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Frequently Asked Questions - Health Care Benefits Overview

Where can I find more information?

Call VA Health Benefits toll-free help line at 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. ET. Information is also available at www.va.gov/healthbenefits.

How can I verify my enrollment?

Once your enrollment is confirmed, you will receive a Veterans Health Benefits Handbook from us notifying you of the status of your enrollment.  You may also call us toll free to verify your enrollment at 1-877-222- VETS (8387) Monday – Friday between 8 a.m. and 8 p.m. ET.

If enrolled, must I use VA as my exclusive health care provider?

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

I am moving to another state. How do I transfer my care to a new VA health care facility?

If you want to transfer your care from one VA health care facility to another, contact your PACT.  Your PACT will work with the Traveling Veteran Coordinator for assistance in transferring your care and establishing an appointment at the new facility.

How do I choose a preferred facility? How do I change my preferred facility?

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

If the facility you choose cannot provide the health care that you need, VA will make other arrangements for your care based on administrative eligibility and medical necessity.  If you do not choose a preferred facility, VA will choose the facility that is closest to your home. You may change your preferred facility at any time.

Can I cancel my VA health care coverage?

You may request to dis-enroll from VA health care, commonly referred to as cancel/decline, at any time.  To request to be dis-enrolled, you must submit a signed and dated document requesting to be dis-enrolled from VA health care to a VA Medical Center or you may mail the request to:

Health Eligibility Center
Enrollment & Eligibility Division
2957 Clairmont Road, Suite 200
Atlanta, GA 30329-1647

Cancelling your VA health care coverage may impact 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 Form 10-10EZ, “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 facility.  Please note that you will be considered a new applicant and eligibility for enrollment will be based upon eligibility requirements in place at that time.

Where can I find the new income limits?

Because VA income limits may change each year, they are not published in this booklet; however, the income limit tables can be viewed online at http://nationalincomelimits.vaftl.us/.

What is a geographic income limit?

Recognizing the cost of living can vary significantly from one geographic area to another, Congress added income limits based on geographic locations to the existing VA income limits for financial assessment purposes.  Veterans whose income falls between the VA income limit and the geographic income limit for the Veteran’s locale will have their inpatient medical care copayments reduced by 80%.

Geographic income limits can be found at http://nationalincomelimits.vaftl.us.

What happens if at the end of the process my income is verified to be higher than the income limits?

Your copay status will be changed from copay exempt to copay required, which may result in disenrollment due to enrollment restrictions for Veterans whose income exceeds the income limits.  VA facilities involved in your care will be notified of your change in status and to initiate billing for services provided during that income year.  Your enrollment priority status may be changed if your financial status is adjusted by the income verification process.  If your enrollment status is changed, you will be notified by mail.

Does VA have access to my income tax return?

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

I am a recently discharged combat Veteran. Must I pay VA copayments?

Veterans who qualify under this special eligibility are not subject to copays for conditions potentially related to their combat service; however, unless otherwise excused, combat Veterans may be subject to appropriate copay rates for care or services VA determines are unrelated to their military service.

What is a VA service-connected rating, and how do I establish one?

A service-connected rating is an official ruling by VA that your illness or condition is directly related to your active military service. To obtain 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 receive a bill and cannot pay?

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 Programs That Can Help” in Copayments on page 12.

What is the Affordable Care Act?

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.  For more information, see “Coverage Under The Affordable Care Act”on page 14 or visit www.va.gov/health/aca/.

If I am enrolled in VA Health care, do I meet the requirements for health care coverage?

Yes. If you are enrolled in any of VA’s programs below, you have coverage under the standards of the health care law:

  • VA health care program
  • CHAMPVA
  • Spina Bifida Health Care Benefits Program

When do I begin declaring health care coverage to IRS?

U.S. taxpayers need to declare their health coverage on their federal tax forms.

When will VA begin notifying the IRS of a Veteran’s enrollment in the VA health care system?

In 2015, VA began sending the IRS, Veterans and eligible beneficiaries forms that provide details of the health coverage provided by VA. These forms are used for the income tax process.

What if I do not receive this form?

