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!
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.
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.