans choose to have their applications processed through their local VA health facility, the staff will process the applications using the Veterans Health Information Systems and Technology Architecture . VistA is an integrated electronic health record system that the VA uses to record the care it provides it also includes administrative tools.

If veterans choose to have the Health Eligibility Center process their applications, the center staff will do so using the Workload Reporting and Productivity tool. HEC staff uses the WRAP tool to maintain and distribute health applications to reviewers, along with supporting documentation.74 The flowchart in Figure 1 depicts how the VA processes health care applications.

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