6 Facts Regarding Veterans Health Insurance

The United States Department of Veteran Affairs oversees the veterans health insurance program, which includes health coverage extended to veterans as well as their eligible family members. The following are six general facts that demonstrate the capacity and scope of coverage available to eligible participants through this federally mandated program.

1.  Coverage Eligibility

It is not necessary for participants to be uninsured to be eligible for VA coverage. However, the law requires all fees related to non-service medical conditions to be billed to the third party insurance carrier. In these cases, some insurance carriers will apply VA coverage benefits towards the patient's annual deductible. Any unpaid balance will be covered by the VA.

2.  Copayments

There are four basic types of VA copayments, those for medication, outpatient, inpatient, and long-term care. Congress has established medication copayments at $8 for a 30-day supply. This amount applies only to non-service conditions treated on an outpatient basis. 

3.  Medications Prescribed by Non VA Personnel

As a general rule, the VA will not cover medications prescribed by medical personnel other than VA doctors. Of course, a veteran may be granted approval under certain circumstances. Individuals approved for aid and assistance or veterans eligible for homebound care are examples of people whose prescriptions may be covered even if prescribed by non-VA medical personnel.

4.  Standard Medical Care Benefits

The standard medical care benefits provided to all eligible candidates include preventative care, ambulatory diagnostic services and treatment, hospital diagnostic services and treatment, and medications and supplies. Preventative care includes immunizations, physical examinations and any health care assessments. Ambulatory services, or outpatient services, refers to VA-provided emergency outpatient care, surgical care and bereavement counseling.  Hospital, or inpatient, services guarantees the same level of coverage as ambulatory services to patients who require an overnight or extended hospital stay. Covered medications and medical supplies must be prescribed by a physician and be included in the VA’s national formulary system.

5.  Change in Priority Group

Veterans may request a change in their priority group enrollment if their income level is drastically reduced from the previous year. Eligible candidates are typically enrolled as a priority group 7 or 8 recipient. Some situations that might warrant a reclassification include increased out-of-pocket medical expenses and unemployment.

6.  Financial and Other Program Assistance

There are several programs available to veterans who are finding it difficult to manage their VA health care debt. These programs include hardship, repayment plan, compromise and waiver. Hardship is a program that qualifies eligible veterans for health care coverage with no co-payments. A repayment plan is available to individuals who cannot afford co-payments. A compromise refers to the VA facility's ability to settle a veterans debt for less than originally owed. Additionally, the VA can waive a veteran's existing debt in extenuating circumstances such as loss of employment, educational or funeral expenses, or significant medical care.

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