Since 2015, VA has annually sent IRS Form 1095-B to Veterans who were enrolled in the VA health care system at any time 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. until 8 p.m. ET.  This form is for your records only and should not be sent to the IRS or returned to VA.

What is a PACT?

A Patient Aligned Care Team (PACT) includes the Veteran, his or her family or caregivers and a group of health care professionals who work together to plan that individual’s whole-person care and life-long health and wellness.  It focuses on:

  • Partnerships with Veterans
  • Access to care using diverse methods
  • Coordinated care among team members
  • Team-based care with Veterans as the center of their PACT

How does a PACT function?

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 in.  For more information, visit www.patientcare.va.gov/primarycare/PACT.asp.

Am I eligible for dental care?

Dental benefits are provided by the VA according to law. In some instances, VA is authorized to provide extensive dental care, while in other cases, treatment may be limited.  The chart below describes dental eligibility criteria and contains information to assist Veterans in understanding their eligibility for VA dental care.

The eligibility for outpatient dental care is not the same as for most other VA medical benefits and is categorized into classes.  For instance, if you are eligible for VA dental care under Class I, IIC or IV, you are eligible for any necessary dental care to maintain or restore oral health and masticatory function, including repeat care.  Other classes have time and/or service limitations.

If you:You are eligible for: 
Have a service-connected compensable dental disability or condition Any needed dental care. Class I
Are a former prisoner of war Any needed dental care. Class IIC
Have service-connected disabilities rated 100% disabling or are unemployable and paid at the 100% rate due to service-connected conditions Any needed dental care. Veterans paid at the 100% rate based on a temporary rating, such as extended hospitalization for a service- connected disability, convalescence or pre-stabilization are not eligible for comprehensive outpatient dental services based on this temporary rating. Class IV
Apply for dental care within 180 days of discharge or release from a period of active duty (under conditions other than dishonorable) of 90 days or more during the Persian Gulf War era One-time dental care if your DD 214, “Certificate of Release or Discharge from Active Duty,” does not indicate that a complete dental examination and all appropriate dental treatment had been rendered prior to discharge.* Class II
Have a service-connected noncompensable dental condition or disability resulting from combat wounds or service trauma Any dental care necessary to provide and maintain a functioning dentition.  A Dental Trauma Rating (VA Form 10-564-D) or VA Regional Office Rating Decision letter (VA Form 10-7131) identifies the tooth/teeth that are trauma rated. Class IIA
Have a dental condition clinically determined by VA to be associated with and aggravating a service- connected medical condition Dental care to treat the oral conditions that are determined by a VA dental professional to have a direct and material detrimental effect to your service-connected medical condition. Class III
Actively engaged in a 38 USC Chapter 31 Vocational Rehabilitation and Employment Program

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

  • Make possible your entrance into a rehabilitation program
  • Achieve the goals of your vocational rehabilitation program
  • Prevent interruption of your rehabilitation program
  • Hasten the return to a rehabilitation program if you are in interrupted or leave status
  • Hasten the return to a rehabilitation program of a Veteran if you are placed in discontinued status because of illness, injury or a dental condition, or
  • Secure and adjust to employment during the period of employment assistance, or enable you to achieve maximum independence in daily living.
Class V
Receive VA care or are scheduled for inpatient care and require dental care for a condition complicating a medical condition currently under treatment Dental care to treat the oral conditions that are determined by a VA dental professional to complicate your medical condition currently under treatment. Class VI
An enrolled Veteran who is homeless and receiving care under VHA Directive 2007039 A one-time course of dental care that is determined medically necessary to relieve pain, assist you to gain employment or treat moderate, severe or complicated and severe gingival and periodontal conditions. Class IIB

*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 address acute pain or a dental condition which is determined to be endangering life or health.

*Note:  Public Law 83, enacted June 16,  1955, amended Veterans’ eligibility for outpatient dental services. As a result, any Veteran who received a dental award letter from the Veteran Benefits Administration (VBA) dated before 1955, in which VBA determined the dental conditions to be non-compensable, is no longer eligible for Class II outpatient dental treatment.

