Decisions, decisions: Stay with the VA or move on? Enroll in the VA or Obamacare?


downloadI hope I haven’t made any gross errors in this post.   Please fact check everything because I am a layperson trying to figure this out like everyone else.

KEY FACT FROM THE VA ACA WEBSITE THAT IS HIDDEN IN THE FAQ:  

I am enrolled in a VA health care program. Would I be eligible for assistance to pay health insurance premiums on the Marketplace if I choose to purchase health care outside of VA?

Since VA care meets the standard for health care coverage, you wouldn’t be eligible for assistance to lower your cost of health insurance premiums if you chose to purchase additional health care coverage outside of VA. However, you may still purchase private health insurance on or off the Marketplace to complement your VA health care coverage.

My assumption:  The term “assistance” refers to a potential tax subsidy.  If so, buying additional health care coverage will be very expensive as we will see a few paragraphs down.

Since over 80% of veterans who apply for disability benefits are denied, let’s look at the situation for Non-Service Connected (NSC) and 0% SC veterans with regard to co-pays.  The first number to know about is the $80,000 limit on gross income and assets to avoid co-pays.

What kind of property is considered an asset? Although there’s very little guidance for this accounting concept, if you don’t report your secret assets, five years prison time is one penalty. However, make no mistake about this: your retirement fund and your spouse’s retirement fund are assets!  Add both IRAs together.  Add up the value of your cash, rare coin, stamp, or fire arms collections, vintage wine, stocks and bonds, your fishing cabin, canoe, boat, ATM, snow mobiles, motorcycles etc…  (Your car, house, house lot, and furniture–things you use everyday–are excluded.)  To determine your net worth, deduct liens and mortgages.  Is the other side of your duplex an asset? Yes. A riding lawn mower used in the summer? Who knows? An outbuilding like a shed? Hmmm..maybe.  If your house is sitting on acreage, beware! 

Section VII – Previous Calendar Year Net Worth. Your net worth is the market value of all the interest and rights you have in any kind of property. However net worth does not include your single-family residence and a reasonable lot area surrounding it. It also does not include the personal things you use every day like your vehicle, clothing and furniture.

2012 Gross Income is used in 2013 to determine status for VA cost-free care.  Here is the figure for a veteran with 1 dependent:  $39,304 or less.  (You can exempt $907 in medical expenses.)  This means that the veteran and spouse can own no more than $41,603 in retirement funds (and/or other assets) together to keep under the $80,000 income and asset limit. 

Post UPDATE (10/7/13  I’ve found a VA online calculator called Health Benefit Explorer that you can use to plug in your own numbers and zip code.  There may be some leeway depending on where you live and other rules I haven’t found:  http://hbexplorer.vacloud.us/

Now, some veterans aren’t required to fill out Form 10-10 EZ Financial disclosure sections IV-VII but they won’t enroll new applicants who don’t! Two examples: You were at Camp Lejeune for 30 days or you served in Vietnam within certain dates.  Why bother paying for ink to print this list when veterans disqualify themselves for care by not filling out the financial disclosures!

Means test

The last paragraph is nonsensical. If you’re not going to provide financial information, and you’re in one of these groups, don’t bother applying for VA health care. Click image to read over the whole form.

The figure of $39,304 for a family size of 2 translates to a Federal Poverty Level of about 251%.  The VA considers this the threshold income before crossing into “high income” veteran status.  I use $39,000 in the following example to see what a veteran & spouse would pay for Obamacare.   I’m using the Kaiser Subsidy Calculator (which calculates a Silver Plan). For a hypothetical non-smoking couple in Charleston, West Virginia (zip 25301), it appears as if this veteran (64) and spouse (62) would pay about 8.09% of their income for a Silver Plan or $263.00 a month ($3,156 a year).  But oddly, if only 1 person is covered, again using the Kaiser Subsidy Calculator,  the premium is the same! The government subsidy for this zip code would be about $12,749 for 2 or $4,625 for the one younger person.

If a veteran keeps the VA AND signs up for Obamacare, the veteran’s portion of the premium will be the retail cost . The un-subsidized premium for 2 is $15,905.  A subsidy for 1 is $4,625.  My best guess is that the cost for a couple to keep the VA and sign up for insurance in the exchange marketplace, the premium could be as high as $11,280 annually ( $15,905 – $4625 =$11,280).   The Kaiser calculator doesn’t allow this scenario but this option would not be affordable for most people earning $39,000!  (If the couple are both veterans, keep the VA and buy private insurance, there will be no tax subsidy for either.)

