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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Summary

The Department of Veterans Affairs (VA) operates over 1,700 hospitals and out-patient clinics which can be an excellent source of low-cost or free medical care for veterans as well as certain dependents and survivors of veterans. Surveys generally show that the system has a higher customer satisfaction rating than the private sector, as well as a higher quality of care and lower mortality rates.

To be eligible for medical benefits, a veteran's medical condition must be:

  • Service related OR 
  • If the medical condition is not service related, the veteran must meet income and asset requirements for free care.

If eligible for both VA and Tricare, veterans are allowed to use both. Likewise, veterans aged 65 years or older are eligible for Medicare and can enroll in both..

Veterans are required to enroll before seeking treatment. (Enrollment is not required prior to receiving service-connected treatment.)

  • The VA health plan covers a wide range of treatments.
  • Health care is provided on a priority list due to limited funding.
  • The VA drug benefit is the cheapest way to purchase drugs.
  • There is no premium charged for VA health care. Only a deductible and co-pays.
  • VA health coverage coordinates with private health insurance and Medicare.
  • Travel for VA care may be reimbursed, or provided by the Disabled American Veterans (www.DAV.org offsite link)

Incarcerated veterans are eligible for VA medical care at VA hospitals and clinics.

Active duty, guard and reserve members, and retirees, as well as their families, are eligible for TRICARE (formerly known as CHAMPUS), basically supplemental health insurance. Family members who are not eligible for Tricare may be eligible for a similar program: Civilian Health and Medical Program of the Department of Veterans Affairs, known as CHAMPVA.

NOTE:

  • If emergency care is needed, all emergency rooms must treat emergency situations without regard to ability to pay. (To learn how to maximize time in an emergency room, click here.) 
  • If the VA is not able to provide the care you need, see: Uninsured: How To Obtain The Medical Care You Need
  • Also keep in mind that all federally funded hospitals must provide a certain amount of free or low cost care because of the Hill-Burton Act. For information, including questions to ask, click hereIn addition, there may be funds available from private donations to pay for care. Ask the finance department of the hospitals in your local or nearby areas.

To Learn More

More Information

Health Insurance: Tricare

What Will VA Health Care Cost Me?

There are no premiums for the VA health plan.

For service-connected treatment there is no cost.

Veterans whose incomes and net worth are above the means test, are 0% service-connected disabled and require treatment for a nonservice-connected condition, may be assessed co-pays in 2013 of:

  • Medication: $8 for each 30 day or less supply of medication. For more information, see: VA Drug Benefit
  • Outpatient: $15 for each visit for basic care services provided by a primary care clinician; $50 for each visit for specialty care services provided by a clinical specialist.
  • Inpatient: Rates vary per priority group. For information, click here offsite link.

Veterans may request a waiver of co-pays owed, as well as a hardship determination. If the hardship determination is approved, any prior co-pay and deductible debt and future co-pays and deductibles are waived.

Health Care Is Provided On A Priority List Due To Limited Funding

Due to limited funding, the VA maintains a priority list. Upon enrolling in the system you will be assigned a priority and access to care will be based on that number and overall availability. The priorities, in order, are:

  • First priority is for emergencies and for patients who have already begun treatment at a particular facility.
  • Second priority is for people needing treatment for service-connected conditions.
  • Third is for patients who are receiving or who are eligible to receive, VA disability benefits and who need treatment for non-service-connected conditions.

The remaining capacity for care is usually filled by veterans and their dependents and survivors who are age 65, receiving a VA pension and who are unable to afford the care elsewhere. 