Veterans receiving hospital, nursing home or domiciliary care will be provided dental services that are professionally determined by a VA dentist, in consultation with the referring physician, to be essential to the management of the patient’s medical condition under active treatment.

For more information about eligibility for VA medical and dental benefits, call toll-free 1-877-222-VETS (8387) or visit www.va.gov/healthbenefits.

What is Community Care?

Community care is when the Veteran’s VA care team determines the Veteran should be referred to a community provider and VA would pay for the cost of that care because:

  • Demand exceeds the VA health care facility capacity
  • There is a need for diagnostic support services for VA clinicians
  • Specialty care services are scarce such as obstetrics, hyperbaric, burn care, oncology and/or when VA resources are not available due to constraints such as staffing, equipment, space
  • It is cost-effective for VA
  • Meets patient wait time requirements

Do I qualify for routine health care at community facilities at VA expense?

To qualify for routine health care at community facilities at VA’s expense, you must first be given a written referral.  Included among the factors in determining whether such care will be authorized is your medical condition and the availability of VA services within your geographic area.  VA copayments may be applicable.

Are there any payment limitations for community emergency care?

Claims must be timely filed for community emergency care not authorized by VA in advance of services being furnished.  Because timely filing requirements differ by type of claim, you should contact the nearest VA medical facility as soon as possible to avoid payment denial for an untimely filed claim.  (See “Emergency Care” on page 22 for specific rules.)

Payment may not be approved for any period beyond the point of stability, except when VA cannot accommodate transfer of the Veteran to a VA or other federal facility.  An emergency is deemed 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 continuation of treatment.

What type of emergency care can VA authorize in advance?

Subject to eligibility and payment limitations described in “Emergency Care” on page 22, VA may preauthorize and issue payment for community emergency care when treatment is needed for:Inpatient CareOutpatient Care
The Veteran’s VA-rated service-connected disability, or for a nonservice condition that is associated with and aggravating the Veteran’s service-connected condition

Yes

Yes

A disability for which the Veteran was released from active duty

Yes

Yes

Any condition of a Veteran who is rated by VA as permanently and totally disabled due to a service-connected disability

Yes

Yes

Any condition of a Veteran who is rated by VA as permanently and totally disabled due to a service-connected disability Any condition of a Veteran who is an active participant in the VA Chapter 31 Vocational Rehabilitation and Employment Program and who needs treatment that is medically determined to make possible the Veteran’s entrance into a course of training or prevent interruption of a course of training that was interrupted due to such illness, injury or dental condition

Yes

Yes

Any condition for a Veteran who has a VA service-connected disability rating of 50% or greater. (Note: A service-connected disability rated at 50 percent or more is for one disability, not as a result of combining multiple disabilities.)

No

Yes

A condition for which the Veteran has been furnished VA hospital care, nursing home, domiciliary care or medical services and who requires medical services to complete treatment incident to such care or services

No

Yes

Any condition of a Veteran who is in receipt of increased VA pension, additional VA compensation or allowances based on the need for regular aid and attendance or by reason of being permanently housebound

No

Yes

A condition requiring emergency care that developed while the Veteran was receiving medical services in a VA facility or contract nursing home or during VA authorized travel

Yes

Yes

Any condition that will prevent the need for hospital admission for a Veteran in the state of Alaska or Hawaii and U.S. Territories, excluding Puerto Rico

Yes

Yes

Any condition for women Veterans

Yes

No

Any dental services, treatment and related dental appliances for Veterans who are former prisoners of war

No

Yes

Hospital care or medical services while in authorized travel status

Yes

Yes

For any disability of a Veteran receiving VA contract nursing home care, and in need of emergency treatment

Yes

Yes

Can VA pay for non-VA emergency care that is not preauthorized?

VA has limited payment authority when emergency care at a non-VA facility is provided without authorization by VA in advance of services being furnished or when notification to VA is not made within 72 hours of admission.  VA may pay for unauthorized emergency care as indicated below.  Since payment may be limited to the point your condition is stable for transfer to a VA facility, the nearest VA medical facility should be contacted as soon as possible for all care not authorized by VA in advance of the services being furnished.

