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 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:
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.
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:
Enrollees in Priority Group 7, whose household incomes fall below the VA copay income threshold, pay reduced rates:
Veterans in areas with high costs of living should find out if they are eligible for additional reductions to their VA copays.
There are three VA health insurance cost categories for long-term care. Veterans insurance coverage and copay rates vary by type.
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.
Some forms of medical care are exempt from copays of any kind under veterans insurance coverage. Exempt services include:
Related Article: VA Health Care Benefits for Family Members of Veterans