Therefore Congress is forcing veterans to choose between the two alternatives even though VA health care is not health insurance but a health benefit.  I think this is a disgrace because veterans have earned this benefit which they may not be able to use.   Why? Because Congress doesn’t want to give veterans tax subsidies for private insurance like other Americans.

Certain politicians in Congress are hysterical about granting health care subsidies to anyone (except themselves).  The VA is trembling too because they don’t know if they’ll be overwhelmed with new patients or the opposite, see an exodus.  Some veterans may be willing to trade the VA for a tax subsidy and the opportunity for flexible, convenient, private health care–without threats of prison terms for mistakes made on their 10-10 EZs.  Some will join, probably young uninsured veterans, for the sake of simplicity. 

calendar-159098_1280

Image credit: Public domain image on Pixabay

And if a veteran needs a lot of medication and care, the VA would be more attractive than a Silver Plan.  However if the veteran’s spouse (62) is in very good health, she could opt for a Bronze minimal plan for $164.00 a month as a bridge policy to Medicare. Uninsured spouses are probably crossing off the days on their calendars to Oct. 1 when they can shop for a plan, and in 2014, get health care coverage despite pre-existing conditions.  But veterans should be furious when they realize that they’ll still be paying “retail” if they want to see a private specialist and keep their VA benefits.  That’s my current understanding of the situation.  I welcome your input and information and check out the multi-state Kaiser subsidy calculator. 

 

 

Ed. note: Is this too cool for school or what. Kiedove is crunching unbelievably large quantities of numbers and data for us here. Devotion to duty is on overtime. I commend her. Two attagirls and a warm Asknod thank you are overdue.

This entry was posted in VA Health Care, VA Medical Mysteries Explained and tagged , , , , , , , , , , , . Bookmark the permalink.

11 Responses to Decisions, decisions: Stay with the VA or move on? Enroll in the VA or Obamacare?

  1. Pam Smith says:

    Veterans who served at camp Lejeune and/or Vietnam are automatically eligible for services due to the environmental exposure. Releasing the financial info is optional and WILL NOT disqualify you EVER. It is only recommending that you release it IF your income falls below the income threshold, which would then make you copay exempt.
    I work for the Veterans Administration and I am also a veteran. It infuriates me that veterans feel forced to disenrolling and essentially give up their veterans status so their family members are able to use the marketplace. Shame on Obama care. It’s another slap to veterans.

  2. USAF says:

    I just found this website and I am posting what I had on another website. I know you have done your home work way before me. I just dis-enrolled from the VA after 33 years. I will post again after I try entering a VA facility for my service connected issues. Read my comments below on this.

    Mr. President,

    How do you explain to me having to dis-enroll from the VA system is not taking my benefits away in order to purchase health insurance on the Affordable Health Care marketplace website?

    August 10, 2013, 10:03 pm speech to the Disabled American Veterans (DAV)
    Obama to disabled vets (DAV): ‘No one’s taking away your benefits’

    “But the good news is if you’re among one of the more than 1 million veterans who don’t have health insurance, starting October 1st, you’ll have a new option. Online marketplaces will let you shop and compare and buy private health insurance plans, just like you can go online to compare prices when you buy a TV, or airplane ticket or acre. And because of the Affordable Care Act, insurance companies will no longer be able to discriminate against you or deny you coverage because of preexisting conditions– like PTSD. (Applause.) So you’ll have more security in being able to get health insurance. So don’t let them fool you. No one is taking away your benefits. Your veterans’ health care is safe. We’re not reducing veterans’ access to health care, we’re expanding it. That’s the truth. (Applause.)”

    READ THE BOLD PRINT BELOW BEFORE MAKING ANY CHANGES TO YOUR HEALTH CARE.

