Frequently Asked Questions – Health Care Benefits Overview – Health Benefits

November 10, 2022

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Frequently Asked Questions: Health Care Benefits Overview

Where can I find more information?

Call VA’s toll-free health benefits helpline at 1-877-222-vets (8387) Monday through Friday between 8 a.m. and 5 p.m. m. and 8 p.m. m. et. information is also available at www.va.gov/healthbenefits.

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How can I verify my registration?

Once your enrollment is confirmed, you will receive a Veterans Health Benefits Handbook notifying you of your enrollment status. You can also call us toll-free to verify your enrollment at 1-877-222-vets (8387) Monday through Friday between 8 a.m. and 5 p.m. m. and 8 p.m. m. et.

Reading: How to find out if you have va health insurance

if I’m enrolled, do I have to use va as my exclusive health care provider?

There is no requirement that you become your exclusive provider of care. If you are a veteran receiving care from both a VA and a local provider, it is important for your health and safety that your care is coordinated, resulting in a treatment plan (co-managed care).

I’m moving to another state. how do i transfer my care to a new va health care facility?

If you would like to transfer your care from one health care facility to another, please contact your agreement. your covenant will work with the itinerant veterans coordinator to help you transfer your care and schedule an appointment at the new facility.

how do I choose a preferred installation? how do i 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 administrative eligibility and medical necessity. if you don’t choose a preferred facility, it will choose the facility closest to your home. you can change your preferred installation at any time.

can i cancel my va medical coverage?

You may request to disenroll from VA health care, commonly known as disenroll/reject, at any time. To request disenrollment, you must submit a signed and dated document requesting disenrollment from VA medical care to a VA medical center or you may mail the request to:

registration at the health eligibility center & Eligibility Division 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 do not have other qualifying health care.

You may reapply for enrollment at any time by completing a new VA 10-10ez form, “Application for Health Benefits,” online at www.vets.gov, by calling toll-free 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 for enrollment will be based on then-current eligibility requirements.

Where can I find the new income limits?

Because income limits can change each year, they are not published in this brochure; however, the income limit for the prior year can be viewed online at 2021 Goes National and Priority Group 8 Relaxation Income Thresholds

what is a geographic income limit?

Recognizing that the cost of living can vary significantly from one geographic area to another, Congress added geographic location-based income limits to the existing VA income limits for financial evaluation purposes. Veterans whose income is between the VA income limit and the geographic income limit for the veteran’s location will have their inpatient health care copays reduced by 80%.

what happens if at the end of the process it is verified that my income exceeds the income limits?

Your copay status will change from copay waived to copay required, which may result in disenrollment due to enrollment restrictions for veterans whose income exceeds the income limits. Facilities involved in your care will be notified of your status change and billing will begin for services rendered during that income year. Your priority enrollment status may change if your financial status is adjusted through the income verification process. if your enrollment status changes, you will be notified by mail.

will you have access to my tax return?

no, you 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.

I am a recently discharged combat veteran. Do I have to pay copays?

Veterans who qualify under this special eligibility are not subject to copays for conditions potentially related to their combat service; however, unless otherwise warranted, combat veterans 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 your illness or condition is directly related to your active duty military service. For more information or to apply for any of these benefits, contact your nearest VA Regional Office at 1-800-827-1000, or visit us online at www.ebenefits.va.gov or www.va.gov.

what if I get a bill and can’t pay it?

If you are unable to pay your bill, you should discuss the matter with the patient billing office at the VA health care facility where you received your care. see “va has options that can help veterans pay copays” on pages 15-16.

what is the affordable care act?

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 quality and coordination of care . For more information, see “Coverage Under the Affordable Care Act” on page 12 or visit www.va.gov/health/aca/.

if I am enrolled in VA health care, am I eligible for health care coverage?

yes. If you are enrolled in any of the VA programs below, you are covered under the standards of the health care law:

a health care program
champagne
spina bifida health care benefits program

when do i start reporting health care coverage to the irs?

we taxpayers must report your health coverage on your federal tax forms.

when did you start notifying the irs about a veteran’s enrollment in the va health care system?

In 2015, VA began submitting forms from the IRS, veterans, and eligible beneficiaries that provide details of VA-provided health coverage. these forms are used for income tax processing.

what happens if I don’t receive this form?

VA annually mailed IRS Form 1095-B to veterans who were enrolled in VA’s health care system at any time in the previous calendar year. If you did not receive a Form 1095-B from VA explaining your health care coverage for each year you are or have been enrolled, call 1-877-222-vets (8387) Monday through Friday from 8 a.m. to 5 p.m. m. to 8 p.m. m. et. 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 (compact) includes the veteran, their family or caregivers, and a group of health care professionals who work together to plan for that individual’s comprehensive care and lifelong health and wellness. focuses on:

partnerships with veterans
access to care through various methods
coordinated care among team members
team care with veterans at the center of their pact

how does a pact work?

a pact uses a team-based approach. you are the center of the care team that also includes your family members, caregivers, and health care professionals: primary care provider, nurse care manager, clinical associate, and administrative clerk. when other services are needed to meet your goals and needs, another care team may be called. For more information, visit www.patientcare.va.gov/primarycare/pact.asp.

am I eligible for dental care?

va is authorized to provide extensive dental care, while in other cases treatment may be limited. The chart below outlines the dental eligibility criteria and contains information to help veterans understand their eligibility for VA dental care. Eligibility for outpatient dental care is not the same as for most other VA medical benefits and is categorized into classes. For example, if you are eligible for dental care under Class I, IIC, or IV, you are eligible for any dental care necessary to maintain or restore oral health and masticatory function, including repeat care. other classes have time and/or service limitations.

