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The Affordable Care Act, VA, and You

 

Not Enrolled in VA Health Care? What You Should Know

The Affordable Care Act, also known as the health care law, was created to expand access to affordable health care coverage to all Americans, lower costs, and improve quality and care coordination. Under the health care law, people will have:

  • health coverage that meets a minimum standard (called “minimum essential coverage”) by January 1, 2014;
  • qualify for an exemption; or
  • pay a fee when filing their taxes if they have affordable options but remain uninsured.

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 to have coverage under the standards of the health care law. The health care law does not change VA benefits or out-of-pocket costs.

Use the VA Health Benefits Explorer to learn about the benefits you could receive as an enrolled Veteran. You will be given an opportunity to apply for enrollment after completing the 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 1,700 places available to get your care. This means your coverage can go with you if you travel or move.
  • Met the new requirement to have health care coverage that meets the minimum standard.

Typical Out-of-Pocket Costs

While most Veterans receive cost-free care and services based on eligibility factors such as service connection and/or income, the 2013 average annual out-of-pocket costs for all other Veterans was just $322.00.

2014 Copayment Requirements at a Glance

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 $8.00-$9.00
Primary Care Copay $15.00
Specialty Care Copay $50.00
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 Marketplace is 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. For more information, visit www.healthcare.gov.

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.

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 VA along with these plans. Remember: it is always a good idea to inform your doctors if you are receiving care outside of VA so your health care can be coordinated.

What happens if I do not have health coverage?

You do not have to pay a fee if you have coverage that meets a minimum standard (called “minimum essential coverage”). If you have access to affordable coverage but 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:

  • $95 or 1% of your taxable income in 2014
  • $325 or 2% of your taxable income in 2015
  • $695 or 2.5% of your taxable income in 2016

Exemptions from the payment will be granted under certain circumstances. For more information on these exemptions, visit www.healthcare.gov.

For More Information

1-877-222-VETS (8387)
8 am to 10 pm ET Mon-Fri
11 am to 3 pm ET Sat

Find out if you're eligible: Health Benefits Explorer
Apply now for VA Health Care
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