Understanding Your Access to Care with the Department of Veterans…

Veterans are eligible to receive healthcare services through the VA, but the degree of coverage varies between individuals.

The Department of Veteran Affairs (VA) offers healthcare services to all those who served in the military, naval, and air forces. These benefits, however, are not automatically given.

In order to have access to these services, you need to enroll. Additionally, coverage through the VA may vary depending on your health status and pre-existing healthcare coverage.

Because of the complexities in the VA enrollment process, seeking coverage can feel overwhelming. This article breaks down coverage eligibility requirements, benefits, and how to enroll so that you can make the most informed choices with your enrollment.

Who qualifies for VA care?

To be eligible for healthcare benefits from the VA, you must have served in the active military, naval, or air service without receiving a dishonorable discharge. Reservists and members of the National Guard will also qualify if they were called to active duty and completed the full period of duty. Those who were just on active duty for training won’t qualify.

You can view all the requirements for VA healthcare eligibility here.

All enrolled Veterans will receive coverage for primary care, specialty care, diagnostics, and preventive care services. Some Veterans will qualify for additional benefits. When you enroll, you’ll be assigned to a priority group. This is to ensure that Veterans with the most pressing need for care can get in quickly.

Your medical benefits package will be unique to you. Your benefits list will depend on:

your priority group

the care your VA primary care doctor determines you need

the medical standards for treating your health conditions

Sharing your household income on your application is optional, but it may help you qualify for additional benefits.

How the 2020 PACT Act expanded benefits

If you were exposed to burn pits, Agent Orange, or other toxins while serving and have chronic health conditions as a result, you may be eligible for expanded benefits.

The PACT Act expands the list of health conditions presumed to be caused by exposure to toxins. The list now includes several forms of cancer, emphysema, chronic rhinitis, and asthma.

If you have been treated for conditions now presumed to be caused by exposure, you can file a claim or re-file a claim. The VA will review all claims, even if they were previously denied.

What services does the VA cover?

Veterans of the U.S. armed forces are eligible to receive healthcare services from the nation’s 1,321 healthcare facilities. VA health benefits include primary, specialty, and mental health care.

Basic healthcare services

Your VA benefits cover the basics of physical and mental health care. That means you’ll have coverage for preventive care checkups and care from specialists, such as cardiologists, gynecologists, and mental health therapists.

Your benefits also cover:

prescription medications

medical equipment and prosthetic devices

home health services

elder care

health education, including nutrition

vaccines, like those for COVID-19 or the flu

counseling on genetic diseases

inpatient care, like surgeries, kidney dialysis, and treatment for illness or injury

Note: You might have a copay for some services. A copay is the amount you pay out of pocket when you receive care.

Advocating for yourself in the doctor’s office

You’re an expert on your own body, so if you feel like something isn’t right or your doctor isn’t giving you the care you need, you should advocate for yourself. To do this:

Start by talking with the doctor about your concerns.

If you still aren’t getting what you need, ask to speak with the chief of the service. So, if you’re seeing a cardiologist, ask for the chief of cardiology.

Your next step is to see a patient advocate. This is someone trained to assist you and help you find a resolution.

Urgent and emergency care services

When the unexpected happens, VA benefits cover care for urgent or emergency services. Here’s what you need to know about coverage.

Urgent care is for illnesses and injuries that require same-day treatment but are not life threatening. That includes illnesses such as sore throats and ear infections or minor injuries like sprained ankles.

To get the most out of your benefits, choose an in-network urgent care location. Urgent care is available at some VA health facilities, but you can also search for urgent care locations that are in the VA network.

For more serious illnesses and injuries that threaten your life or health, call 911 or go to an emergency room. Signs you need emergency care include:

chest pain

pregnancy complications, such as vaginal bleeding

severe cuts and burns

difficulty breathing

head injuries

severe dizziness, slurred speech, and confusion

attempts to hurt yourself or someone else

For your VA benefits to cover emergency care outside of a VA hospital, you must go to an emergency room. Urgent care facilities won’t necessarily be covered. Also, make sure you report your care to the VA within 72 hours.

Other health services

Depending on your plan and your needs, you may also receive benefits for:

blood work, X-rays, ultrasounds, and other tests used for diagnosis

therapy and rehabilitation services (this could include physical therapy, vision rehab, and therapy for traumatic brain injury)

medical equipment, like prosthetics

care for hearing loss

What is the VA Community Care Network?

When care is not available through VA locations, Veterans can use the VA Community Care Network. Healthcare professionals in the Community Care Network help the VA deliver on its mission to get Veterans the care they need, quickly.

Who is eligible?

Veterans must be enrolled with VA Care to use VA Community Care. You need to get approval from the VA to use the Community Care Network. It’s usually granted if the care isn’t something the VA can provide (or provide in a reasonable amount of time) or you live a long distance from a VA center that offers the service.

The cost of Community Care is covered the same as if you received care at a VA center.

Free VA health services

All Veterans get some services covered in full, meaning there’s no copayment. Free services include:

treatment of illness or injuries that the VA determines to be related to military service

counseling to help with readjustment, issues related to military sexual trauma, and mental health

programs for smoking cessation and weight loss

exams for health problems linked to military service

care for a disability obtained during service

cancer care for head or neck cancers from military-provided radium treatments

electrocardiograms that check for heart problems

lab tests

registry health exams

compensation and pension exams

A note for Veterans on Medicaid

If you qualify for Medicaid in your state, you should also qualify for priority group 5 for your VA health benefits. You might qualify for a higher priority group and disability compensation if you also have a service-related disability.

You can have both Medicaid and VA benefits at the same time.

More on Medicaid eligibility

Medicaid is a program that provides healthcare coverage to people who qualify based on income or health condition. Eligibility varies by state. Contact your state’s Medicaid enrollment office for more information.

You can enroll in Medicaid anytime you qualify. There’s no annual enrollment period.

Where can Veterans apply?

If you’re a Veteran, you can apply for VA healthcare online anytime. If you prefer paper, you can also print the application and mail it.

To apply in person, find a VA Medical Center location near you. Your state’s Department of Veterans Affairs can also help. You can find your state’s department here.

Takeaway

Those who served in the U.S. armed forces are eligible for healthcare services, and the VA continues to expand eligibility for coverage. The process of enrollment, however, remains just as complex. Thankfully, free enrollment help is available. You can call the VA benefits hotline at 877-222-8387 for assistance. Hours are Monday through Friday, 8 a.m. to 8 p.m. ET.

Additionally, you can contact an accredited representative who can help with the application process.

Posted : 2024-08-29 10:50

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