Dental care to the extent necessary as determined by a dental professional to:

make it possible for you to enter a rehabilitation program
achieve the goals of your vocational rehabilitation program
prevent disruption of your rehabilitation program
expedite return to a rehabilitation program if you are on interrupted or discharged status
expedite a veteran’s return to a rehabilitation program if discharged due to illness, injury, or dental condition, or
secure and adjust to employment during the work assistance period, or enable you to achieve maximum independence in daily life.

*note: Outpatient emergency dental care may be provided as a humanitarian service to individuals who do not have established dental eligibility. dental treatment is limited to that necessary to treat acute pain or a dental condition determined to be life- or health-threatening.

*note: Public Law 83, enacted June 16, 1955, changed veterans’ eligibility for outpatient dental services. As a result, any veteran who received a Veterans Benefits Administration (VBA) dental award letter dated prior to 1955, in which the VBA determined that the dental conditions are not compensable, is no longer eligible for dental treatment. class ii outpatient clinic.

what is community care?

va provides health care for veterans from providers in your local community outside of va. Veterans may be eligible to receive care from a community provider when VA is unable to provide needed care. this care is provided on behalf of and paid for by va.

Community care is available to veterans based on certain conditions and eligibility requirements, and taking into account a veteran’s specific needs and circumstances. Community care must first be authorized by VA before a veteran can receive care from a community provider.

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 must first receive a written referral. factors in determining whether such care will be authorized include your medical condition and the availability of services within your geographic area. copays may apply.

Are there payment limitations for community emergency care?

Claims must be timely submitted for non-VA authorized community emergency care before services are provided. Because timely filing requirements differ by claim type, you should contact your nearest VA medical center as soon as possible to avoid a denial of payment for a late-filed claim. (See “emergency care” on page 29 for specific rules.)

Payment may not be approved for any period beyond the point of stability, except when the VA cannot accommodate the veteran’s transfer to a VA or other federal facility. An emergency is considered to have ended at the point of stability when a VA physician has determined that, based on sound medical judgment, a Veteran who received emergency hospital care could have been transferred from the community facility to a VA medical center for treatment. continue treatment. .

What type of emergency care can you authorize in advance?

yes

can the va pay for non-va emergency care that is not pre-authorized?

va has limited payment authority when emergency care is provided at a community center without authorization from va before services are provided or when va is not notified within 72 hours of admission. VA may pay for unauthorized emergency care as listed below. Since payment may be limited to the point where your condition is stable for transfer to a VA facility, the nearest VA medical facility should be contacted as soon as possible for all non-VA authorized care before care is provided. services.

Additional requirements for approval of retroactive payments for unauthorized emergency treatment for service-connected veterans can be found at (38 U.S.C. §1728): In addition to the general eligibility requirements, for payment to be approved retroactively for emergency care under title 38 u.s.c. §1728, one of the following criteria must also be met:

emergency treatment of a service-connected* or adjunctive* condition in a community

emergency service; o

a veteran who is permanently and totally disabled (p&t) as a result of a service-connected injury

condition is eligible for emergency treatment of any condition; o

a veteran who is participating in a vocational rehabilitation program and requires

emergency treatment to expedite your return to the program is eligible for emergency

treatment for any condition

va may also pay for unauthorized non-service-connected emergency care, listed below, contained in title 38 u. yes c. §1725 and 38 cfr § 17.1000: In addition to the general eligibility requirements, for payment to be retroactively approved for emergency care under 38 u.s.c. §1725, all of the following 5 criteria must also be met:

care was provided in a hospital emergency department (or similar public facility charged with providing it

emergency treatment to the public); and

the veteran has received care in a health care facility during the 24 months prior to the emergency

careful; and

the veteran is financially responsible to the emergency treatment provider; and
if the treatment was due to an injury or accident, the claimant has exhausted, unsuccessfully,

all liability claims and remedies reasonably available to the veteran or provider against a third party

part of the payment for such treatment, and the veteran has no legal or contractual recourse to

extinguish, in its entirety, the veteran’s liability to the provider; and

the veteran is not eligible for reimbursement under title 38 u.s.c. §1728 for emergency

treatment.

For more information on emergency care, visit www.va.gov/communitycare/

Does VA offer compensation for travel expenses to and from a VA facility?

yes, but not all veterans qualify. If you meet specific criteria (see “health-related travel benefits” on page 24), you are eligible for travel benefits.

I already provided financial information on my initial VA application. Why is it necessary to complete a separate financial assessment for long-term care?

Your initial enrollment application is based on your income from the previous year. The Long-Term Care Financial Assessment (Form VA 10-10EC, Application for Extended Care Services) is designed to assess your current financial status, including current expenses. This detailed analysis provides the necessary monthly income/expense information to determine if you qualify for free long-term care or a significant reduction in the maximum copay charge.

once I submit a completed va 10-10ec form, who notifies me of my long-term care copay requirements?

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

Assuming I qualify for nursing home care, how do you determine if the care will be provided in a health care facility or a private nursing home at va’s expense?

Generally, if you qualify for indefinite nursing home care, your care will be provided in a VA facility. care may be provided in a private facility under va contract when there is a pressing medical or social need.

If you don’t qualify for indefinite care, you may be placed in a community nursing home, usually not to exceed six months, after an episode of va care. The purpose of this short-term placement is to assist you and your family while alternative long-term arrangements are explored.

for veterans who do not qualify for indefinite care at a va community living center operated by va, what assistance is available to make alternative arrangements?

When the need for nursing home care extends beyond the veteran’s eligibility, our social workers will help family members identify potential sources of financial assistance. Our staff will review basic Medicare and Medicaid eligibility and direct the family to the appropriate sources for further assistance, including the ability to apply for additional VA benefit programs.

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November 10, 2022

0 564 10 minutes read