Frequently Asked Questions – Health Care Benefits Overview – Health Benefits

Where Can I Find More Information?

If you need more information about health care benefits, you can call VA’s toll-free helpline at 1-877-222-VETS (8387) from Monday to Friday, between 8 a.m. and 8 p.m. ET. You can also visit the website www.va.gov/healthbenefits.

How Can I Verify My Registration?

Once your enrollment is confirmed, you will receive a Veterans Health Benefits Handbook that will notify you of your enrollment status. If you want to verify your enrollment, you can call the toll-free number 1-877-222-VETS (8387) from Monday to Friday, between 8 a.m. and 8 p.m. ET.

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Do I Have to Use VA as My Exclusive Health Care Provider?

No, there is no requirement for you to use VA as your exclusive health care provider. If you receive care from both VA and a local provider, it’s important to ensure that your care is coordinated to guarantee your health and safety. This means that your care should be managed and co-managed by both providers.

How Do I Transfer My Care to a New VA Health Care Facility?

If you’re moving to another state and want to transfer your care to a new VA health care facility, you should contact your agreement. Your agreement will work with the itinerant veterans coordinator to assist you with the transfer and schedule an appointment at the new facility.

How Do I Choose or Change My Preferred Installation?

When you apply for enrollment, you will be asked to choose a preferred health care facility. This will be the VA facility where you will receive your primary care. You can select any installation that is convenient for you.

If the facility you choose cannot provide the medical care you need, VA will make other arrangements for your care based on eligibility and medical necessity. If you don’t choose a preferred facility, VA will assign you to the facility closest to your home. You can change your preferred installation at any time.

Can I Cancel My VA Medical Coverage?

Yes, you can request to disenroll from VA health care at any time. To do this, you need to submit a signed and dated document to a VA medical center or mail the request to the Health Eligibility Center & Eligibility Division at 2957 Clairmont Road, Suite 200, Atlanta, GA 30329-1647.

Closing your VA health care coverage may affect your health care coverage requirements under the Affordable Care Act if you don’t have any other qualifying health care. You can reapply for enrollment at any time by completing a new VA 10-10EZ form online at www.vets.gov, by calling 1-877-222-VETS (8387), or by visiting your local VA health care center. Please note that you will be considered a new applicant and eligibility will be based on the current requirements.

Where Can I Find the New Income Limits?

The income limits can change each year, so they are not published in this brochure. However, you can view the income limit for the previous year online at 2021 Goes National and Priority Group 8 Relaxation Income Thresholds.

What Is a Geographic Income Limit?

Congress added geographic location-based income limits to the existing VA income limits to account for the cost of living variations across different areas. Veterans whose income falls between the VA income limit and the geographic income limit for their location may have their inpatient health care copays reduced by 80%.

What Happens If My Income Exceeds the Income Limits?

If it is verified that your income exceeds the income limits, your copay status will change from waived to required. This may result in disenrollment due to enrollment restrictions for veterans whose income exceeds the limits. The facilities providing your care will be notified of this change, and billing will begin for services rendered during that income year. Your priority enrollment status may also change if your financial status is adjusted. If your enrollment status changes, you will receive a notification by mail.

Will You Have Access to My Tax Return?

No, VA will not have access to your tax return. The IRS and SSA share data on earned and unearned income reported by employers and financial institutions.

Do Combat Veterans Have to Pay Copays?

Combat veterans who qualify under this special eligibility are not subject to copays for conditions potentially related to their combat service. However, they may be subject to appropriate copayment rates for care or services determined to be unrelated to their military service.

What Is a Service-Related Rating and How Do I Set One?

A service-connected rating is an official decision by VA that establishes a direct relationship between your illness or condition and your active duty military service. To apply for any of these benefits or for more information, you can contact your nearest VA Regional Office at 1-800-827-1000 or visit the websites www.ebenefits.va.gov or www.va.gov.

What If I Can’t Pay a Bill?

If you are unable to pay a bill, you should discuss the matter with the patient billing office at the VA health care facility where you received your care. They can provide you with options and assistance to help you manage your payment.

