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Not Enrolled in VA Health Care? What You Should Know
The Affordable Care Act, also known as the health care law, was created to provide more Americans with access to affordable health insurance, improve the quality of health care and health insurance, and reduce health care spending in the U.S. Under the health care law, individuals:
- must have health insurance that meets the “minimum essential coverage” requirement, or
- must pay an “individual shared responsibility payment,” also known as a “penalty,” when filing their taxes if they can afford to buy health insurance, but choose not to buy health insurance, unless they meet certain requirements to qualify for an exemption from paying the penalty.
The Health Insurance Marketplaces is a way to find health coverage. On the Marketplaces, some people may be eligible for lower costs on health premiums and out-of-pocket costs based on their income.
VA Health Care Enrollment
If you are not enrolled in VA health care, you can apply at any time. If you served in the U.S. Armed Forces, you can use the VA Health Benefits Explorer to learn about the benefits you could receive if you are enrolled with VA for your health care. You will be given an opportunity to apply for enrollment after completing the VA Health Benefits Explorer. If you wish, you can skip the Explorer and simply apply for enrollment now.
In addition, enrollment in VA means you can enjoy:
- Medical care rated among the best in the U.S.
- Immediate benefits of health care coverage. Veterans may apply for VA health care enrollment at any time.
- No enrollment fee, monthly premiums, or deductibles. Most Veterans have no out-of-pocket costs. Some Veterans may have to pay small copayments for health care or prescription drugs.
- More than 1,500 places available to get your care. This means your coverage can go with you if you travel or move.
- Health care coverage that meets the minimum essential coverage standard.
2016 Copayment Requirements at a Glance
While most Veterans receive cost-free care and services based on eligibility factors, such as service connection and/or income, the 2016 average annual out-of-pocket costs for all other Veterans was just $320.
| VA Health Care Plan | Out-of-Pocket Costs |
|---|---|
| Annual Premium/Deductible/Cost Shares | $0 |
| Durable Medical Equipment (e.g. wheelchairs, prosthetics, braces) |
$0 |
| Medication Copay | $8-$9 |
| Primary Care Copay | $15 |
| Specialty Care Copay | $50 |
| Inpatient Care Copay | Based on annual Medicare deductible, or percentage thereof, for each 90 days of care |
Only one copay is charged per day, regardless of the number of appointments.
Family Members and the Marketplace
The Marketplaceis a way to shop for and purchase private health insurance (for example, health coverage other than VA health care programs) that fits your budget and meets your needs. People who purchase insurance through the Marketplace may be able to lower the costs of health insurance coverage by paying lower monthly premiums. The Marketplace open enrollment period is November 1, 2017, through December 15, 2017. For more information, visit https://www.healthcare.gov/income-and-household-information/household-size/ to preview plans and prices for your spouse and dependents. You can also see more information about family members and the marketplace on the Family Members section of the ACA website.
Even if you are covered by your VA health care enrollment, your family members who are not enrolled in a VA health care program and who do not meet the health care law coverage standards should use the Marketplace to get coverage. They may get lower costs on monthly premiums or out-of-pocket costs. They could be eligible for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). They can submit an application for health care coverage through the Marketplace, and learn the amount of assistance they are eligible for. For more information, visit www.healthcare.gov.
Special Enrollment Period on the Marketplace
A special enrollment period is a time outside of the open enrollment period during which you and your family have a right to sign up for health coverage. In the Marketplace, you qualify for a special enrollment period 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. Job-based plans must provide a special enrollment period of 30 days. If you don’t have a special enrollment period, you can’t buy insurance inside or outside the Marketplace until the next open enrollment period. Not all special enrollment periods are the same length, so visit https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/ for details.
VA and Other Health Insurance
If you have other forms of health care coverage, such as a private insurance plan, Medicare, Medicaid or TRICARE, you can continue to use your VA health care benefits along with these plans. Remember: it is always a good idea to inform your doctors if you are receiving care by other doctors so that your health care can be coordinated.
What happens if I do not have health coverage?
If you remain uninsured, you may have to make payment when filing your taxes. This payment will either be a flat fee or a percentage of your taxable household income, depending on which amount is higher. This payment will be phased-in according to the schedule below:
- $695 or 2.5% of your taxable income in 2017, up to a maximum of $2,085, whichever is greater
Exemptions from the payment will be granted under certain circumstances. For more information on these exemptions, visit www.healthcare.gov.
