Congress has required that after October 1, 1998, most veterans must be enrolled to receive VA health care services. Congress has also expanded the range of medical services that enrolled veterans may receive. Veterans may apply for enrollment at any time. Here are some common questions about enrollment and benefits.
If I am enrolled with VA, what benefits will I receive? Veterans in the VA health care system will be eligible to receive necessary inpatient and outpatient ser 'vices, including preventive and primary care. These include: diagnostic and treatment services; rehabilitation; mental health and substance abuse treatment; home health, respite and hospice care; and drugs in conjunction with VA treatment.
If I am enrolled, what cost will there be for me? There is not a monthly premium required to use VA care. However, you may have to agree to pay some copayments. If you have insurance, it may cover the cost of the copayments. For hospital care, the copayment is the same as the Medicare inpatient deductible for the first 90-day period of care ($776 in calendar year 2000) and $ 10 for each day of care. For outpatient care, the per visit copayment is 20% of the average cost of a VA outpatient visit ($50.80 calendar year 2000). There is also a $2 copayment for each 30-day supply of prescription drugs.
Is this an insurance policy or a HMO? It is neither. VA health benefits are established by Federal law and regulations and funded through appropriations. They are not the same as an insurance contract. Also, veterans do not pay monthly premiums to received VA health care. In addition, you are not required to use VA as your exclusive health care provider. If you have health insurance, or eligibility for other programs such as Medicare, Medicaid, or CHAMPUS, you may continue to use services under those programs. We recommend that, if you have other insurance or HMO coverage, you SHOULD keep that coverage to provide you with options and flexibility in the future.
Do enrolled veterans have to pay the deductibles that their insurance carrier requires when treated at VA? NO. VA does not require veterans to pay those charges. In addition many insurance companies will apply VA co-payment charges toward satisfaction of the annual deductible.
Are there any restrictions on getting care in private facilities at VA expense? YES. Care in private facilities at VA expense is provided only under certain circumstances, namely, when VA has a contract arrangement for certain services or when a veteran who is service disabled is too far from a VA facility to receive care.
Will VA pay for care in private facilities? Usually not. VA provides care in private facilities at VA expense when VA has a contract arrangement for certain services or, under very limited circumstances, when VA approves the care in advance.
What is the coverage for emergency -services? VA provides urgent and limited emergency care services in VA facilities. Emergency care may be provided in non-VA facilities with which VA has entered into a contract to provide such services. However, VA's ability to pay for emergency care in non-VA facilities is very limited.
What If I got sick while on travel? You may receive health care at any VA health care facility in the country. To minimize any "out of pocket" expenses while traveling, you should familiarize yourself with the location of any VA health care facilities in the area. VA's authority to reimburse you for care in non-VA facilities is very limited.
If enrolled, can I get dental care? In general, dental benefits are limited to service connected dental conditions or to veterans who are permanently and totally disabled from service-connected causes. For specifics, contact the VA health benefits advisor at your local VA health care facility.
Will VA take care of my nursing home needs? Public Law 104-262, "The Veterans Health Care Eligibility Reform Act of 1996" did not change eligibility for nursing home care. Nursing home care in VA or private nursing homes may be provided, as space and resources permit, to. certain veterans who are acutely ill or incapacitated but not in need of hospital care. To determine if you are eligible for VA nursing home care, you will need to contact the nearest VA health care facility.
Will VA provide hearing aids and eyeglasses? Yes, if you are service-disabled with a disability rating of 10% or greater. Otherwise, hearing aids and eyeglasses will only be provided in special circumstances, and not for generally occurring hearing or vision loss.
What kind of maternity services are available? VA provides maternity care, but cannot provide care to a newborn child, even in the immediate aftermath of the birth. The veteran mother must make other arrangements for payment for the care of the child.
Are there any limits on days of care or outpatient visits VA will provide? No, your treating physician will determine what is considered appropriate and necessary hospital care or outpatient services and will provide such care consistent with current medical care practices.
Are all veterans being notified of their enrollment confirmation at the same time? VA will be sending out confirmation letters by priority group. Therefore veterans will be notified at different times.
Click here for the Veterans' Affairs Health Care Enrollment Form