    Veterans, you are about to find out if you and your family apply for health coverage on the famous Affordable Health Care website that it is the most discriminating act against the veterans of the United States ever. If you are a veteran and are in enrolled in the VA health care system you will get little or none of the subsidy that every other family with low or middle income gets. As soon as you click the button that asks if you are using the VA health system you are denied the subsidy. The VA benefits overview booklet states that the VA health system is not health insurance! Those of you who are in the VA system know that this health service is only a basic health care system. If you break a leg or need surgery and it is not service related you have a slim chance if none to get these types of services. You may have to drive hundreds of miles to go to a VA hospital. Enough said, it is not a health insurance! I will say that it did act as a gap care between your regular HSA type insurance and nothing. Well, it is gone now and your high deductible insurance is your only security unless you buy a very low deductible policy like the congress and senate gets. If you go this route you really pay some outrageous premiums.

    Of Course, the secretary of the VA says sign up for health care in the VA system as you will avoid the penalty for not having health insurance. Good advice for some, dumb for others trying to get the most useful health insurance for your family or spouse. All depends on your situation. The only way I would think that a person would want to sign up for the VA system is if you do not have a dime to your name and are unemployed. If you have a family and enough money to get a health insurance policy do not think twice about going the safe route and actually having health insurance you can count on.

    The only way to get the FULL subsidy, for you ( a veteran enrolled in the VA system) and your family, offered by this Affordable Health Care Act is to fax a letter to the Department of Veteran affairs, Health Eligibility Center, 2957 Clairmont Road NE, Atlanta Georgia, 30329-1647 attention: enrollment and disenrollment. Their phone number is 404-828-5257. Their fax number is 404-828-5146. State you want out of the VA system in a letter. They will either mail or fax you back a letter stating you have been un-enrolled and that letter then has to be uploaded on the affordable health care website to finish your application. Remember you need the letter from the VA dated and sent to you ASAP so you can show you are out of the VA system. Otherwise the IRS could come back and demand you pay the subsidy back for the months you waited for the letter.

    If you have a service connected disability and you have now un-enrolled the VA by law still has to treat your service connected disability without being enrolled in the VA system. We shall see how that works out. I believe the first time you go into a VA facility and try to get treated for your service connection disability they are going to want to sign you up in the system. They are going to want your health insurance card too. Do not let them do it or the IRS is going to come and get your subsidy back with interest and penalties. That is my take on this super goof up by the Affordable Health Care act.

    BE AWARE: IF YOU EXPECT YOUR JOINT INCOME TO RISE ABOVE THE INCOME BRACKET FOR THE NUMBER OF DEPENDENTS IN YOUR FAMILY THEN STAY PUT. THIS IS A MOVING TARGET EVERY YEAR! SO DON’T GET OUT OF THE VA SYTEM UNLESS YOU ARE CERTAIN YOUR INCOME FROM YEAR TO YEAR IS GOING TO BE UNDER THE INCOME BRACKET NUMBERS. SIT DOWN WITH YOUR TAX ADVISOR AND DETERMINE YOUR FUTURE INCOME AND HOW IT WILL AFFECT YOUR SUBSIDY AMOUNT. YOU DO NOT WANT TO END UP HAVING TO PAY BACK THE GOVERNMENT MONEY AT THE END OF THE YEAR IF YOUR INCOME GOES OVER THE LIMIT.

    I urge you to call your Congresspersons and Senators and complain that this is discrimination. We deserve better.

    Thanks again for serving your country.

    Mr. President,

    How do you explain to me having to dis-enroll from the VA system is not taking my benefits away in order to purchase health insurance on the Affordable Health Care marketplace website?

    August 10, 2013, 10:03 pm speech to the Disabled American Veterans (DAV)
    Obama to disabled vets (DAV): ‘No one’s taking away your benefits’

    “But the good news is if you’re among one of the more than 1 million veterans who don’t have health insurance, starting October 1st, you’ll have a new option. Online marketplaces will let you shop and compare and buy private health insurance plans, just like you can go online to compare prices when you buy a TV, or airplane ticket or acre. And because of the Affordable Care Act, insurance companies will no longer be able to discriminate against you or deny you coverage because of preexisting conditions– like PTSD. (Applause.) So you’ll have more security in being able to get health insurance. So don’t let them fool you. No one is taking away your benefits. Your veterans’ health care is safe. We’re not reducing veterans’ access to health care, we’re expanding it. That’s the truth. (Applause.)”

    READ THE BOLD PRINT BELOW BEFORE MAKING ANY CHANGES TO YOUR HEALTH CARE.