What The VA Health Plan Covers

Chiropractic care: Available at limited locations. To learn more, call: 800.827.1000
Drugs, Biologicals, and Medical Devices approved by the Food and Drug Administration (FDA) as medically required and prescribed or approved by a VA physician.
Elective Sterilization: The Department of Veterans Affairs will provide elective sterilization, e.g. vasectomy or tubal ligation procedure, to eligible veterans as part of contraceptive services.
Emergency Care: Urgent and limited emergency care services in VA health facilities
Home Care: VA operates the Home Based Primary Care (HBPC) Program, formally called Hospital Based Home Care, which is governed by clinical admission standards.
Hospice Care in a hospice facility or through a home hospice agency.
Hospital Care in a VA or other federal facility
Outpatient Care: Treatment in the outpatient department or clinic run by the VA including treatment by a physician, diagnostic tests and X-rays.
Maternity Benefits: Maternity benefits are included in the benefits package for women veterans who are enrolled in the VA Health Care System. Maternity benefits begin with the confirmation of pregnancy and continue through the post-partum visit, usually at 6 weeks after the delivery. The Department of Veterans Affairs has no authority to provide care to the newborn infant of the veteran.
Medical and Surgical Care: If medically necessary, as determined by VA.
Mental Health Care: If medically necessary, as determined by VA.
Palliative Care: Care that is provided strictly to relieve pain and provide comfort to the patient with no attempt at a cure. Palliative Care is the only care provided to people in a hospice program. (To learn more, see: Hospice.)
Preventive Care and Services. For instance, mammographies. To learn more, call the Mammography Hotline: 888.492.7844
Prosthetics and Orthotics: Covers the usual and customary orthotic and prosthetic services provided to inpatients and outpatients.
Rehabilitation Care and Services
Respite Care for caregivers
Substance Abuse Services: If medically necessary, as determined by VA

Certain Treatments May Be Covered If Requirements Set By The VA Are Met

  • Adult Day Health Care
  • Dental Care
  • Domiciliary Care
  • Emergency Care in Non-VA Facilities
  • Homeless Programs
  • Non-VA Care
  • Nursing Home Care (including a system of VA nursing homes)
  • Readjustment Counseling Service (Vet Centers)
  • Sensori-Neural Aids (eyeglasses, contact lenses, hearing aids)
  • Sexual Trauma Counseling

Certain Treatments Are Not Covered By The VA Health Plan

Abortions and Abortion Counseling

Drugs, Biologicals, and Medical Devices not approved by the Food and Drug Administration (FDA), unless:

  • The treating medical facility is conducting formal clinical trials under an Investigational Device Exemption (IDE), or an Investigational New Drug (IND) application, or
  • The drugs or medical devices are prescribed under a compassionate use exemption.

Gender Alterations

Membership in Health Clubs and Spas

Private Duty Nursing  

The VA Drug Benefit

The VA Health Plan can be a good source of medications for eligible veterans. Getting drugs through the VA involves registering with the agency and being seen by a VA doctor. The VA will not fill prescriptions that were issued by a private physician - only those prescribed by VA physicians are covered.

Like most insurers, the VA uses only certain brand-name medications to help hold down costs.

The VA won't automatically provide prescriptions for the same medicines a private doctor has prescribed. The choice is up to the VA doctor.

Unlike most insurers, the VA provides coverage for over-the-counter medicines. It also offers refills through the VA mail order system.
However, there are some downsides to the VA benefit.

  • There is no drug coverage for spouses and dependents.
  • The co-payment can be significantly more than an HMO charges.
  • Many seniors use the VA to complement their Medicare coverage. Because of this, each patient might be under the care of two doctors. If care is not coordinated, patients could end up taking too many drugs or ones that don't mix well. 

What If I Have Other Insurance?

Coverage From An Insurance Company

If you have private health insurance either directly or through a group plan, and use the VA Health Plan, VA will bill the private insurance company for payment. You will never pay more than the co-payments described above.

Medicare

If you have Medicare, you may choose to use either Medicare or VA, based on whether you use a VA or a non-VA facility.

VA is prohibited from billing Medicare for services that VA provides.

Tricare
TRICARE is a regionally managed health care program for Active Duty, Activated Guard and Reserves, Retired members of the uniformed services, their families, and survivors.
TRICARE supplements military resources with networks of civilian health care professionals.
Active Duty and Guard and Reserve service members are automatically enrolled in Tricare Prime. However military dependents and retirees must choose the Tricare option that best suits their needs.

CHAMPVA
As summarized by the VA: CHAMPVA is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by Health Administration Center.

CHAMPVA is a Department of Veterans Affairs program whereas TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. In some cases a veterans may look to be eligible for both/either program on paper. However, if you are a military retiree, or the spouse of a veteran who was killed in action, you are and will always be a TRICARE beneficiary, you can't choose between the two. 

How Do I Get More Information About Veterans Health Care?

For Veterans benefits, go to the VA's MyHealtheVet offsite link or call VA Health Benefits: 877.222.VETS (8387)

For information about TRICARE, go to: www.tricare.mil offsite link or call 800.538.9552.

For more information about CHAMPVA, see: http://www.va.gov/hac/forbeneficiaries/champva/champva.asp offsite link or call 877.222.8387.