What Is the Affordable Care Act?

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The Affordable Care Act, also known as the Health Care Act, was created to expand access to affordable health care coverage for all Americans, reduce costs, and improve the quality and coordination of care. For more information, you can visit the website www.va.gov/health/aca/.

Am I Eligible for Health Care Coverage if I’m Enrolled in VA Health Care?

Yes, if you are enrolled in any of the VA programs such as a health care program, CHAMPVA, or the Spina Bifida Health Care Benefits Program, you are covered under the standards of the health care law.

When Do I Start Reporting Health Care Coverage to the IRS?

As a taxpayer, you must report your health coverage on your federal tax forms.

When Did VA Start Notifying the IRS about a Veteran’s Enrollment?

Since 2015, VA has been submitting forms to the IRS, veterans, and eligible beneficiaries to provide details of VA-provided health coverage. These forms are used for income tax processing.

What If I Don’t Receive the Form from VA?

VA annually mails IRS Form 1095-B to veterans who were enrolled in VA’s health care system during the previous calendar year. If you did not receive this form, you can call 1-877-222-VETS (8387) from Monday to Friday, between 8 a.m. and 8 p.m. ET. Please note that this form is for your records only and should not be sent to the IRS or returned to VA.

What Is a Patient-Aligned Care Team (PACT)?

A Patient-Aligned Care Team (PACT) is a team of health care professionals, including the veteran, their family or caregivers, who work together to plan for comprehensive care and lifelong health and wellness. The focus is on partnerships with veterans, access to care through various methods, coordinated care among team members, and putting veterans at the center of their care.

How Does a PACT Work?

A PACT uses a team-based approach, where you, as the veteran, are the center of the care team. The team includes your family members, caregivers, and health care professionals such as a primary care provider, nurse care manager, clinical associate, and administrative clerk. If additional services are needed, another care team may be involved. For more information, you can visit www.patientcare.va.gov/primarycare/pact.asp.

Am I Eligible for Dental Care?

VA is authorized to provide extensive dental care, but there may be limitations in some cases. The eligibility criteria for dental care are categorized into different classes. The extent of dental care you are eligible for depends on the class you fall into. For more information about dental eligibility and the services provided, you can call toll-free 1-877-222-VETS (8387) or visit the website https://www.va.gov/health-care/.

What Is Community Care?

Community care refers to health care provided by providers in your local community outside of VA. Veterans may be eligible for community care when VA is unable to provide the necessary care. This care is provided on behalf of and paid for by VA.

Do I Qualify for Routine Health Care at VA-Run Community Centers?

To qualify for routine health care in community facilities at VA expense, you need to receive a written referral. The authorization for such care depends on factors like your medical condition and the availability of services in your geographic area. Copays may apply.

Are There Payment Limitations for Community Emergency Care?

Claims for non-VA authorized community emergency care must be timely submitted before services are provided. It’s important to contact your nearest VA medical center as soon as possible to avoid denial of payment for a late-filed claim. Payment may not be approved for any period beyond the point of stability, except in cases where the veteran cannot be transferred to a VA or other federal facility. For more specific rules regarding emergency care, you can refer to page 29.

What Type of Emergency Care Can VA Authorize in Advance?

VA can authorize emergency care in advance in certain situations. You should consult with your nearest VA medical facility or refer to the specific guidelines.

Can VA Pay for Unauthorized Non-VA Emergency Care?

VA has limited payment authority when emergency care is provided at a community center without prior authorization or when VA is not notified within 72 hours of admission. VA may pay for unauthorized emergency care under specific circumstances. It’s important to contact the nearest VA medical facility as soon as possible for all non-VA authorized care to ensure proper payment.

Does VA Offer Compensation for Travel Expenses to a VA Facility?

Yes, VA offers travel benefits to certain qualifying veterans. If you meet the specific criteria, you may be eligible for travel benefits. For more information, you can refer to “health-related travel benefits” on page 24.

Why Do I Need to Complete a Separate Financial Assessment for Long-Term Care?

