VA to Vets: Health Care Act talking points

aca va

This week, the VA mailed my DH a shiny FAQ and a form letter about the health care law. They are “sell sheets” for the VA.  Could the VA be concerned that too many veterans will drop out of the system in favor of the private marketplace?

Consider the benefits they write: no monthly premium, deductibles or enrollment fees!  But wait, there’s more.  The VA offers 1,700 places to get care!  And, “most veterans have no out-of-pocket costs.” Is that a true statement?  The VA website says that “copays…may be required from some Veterans for treatment of nonservice-connected conditions.”  The co-pay to see a specialist is $50.00 per outpatient visit.

If a veteran stays with the VA, they CANNOT get the tax subsidy. (If someone qualifies for Mediaid, they will not get a tax subsidy because they will pay very little for health care.)

VA health care benefits depend on gross income and net worth.  (LINK)

The whole priority group scheme and means test is confusing.  If you are in Priority Group 7, you will have a co-pay and your income is determined by the Geographical region income limit.  If you are Priority 8 (high income) you may not be eligible for any health care but there are some exceptions (read here).  To determine if you are in 7 or 8, pick the fiscal year, pick your state’s county and family size and hope you’re not above the VA’s income thresholds for health care.   (Service in the Republic of Vietnam should put a veteran in Priority 6 but some are still charged co-pays.  What’s up with that?)

Either/or scenarios. Veterans who live more than 30 miles from a VA hospital might be better off with private insurance so they aren’t stuck with an emergency room bill should they have an emergency that the VA won’t cover.   On the other hand, if a veteran needs a lot of expensive medications, the VA looks attractive in comparison to private plans.  And if their current VA health care team is top-notch, it makes good sense to continue with them.  The VA is also better about issuing needed medical equipment than, say, Medicare. 

The VA does not want veterans to flee en mass.  Question:  Can I cancel my VA health care coverage?  The answer is a warning: “Yes, however acceptance for future VA health care coverage will be based on eligibility factors at the time of application, which may result in a denial of health care coverage.”  There’s that favorite word again, denial.  

This is a not very veiled threat.  But, if tens of thousands of new veterans decide to enroll in the VA, with few cancelling, Congress may push out more middle-class income veterans.  It’s not really about one’s service to the country.

 The number of Veterans who can be enrolled in the health care program is determined by the amount of money Congress gives VA each year. Since funds are limited, VA set up Priority Groups to make sure that certain groups of Veterans are able to be enrolled before others. instead of expanding funding to care for them.

Going forward, the VA is going to have to compete with the convenience that regional hospitals and local health care providers offer.  The safest best option, for veterans who can afford to forgo the tax subsidy and pay a premium, is to stay enrolled in the VA (hopefully with your “spot” grandfathered in) and pay for private insurance through the marketplace even if it’s not a premium plan.  That way you won’t face debtors’ court (or prison!) should you get hit by a thunderbolt far from VA-land.  (In any case, family members may qualify for a tax subsidy even if the veteran stays enrolled in the VA.)


Image: Public Domain on Pixabay.

Ed. Note: Kiedove has done her homework on this one. If they had not tried to kill me (four times) I might be amenable to their brand of medicine. I believe VA suffers a “treat each item apart from the whole human”- e.g. you are service connected for disease A so come on down and we won’t charge you anything but if you even mention symptom B related to a non-service connected item, you can be billed for it. I dislike having to defend a ride to the hospital to get VA coverage. I know I’m Priority one and it is immaterial yet I have to submit the documentation each time to help my local Fire Dept. recoup the cost of the ride from the VA. Otherwise they wait two years to get the dough.

About Laura

NW Vermont.
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3 Responses to VA to Vets: Health Care Act talking points

  1. karen stern says:

    Thanks for explaining this, A

    • Kiedove says:

      Thank you. This topic is huge. We live 40 miles from a VA hospital. If my husband has a heart attack or stroke at home, I’ll be sure he gets to the Mayo regional hospital 2 miles away because every minute counts. Therefore we both need another insurance plan because the VA probably has a bad record for paying for non-VA ER care. There are lots of time traps for these claims.
      I will probably be shopping for 2 different plans when the exchanges open next week because our needs are different. I’ll try to do some research before hand on the bronze plans, silver plan, platinum plan this week. We might be able to get by with a bronze plan ( with a lower premium) for him since he’s keeping his VA coverage for meds. I wish there was a reference for the best VA hospitals similar to the U S News review references, that we could consult.

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