VA Health Care Costs and Coverage

VA health insurance plans connect veterans to invaluable health care services. Veterans with service-related disabilities or who fall into special enrollment categories may qualify to receive benefits and services at no charge.

Veterans may also qualify for free VA medical coverage if they are low or very income and meet Department of Veterans Affairs annual income limits. All other honorably discharged former servicemembers qualify to enroll in veterans insurance coverage but must contribute copayments, premiums and some out-of-pocket expenses toward their care.

Veterans contributing to their own care will face varying copays depending on the types of products or services they are seeking. Extended and long-term care copay rates, for instance, are typically different than short-term rates. Enrollees living in areas with particularly high costs of living may be eligible for copay rate adjustments and other subsidies, as well. As a result, it is essential that enrollees familiarize themselves with their plans and out-of-pocket responsibilities upon enrollment.

VA Insurance Coverage

VA insurance coverage incorporates all of the necessary elements and minimum coverage categories required by the Affordable Care Act. It further seeks to anticipate and accommodate the unique needs and situations of America’s veterans and to offer the coverage necessary to meet those needs. All VA health insurance plans include coverage for:

  • Primary care.
  • Preventative care.
  • Emergency care.
  • Specialty medical services.
  • Diagnostic and laboratory tests.
  • Inpatient and outpatient services.
  • Surgical care.
  • Rehabilitative care.
  • Counseling services.
  • Case management.
  • Mental and behavioral health care.
  • Crisis intervention.

VA medical coverage plans do not typically include provisions for dental health care. The VA does, however, offer veterans the opportunity to purchase discounted dental coverage separately. Alternatively, veterans may qualify for some dental care under Medicaid or Medicare, depending on the provisions in their states of residence.

VA Health Care Copays

Standard VA copay rates are determined by the nature of the products or services being provided and by individual enrollee characteristics.  For example, the copay for outpatient primary and preventative care services is $15. Outpatient specialty care services carry a copay of $50. Veterans in Priority Group 1 (e.g. former servicemembers with serious service-connected disabilities and former Prisoners of War) receive their prescription medications free of charge.

Related Article: How to Apply for VA Health Care Benefits

Veterans in all other priority groups receive prescription medications at no cost only for medical conditions associated with their military service or conditions developed as a result of service. They are required to pay for all other prescription medications out of pocket. Veterans may receive exemptions from that requirement, if they are low income, participating in VA-funded research or meet other exemption criteria.

Inpatient services may be assigned a full VA health care cost rate or a reduced rate. Enrollees in Priority Group 8, or those with annual household incomes above the VA copay income threshold, are charged full rates as follows:

  • $1,316 inpatient copay for the first 90 days of care (per 365-day period)
  • $658 inpatient copay for each subsequent 90 days of care (per 365-day period)
  • $10/day per diem charge

Enrollees in Priority Group 7, whose household incomes fall below the VA copay income threshold, pay reduced rates:

  • $263.20 inpatient copay for the first 90 days of care (per 365-day period)
  • $131.60 inpatient copay for each subsequent 90 days of care (per 365-day period)
  • $2 per day Per Diem Charge

Veterans in areas with high costs of living should find out if they are eligible for additional reductions to their VA copays.

VA Geriatric and Extended Health Care Costs

There are three VA health insurance cost categories for long-term care. Veterans insurance coverage and copay rates vary by type.

  • Inpatient long-term care provided by nursing homes, respite facilities and for the purposes of geriatric evaluations carries copays of up to $97 per day.
  • Outpatient long-term care in the form of adult day care, respite facilities and geriatric evaluations carries copays of $15 per day.
  • Domiciliary long-term care situations require copays of only $5 per day. Domiciliary care is a mode of care in which veterans unable to live independently are housed with individuals or families in private homes within their communities. Veterans cannot qualify for domiciliary care if they have living relatives willing and able to provide for support for them instead.

Long-term care copays do not go into effect until the 22 day within a 12-month period that policy holders receive such care. Long term care VA copays may be waived or adjusted depending on enrollees’ financial status at the discretion of the Department of Veterans Affairs.

VA Medical Coverage Exempt Services

Some forms of medical care are exempt from copays of any kind under veterans insurance coverage. Exempt services include:

  • Internal VA Research and Evaluations. There is no cost to veterans to participate in exams authorized by the VA to assess the risks and health consequences associated with military service. Veterans who enroll in VA research projects may also receive all associated care free of charge.
  • Enrollment exams. Where examinations are necessary to determine veterans’ eligibility for VA medical coverage, benefits, compensation or pensions, they will be provided at no cost to veterans.
  • Military Sexual Trauma services. All care related to MST, including counseling services, is free to affected veterans.
  • Service-connected disability services. All treatment, prescriptions, services and other needs associated with military service-related disabilities are included in VA insurance coverage at no cost to veterans.
  • Public and group health initiatives. These include public events, such as health fairs, as well as Smoking Cessation and Weight Reduction services.
  • Readjustment counseling. This may include personal, group, marital and family counseling.
  • Specified cancer treatments. Veterans with head or neck cancer resulting from radium treatments for the nose or throat received during military service qualify to receive all necessary treatment and care free of charge.
  • Care for combat-related conditions. Veterans who served in combat theaters after November 11, 1998 are eligible to receive no-cost care for conditions linked to that service.
  • Laboratory tests and electrocardiograms. As authorized by veterans’ physicians or other authorized parties.
  • Hospice care. End of life hospice care is provided under VA medical coverage at no charge to veterans or their families.

Related Article: VA Health Care Benefits for Family Members of Veterans

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