For service-connectedFor nonservice-connected conditions

The Veteran’s VA rated service-connected disability or for a nonservice-connected condition that is associated with and aggravating the Veteran’s service-connected condition

If a nonservice-connected condition is associated with and held to be aggravating your service-connected condition.
The treatment is to make possible your entrance into a training course or to prevent interruption of a training course, if you are an active participant in the 38 U.S.C. Chapter 31 Vocational Rehabilitation and Employment Program.

If you are rated as having a total disability permanent in nature resulting from your service-connected disability.

A VA facility was not considered feasibly available when the urgency of the Veteran’s medical condition, the relative distance of the travel involved or the nature of the treatment required makes it necessary or economically advisable to use public or private facilities

The Veteran is enrolled in the VHA health care system and received VA medical care within a 24-month period preceding the furnishing of the emergency treatment

Any condition of a Veteran who is rated by VA as permanently and totally disabled due to a service- connected disability

The Veteran is personally liable to the health care provider for the emergency treatment that meets the prudent layperson definition of an emergency

Any condition of a Veteran who is an active participant in the VA Chapter 31 Vocational Rehabilitation and Employment Program, who needs treatment medically determined to make possible the Veteran’s entrance into a course of training or to prevent interruption of a course of training that was interrupted due to such illness, injury or dental condition

The Veteran has no other contractual or legal recourse against a third party that would, in whole, extinguish the Veteran’s liability.  The claim must be filed within 90 days from the date of discharge or the date the Veteran exhausted without success any actions to obtain payment from a third party

For 38 U.S.C. § 1728 a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health 

For 38 U.S.C. 1703, a clinical emergency existed that poses a serious threat to the life or health of a veteran receiving hospital care or medical services

A prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health

Once authorization for care is granted by VA, the authorization will be continued after admission only for the period of time required to stabilize or improve the patient’s condition to the extent that further care is no longer required to satisfy the purpose it was initiated

Once authorization for care is granted by VA, the authorization will be continued after admission or only for the period of time required to stabilize or improve the patient’s condition to the extent that further care is no longer required to satisfy the purpose it was initiated

 

Treatment was provided in a hospital emergency room

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 “Medically Related Travel Benefits” on page 27), 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?

Unlike the information collected from the financial assessment, which is based on your previous year’s income, the 10-10EC is designed to assess your current financial status, including current expenses.  This in-depth analysis provides the necessary monthly income/expense information to determine whether you qualify for free, long-term care or a significant reduction from the maximum copay charge.

Once I submit a completed VA Form 10-10EC, 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 copayment charges.

Assuming I qualify for nursing home care, how is it determined whether the care will be provided in a VA facility or a private nursing home at VA expense?

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

If you do not qualify for indefinite care, you may be placed in a community nursing home, generally not to exceed six months, following an episode of VA care. The purpose of this short-term placement is to provide assistance to you and your family while alternative, long-term arrangements are explored.

For Veterans who do not qualify for indefinite VA Community Living Center care at VA expense, what assistance is available for making alternative arrangements?

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

What does the new VHIC provide that the old ID card did not?

  • Increased security for your personal information – no personally identifiable information is contained on the magnetic stripe or barcode.
  • A salute to your military service – the emblem of your latest branch of service is displayed on your card. Several special awards will also be listed.

What document(s) do I need to prove my identity to receive a VHIC?

Primary Identification
Present ONE form of Primary Identification (Unexpired)
Driver’s license
U.S. Passport or U.S. Passport Card
Other Government ID*

* The "Other Government ID" card can be issued by federal, state or local government agencies provided it contains a photograph, name, Date of Birth, address.  If address is not on the proofing document, Veteran can provide separate documentation that contains address in order to confirm the address information in the proofing Task.  Acceptable address documents include the following:

  • Electric bill
  • Cable bill
  • Other mailing document
  • Voters Registration card

What do I do if my VHIC is lost or stolen?

If your VHIC is lost or stolen, contact your local VA medical facility where you receive your care to request a new card be re-issued or call 1-877-222-VETS (8387).  You will need to provide the proper identification during the call.  If you request a replacement VHIC, your previous card will be deactivated.