Enrollment Frequently Asked Questions (FAQs)
Questions
- If I am enrolled with VA, what benefits will I receive?
- If I am enrolled, what cost will there be for me?
- Am I eligible for prescriptions from VA?
- I can't afford to make copays. What do I do?
- How do I request VA health care?
- If enrolled, can I get dental care?
- Will VA take care of my nursing home care needs?
- What is the coverage for emergency services?
- Are there any restrictions on getting care in private facilities at VA expense?
- What should I do if I was awarded the Purple Heart?
- What If I’m Catastrophically Disabled?
- Will VA provide hearing aids and eyeglasses?
- Are there any special benefits for combat veterans?
Answers
Veterans enrolled in the VA health care system are eligible to receive necessary hospital and outpatient services, including preventive and primary care. These services include: diagnostic and treatment services; rehabilitation; mental health; substance abuse treatment; home health, prosthetic equipment, respite and hospice care; and medications in conjunction with VA treatment. 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 TRICARE, 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.
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Priority Group 8 and certain other veterans are responsible for VA's inpatient copay of $1024 for the first 90 days of care during any 365-day period. For each additional 90 days, this charge is $512. In addition, there is a $10 per diem charge.
NOTE: VA's inpatient copay rate is based on the current Medicare deductible of $1024.
A three-tiered copay system is used for all outpatient services. The copay is $15 for a primary care visit and $50 for some specialized care. Certain services are not charged copays.
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Yes, generally, to receive medications from a VA pharmacy, the prescriptions must be written by a VA health care provider. Most veterans are currently charged $8 for each 30-day or less supply of medication provided by VA for treatment of conditions that are not service-connected. For veterans enrolled in Priority Groups 2 through 6, the maximum copay for medications that will be charged in calendar yea 2008 is $960.
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There are two options. The first option is to request a waiver from paying your current debt. If you request a waiver, you must submit sufficient proof that you cannot financially afford to make payment to VA. For assistance in applying for a waiver, contact the Revenue Coordinator at the VA health care facility where you receive care. The second option is to request a hardship determination to avoid future medical care copay charges. You will need to submit specific financial information about your current year income. If you are approved for a hardship determination, your copay status will change and your enrollment priority will improve. For further information on applying for a hardship determination, contact your Enrollment Coordinator.
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To schedule an appointment, contact your local VA health care facility.
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In general, dental benefits are limited to dental conditions determined by VA to be service-connected, veterans who were Prisoners of War, and veterans who are receiving 100% SC disability compensation. For specifics, contact the VA health benefits advisor at your local VA health care facility.
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The following veterans will be offered nursing home care when appropriate:
- Veterans requiring nursing home care for a SC disability
- Veterans with service-connected disabilities rated 70% or greater
- Veterans determined by VA to be unemployable or permanently and totally disabled from a service-connected condition.
Most other veterans are eligible for nursing home care as space and resources permit.
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VA provides urgent and limited emergency care in VA facilities. However, VA's ability to pay for emergency care in non-VA facilities is limited to veterans receiving care for a SC condition, or as payor of last resort for a NSC condition but only under the following conditions:
- You do not have coverage under a health insurance plan, and the services are not eligible for payment under Medicare or Medicaid.
- Emergency care was provided in a hospital emergency department or similar facility.
- You are financially liable to the provider of care for payment of the emergency treatment.
- You are enrolled in the VA health care system and receive care from VA within the 24 months preceding the non-VA emergency care.
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Yes. Care in private facilities at VA expense is provided only under certain circumstances. To determine if you are eligible for private care at VA expense, contact your local VA health care facility.
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You should submit appropriate documentation to your local VA health care facility. Appropriate documentation includes a Department of Defense Form DD 214 or, for World War II veterans, a "WD" form, any military service records or orders that document your award of a Purple Heart. If you need to obtain a copy of your military records you may use a Standard Form 180 Request Pertaining to Military Records, available at http://www.archives.gov/st-louis/military-personnel/standard-form-180.html or at VA offices. Veterans who were awarded the Purple Heart are assigned to Priority 3.
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If you believe you are catastrophically disabled, contact your VA health care provider or the Enrollment Office at your local VA health care facility for an evaluation. If it is determined that you are catastrophically disabled, you will be assigned to Priority 4; however, if you were previously identified as requiring copays, you will still be responsible for copays after moving to Priority 4.
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Yes, if you receive increased pension based on the need for regular aid and attendance or being permanently housebound, receive compensation for a service-connected disability, require these items for treatment of a service-connected condition, or are a former prisoner of war or purple heart recipient. Otherwise, hearing aids and eyeglasses will only be provided in special circumstances, and not for generally occurring hearing or vision loss.
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On January 28, 2008, the "National Defense Authorization Act of 2008" was signed into law. This law extends the period of eligibility for health care for veterans who served in a theater of combat operations after November 11, 1998. Under this authority, the Department of Veterans Affairs (VA) provides cost-free health care services and nursing home care for conditions possibly related to military service and enrollment in Priority Group 6 unless eligible for enrollment in a higher priority to:
- Currently enrolled veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits, for 5 years post discharge.
- Veterans discharged from active duty before January 28, 2003, who apply for enrollment on or after January 28, 2008, are eligible for the enhanced benefit until January 27, 2011.
Combat veterans, while not required to disclose their income information, may do so to determine their eligibility for a higher priority, beneficiary travel benefits and exemption of copays for care unrelated to their military service.
For those veterans who do not enroll with VA during their enhanced eligibility period, eligibility for enrollment and subsequent care is based on other factors such as a compensable service connection rating, VA pension status, catastrophic disability determination or the veteran's financial circumstances. For this reason, combat veterans are strongly encouraged to apply for enrollment within their enhanced eligibility period, even if no medical care is currently needed.
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