The initial enrollment application is based on your income from the previous year. However, the Long-Term Care Financial Assessment (Form VA 10-10EC) is designed to assess your current financial status, including your current expenses. This assessment provides the necessary information to determine if you qualify for free long-term care or a reduced copay charge.

Who Notifies Me of My Long-Term Care Copay Requirements Once I Submit the Form?

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The social worker or case manager overseeing your long-term care will provide you with an annual projection of your monthly copay charges based on available resources.

How Is the Decision Made to Provide Nursing Home Care in a Health Care Facility or a Private Nursing Home?

If you qualify for indefinite nursing home care, it will generally be provided in a VA facility. However, if there is a pressing medical or social need, care may be provided in a private facility under a VA contract.

What Assistance Is Available for Veterans Who Don’t Qualify for Indefinite Care at a VA Community Living Center?

If you don’t qualify for indefinite care at a VA community living center, social workers can help you and your family identify potential sources of financial assistance. They can also review eligibility for Medicare and Medicaid and direct you to the appropriate resources, including other VA benefit programs.

For more information about eligibility for VA medical and dental benefits, you can call toll-free 1-877-222-VETS (8387) or visit the website https://www.va.gov/health-care/.

What Is Community Care?

Community care refers to health care provided by providers in your local community outside of VA. Veterans may be eligible for community care when VA is unable to provide the necessary care. This care is provided on behalf of and paid for by VA.

Do I Qualify for Routine Health Care at VA-Run Community Centers?

To qualify for routine health care in community facilities at VA expense, you need to receive a written referral. The authorization for such care depends on factors like your medical condition and the availability of services in your geographic area. Copays may apply.

Are There Payment Limitations for Community Emergency Care?

Claims for non-VA authorized community emergency care must be timely submitted before services are provided. It’s important to contact your nearest VA medical center as soon as possible to avoid denial of payment for a late-filed claim. Payment may not be approved for any period beyond the point of stability, except in cases where the veteran cannot be transferred to a VA or other federal facility. For more specific rules regarding emergency care, you can refer to page 29.

What Type of Emergency Care Can VA Authorize in Advance?

VA can authorize emergency care in advance in certain situations. You should consult with your nearest VA medical facility or refer to the specific guidelines.

Can VA Pay for Unauthorized Non-VA Emergency Care?

VA has limited payment authority when emergency care is provided at a community center without prior authorization or when VA is not notified within 72 hours of admission. VA may pay for unauthorized emergency care under specific circumstances. It’s important to contact the nearest VA medical facility as soon as possible for all non-VA authorized care to ensure proper payment.

Does VA Offer Compensation for Travel Expenses to a VA Facility?

Yes, VA offers travel benefits to certain qualifying veterans. If you meet the specific criteria, you may be eligible for travel benefits. For more information, you can refer to “health-related travel benefits” on page 24.

Why Do I Need to Complete a Separate Financial Assessment for Long-Term Care?

The initial enrollment application is based on your income from the previous year. However, the Long-Term Care Financial Assessment (Form VA 10-10EC) is designed to assess your current financial status, including your current expenses. This assessment provides the necessary information to determine if you qualify for free long-term care or a reduced copay charge.

Who Notifies Me of My Long-Term Care Copay Requirements Once I Submit the Form?

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The social worker or case manager overseeing your long-term care will provide you with an annual projection of your monthly copay charges based on available resources.

How Is the Decision Made to Provide Nursing Home Care in a Health Care Facility or a Private Nursing Home?

If you qualify for indefinite nursing home care, it will generally be provided in a VA facility. However, if there is a pressing medical or social need, care may be provided in a private facility under a VA contract.

What Assistance Is Available for Veterans Who Don’t Qualify for Indefinite Care at a VA Community Living Center?

If you don’t qualify for indefinite care at a VA community living center, social workers can help you and your family identify potential sources of financial assistance. They can also review eligibility for Medicare and Medicaid and direct you to the appropriate resources, including other VA benefit programs.

For more information about eligibility for VA medical and dental benefits, you can call toll-free 1-877-222-VETS (8387) or visit the website https://www.va.gov/health-care/.

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