29 May Veteran’s Healthcare Options
in Health Insurance
For veterans, both young and old, there are many healthcare options. A veteran may decide to seek medical care through available programs at the Department of Veteran Affairs (VA)hospitals and clinics, or go to doctors and hospitals open for the general public and not based on veteran status. There are many factors to consider before choosing what option is best such as income, co-pay amounts, health needs, and distance to the closest VA.
A veteran may choose to go to the closest VA because they enjoy the atmosphere of comradery, the military knowledge and services the medical staff are trained in, and the veteran-specific programs not usually available elsewhere. Additionally, the VA can be beneficial to low income veterans because eligibility and co-pay amountsare determined by factors such as income, type of service and medals received, and whether the veteran has recognized service-connected disabilities. Once a veteran registers with a VA and these factors are considered, the VA places the veteran into one of eight Priority Groups which determine out-of-pocket costs for care.
The VA has additional programs for its patients who cannot travel to the VA, need care the VA is unable to provide, had to go to the nearest public hospital due to an emergency, or the veteran resides in a designated area in which there are no VA services. One such program is the Non-VA Medical Care Program. The Non-VA Medical Care Programcovers medical costs for veterans when the VA services are either unavailable at the VA, the closest VA facility is not accessible geographically, or the veteran had an emergency and was not able to travel the distance to the closest VA. Another program is called Patient-Centered Community Care(PC3 or PCCC). PC3 is a VA initiative to provide primary and specialty care to veterans when the VA is unable to offer sufficient services. The program was created in 2013 and incorporated findings from previous VA pilot programs in order to improve the care offered. PC3 has been expanded in the past few years to include more covered services.
A veteran may also choose to purchase private health insurance, either through an employer or through a state-run marketplace or other such program developed in response to the passage of the Affordable Care Act. In New York State plans can be purchased through the Official Health Plan Marketplace. Private health insurance offers veterans more choices in choosing medical providers because the veteran can still go to the VA (if eligible for medical services) or decide on providers covered under their individual plan.
Additionally, depending on age, income, and disabilities, a veteran may be eligible for Medicaid and/or Medicare. Medicaid is administered by individual states meeting specific federal requirements. Eligible groups regardless of veteran status include low-income families and individuals, pregnant women, and aged, blind and disabled individuals. Medicareis another large insurance program which can be used in conjunction with VA care by veterans. To be eligible, individuals must be 65 years or older, diagnosed with End-Stage Renal Disease, or deemed disabled and receiving Social Security Disability Insurance benefits. One thing to note is Medicare specifically will not covertreatment received at the VA because Medicare is unable to cover services at a government facility. The veteran can choose whether or not to use the VA and pay the VA copayment based on his or her Priority Group, or use a facility outside of the VA which accepts Medicare. Medicare Part A, the hospital coverage, generally does not cost an individual extra and is a good idea to have if the veteran may use a hospital outside of the VA system.
Veterans receive healthcare through multiple systems and programs, and can compare which is most convenient or beneficial to their health and wallet before deciding which to choose. Please read more at https://www.americanbar.org/groups/health_law/publications/aba_health_esource/2017-2018/march2018/healthcareoptions.html.
Guest blog credit:
Staff attorney LegalHealth, New York Legal Assistance Group