    Veterans, you are about to find out if you and your family apply for health coverage on the famous Affordable Health Care website that it is the most discriminating act against the veterans of the United States ever. If you are a veteran and are in enrolled in the VA health care system you will get little or none of the subsidy that every other family with low or middle income gets. As soon as you click the button that asks if you are using the VA health system you are denied the subsidy. The VA benefits overview booklet states that the VA health system is not health insurance! Those of you who are in the VA system know that this health service is only a basic health care system. If you break a leg or need surgery and it is not service related you have a slim chance if none to get these types of services. You may have to drive hundreds of miles to go to a VA hospital. Enough said, it is not a health insurance! I will say that it did act as a gap care between your regular HSA type insurance and nothing. Well, it is gone now and your high deductible insurance is your only security unless you buy a very low deductible policy like the congress and senate gets. If you go this route you really pay some outrageous premiums.

    Of Course, the secretary of the VA says sign up for health care in the VA system as you will avoid the penalty for not having health insurance. Good advice for some, dumb for others trying to get the most useful health insurance for your family or spouse. All depends on your situation. The only way I would think that a person would want to sign up for the VA system is if you do not have a dime to your name and are unemployed. If you have a family and enough money to get a health insurance policy do not think twice about going the safe route and actually having health insurance you can count on.

    The only way to get the FULL subsidy, for you ( a veteran enrolled in the VA system) and your family, offered by this Affordable Health Care Act is to fax a letter to the Department of Veteran affairs, Health Eligibility Center, 2957 Clairmont Road NE, Atlanta Georgia, 30329-1647 attention: enrollment and disenrollment. Their phone number is 404-828-5257. Their fax number is 404-828-5146. State you want out of the VA system in a letter. They will either mail or fax you back a letter stating you have been un-enrolled and that letter then has to be uploaded on the affordable health care website to finish your application. Remember you need the letter from the VA dated and sent to you ASAP so you can show you are out of the VA system. Otherwise the IRS could come back and demand you pay the subsidy back for the months you waited for the letter.

    If you have a service connected disability and you have now un-enrolled the VA by law still has to treat your service connected disability without being enrolled in the VA system. We shall see how that works out. I believe the first time you go into a VA facility and try to get treated for your service connection disability they are going to want to sign you up in the system. They are going to want your health insurance card too. Do not let them do it or the IRS is going to come and get your subsidy back with interest and penalties. That is my take on this super goof up by the Affordable Health Care act.

    BE AWARE: IF YOU EXPECT YOUR JOINT INCOME TO RISE ABOVE THE INCOME BRACKET FOR THE NUMBER OF DEPENDENTS IN YOUR FAMILY THEN STAY PUT. THIS IS A MOVING TARGET EVERY YEAR! SO DON’T GET OUT OF THE VA SYTEM UNLESS YOU ARE CERTAIN YOUR INCOME FROM YEAR TO YEAR IS GOING TO BE UNDER THE INCOME BRACKET NUMBERS. SIT DOWN WITH YOUR TAX ADVISOR AND DETERMINE YOUR FUTURE INCOME AND HOW IT WILL AFFECT YOUR SUBSIDY AMOUNT. YOU DO NOT WANT TO END UP HAVING TO PAY BACK THE GOVERNMENT MONEY AT THE END OF THE YEAR IF YOUR INCOME GOES OVER THE LIMIT.

    I urge you to call your Congresspersons and Senators and complain that this is discrimination. We deserve better.

    Thanks again for serving your country.

  3. The gist that I get of this: The “Affordable” Health care Act isnt affordable for disabled Vets. And, I am not so sure its all that “affordable” for all non Vets, either. The only ones its “affordable” for, is the very poor, who dont have health insurance now, they currently just go to the ER when they need health care and wind up paying nothing. So it does not help them, either. I am trying to figure out who “affordable” health care helps, but it is certainly not Vets. Like other things, it probably helps insurance companies, and politicians.

    • Kiedove says:

      If a middle-class disabled veteran lives near one of the worst VA hospitals, and not one of the best VA hospitals, and wants to switch to private care because of long waits, bad care etc.. he would not be able to buy insurance at group rates now due to his pre-existing conditions. For example, a vet just get diagnosed with cancer or Hep. C, will not be able to get private insurance unless he can pay the retail price of the high risk pool rate of $30,000 or more per year. So it’s either the bad VA near his home, move to a good VA, r get NO care, cash and sell any assets for care, run up debts, borrow money from family.
      .
      The ER is not going to treat either of these conditions. In contrast, a veteran and his spouse can pay about $250 for a Silver Plan, or more for a higher cost plan that will cover more drugs. Higher monthly payment but less out of pocket expenses.

