VA HEALTHCARE AND ENROLLMENT FAQ

 

Congress has required that after October 1, 1998, most veterans must be enrolled to receive VA hospital and outpatient care. 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 hospital and outpatient services, 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 co-payments. If you have insurance, it may cover the cost of the co-payments. For hospital care, the co-payment 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 co-payment is 20% of the average cost of a VA outpatient visit ($50.80 calendar year 2000).  There is also a $2 co-payment for each 30-day supply of prescription drugs.

 

Is this an Insurance policy or an 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 receive 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.

 

Are them 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.  To determine if you are eligible for private care at VA expense, you will need to contact the nearest VA health care facility.

 

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 in VA facilities. However, VA's ability to pay for emergency care in non-VA facilities is very limited. The Veterans Millennium Health Care and Benefits Act has authorized VA to expand emergency care coverage. Refer to the last paragraph for additional details.

 

What If I get 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? Nursing home care in VA or private nursing homes may be provided to certain veterans as space and resources permit. The Veterans Millennium Health Care and Benefits Act has authorized VA to expand long-term care services.  Refer to the last paragraph for additional details.  To determine it 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 receiving VA care and are service-disabled with a disability rating of 10% or greater or are a former POW. Otherwise, hearing aids and eyeglasses will only be provided in special circumstances, and not for generally occurring hearing or vision toss.

 

What kinds 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 hospital 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 there any plans to further expand VA's health care benefits?  On November 30, 1999, the President signed Public Law 106-117, the Veterans Millennium Health Care and Benefits Act. This legislation authorizes VA to expand long-term care services and to reimburse for the emergency treatment of certain enrolled veterans. The law also requires VA enroll veterans awarded the Purple Heart into Priority Group Three. VA is currently in the process of drafting regulations required to implement these new authorities.   For specifics, contact the Health Benefits Service Center at 877-222-VETS (8387).

 

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