      Among the issues that bothers me is that if you want dis-enroll from the VA to buy private care while you’re being treated for say, cancer, and then want to return to the VA, they may not get back in!!! So that’s a big control play on your health care planning.

      Disabled veterans are being held hostage by the VA health care in this sense. If or when a veterans income (including spouses income and kids) put him over Priority 8 eligibility, he can’t get VA care anyway unless its service connected. And since so few veterans win their claims (less than 20%, that means that the 80% of disabled veterans who are denied, cannot get any private insurance that isn’t the high risk pool
      I do want to do a post on the Priority 8 group because at quick glance, it’s looks really easy for a veterans family to pass these income/asset limits. If the Mrs. works a part-time job, Junior delivers pizza after school, the vet gets monthly payments, and they’ve managed to save a little nest egg of say, $40,000, and buy a the veteran will be booted of of the VA.

      So it is in the best interest of veterans, disabled or not, to have Obamacare implemented where they are working or not, disabled or not.

      ,

  4. mark tolomei says:

    I think They want all Vets in the VA System, that way they can claim all Vets have Mental Problems, and can not own Firearms, sneaky way to by pass 2ND adm , I know this is going on, lots of Vets all ready targeted, I know a few, but there are many other bad things going on in this BILL, I think this is a take over of are Republic.

    • Kiedove says:

      –Another good point. There IS a strong element of control over veterans’ lives implied here.
      –Although its true that seriously mentally ill and violent people should not have access to guns because they are a danger to themselves or others, these determinations could be abused or misapplied. In general, I’m not worried about sane/non-criminals losing their rights to gun ownership due to my experience in Vermont, Vermont is the most liberal state in the union yet is VERY protective of gun ownership. The most outspoken critics are ignored and old-fashioned Yankee individualism rules.

      –Your comment reminds me of state applications for vehicle disability signs. Your physicians has to sign off on it. It he writes that you have some mental issues, this raises a red flag at the DMV and you can have your license taken away!

      • mark says:

        I just moved out of California, THANK GOD, and They are going after Vets Hard on Gun rights there, If they disarm the vets then the people will be screwed, its been done before in History, many times, What do you think HomeLand Security is about? Its for the American People, why do the cops need Tanks? What are Fema Camps For? What about Infraguard? The Brown shirts of America? Brother It aint looking good.

        • Kiedove says:

          If that happens (attempts at the widespread disarming of veterans) veterans will find a way to get what they need to protect themselves and their families. I believe that any such attempts will fail. Anyone reading the papers knows that our society has become more violent. Robberies, break-ins, car-jacking etc…Women are arming themselves in greater numbers. Women, especially those who have been raped or victimized, will NOT disarm. This is a feminist issue. Those bulges in ladies’ big purses just might be a Baretta. Don’t even think about disarming these women. It won’t happen.

          • mark says:

            Lets Hope and Pray it does not come down, but after 15 years of study, the things I told people about have all come True, I now live in Fema Region X,More American Here,but the things that were going on in Cal are starting here now. Keep your head up and your eye on the Ball.

  5. Rob says:

    Not a problem, then they better not ask for my income when it comes to my spouse and children!!!! If I can’t utilize both then there is no need to even place my name in their hat…

    • Kiedove says:

      Good point.
      We are weighing our options. My DH is probably going to keep VA for a year and see if veterans make a stink and/or sue for equal treatment under the law for the tax subsidy. He will most likely pay retail to see one private specialist that he likes. If he has an emergency, he’ll go to the local ER and submit the bill to the VA. This is risky. If the cuts himself, we’ll drive 40 miles to the VA ER for stitches.

      Veterans need to be very clear. They want the option of staying enrolled in the VA health care (or enroll for the VA health care benefits for the first time) AND buy subsidized private health insurance if they choose. They are two different systems! Veterans have earned their VA health benefits through their military service.

      And I believe that most veterans want to see uninsured members of their families and neighborhoods have the ability to buy insurance at group rates (subsidized). Preventative care is important and Obamacare is strong on preventative services. .

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