VA Health

VI. Key Issues: Financing and Delivery >> D . Health Insurance Coverage >> Public Health Insurance >> Military Health Care >> VA Health (Last updated 7.6.16)

Topic Outline

1 Key Questions
2 VA Health Reform
3 Analysis
4 Links

Key Questions

What is the VA Health System?

VA operates the nation’s largest integrated health care system with more than 1,400 sites of care, including hospitals, community clinics, community living centers, domiciliaries, readjustment counseling centers, and various other facilities.

Who is Eligible for VA Health Benefits?

Eligibility. A person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable may qualify for VA health care benefits. Reservists and National Guard members may also qualify for VA health care benefits if they were called to active duty (other than for training only) by a Federal order and completed the full period for which they were called or ordered to active duty.

Income Eligibility. Most veterans not receiving VA disability compensation or pension payments must provide information on their gross annual household income and net worth to determine whether they are below the annually adjusted geographic financial thresholds to obtain free VA health care and a companion medical expense deduction even if they have no service-connected disability; a lower threshold is used for eligibility for free medications and medical travel expenses.
Health Insurance Coverage. Whether a veteran has or does not have insurance plays no role in determining whether that individual is eligible for VA health care benefits.

Enrollment. For most veterans, entry into the VA health care system begins by applying for enrollment using VA Form 10-10EZ, Application for Health Benefits, which may be obtained from any VA health care facility or regional benefits office, on line or by calling 1-877-222-VETS (8387).

Selected categories are exempt from enrollment.
Applications are processed no later than 7 business days from receipt of a signed application. The VA’s Health Eligibility Center sends a letter–generally within 7 to 14 days–with information about the individual’s enrollment priority group assignment and instructions to contact the local VA health care facility for an appointment. This letter provides instructions on how to appeal a decision denying eligibility.
Once enrolled, veterans can receive health care at VA health care facilities anywhere in the country.

Priority Groups. During enrollment, each veteran is assigned to one of 8 priority groups. VA uses these groups to balance demand for VA health care enrollment with resources. Changes in available resources may reduce the number of priority groups VA can enroll. This geographically contingent nature of VA health benefits is why they are not viewed as the equivalent of health insurance coverage. Veterans who are 50 percent or more disabled from service-connected conditions, unemployable due to service-connected conditions, or receiving care for a service-connected disability receive priority in scheduling of hospital or outpatient medical appointments.

What Benefits Does VA Health Provide?

VA’s medical benefits package provides a wide range of standard benefits to all enrolled veterans, including:

Preventive care services
Outpatient diagnostic and treatment services
Hospital inpatient diagnostic and treatment services
Medications and supplies
- Medications generally must be prescribed by a VA provider and be available under VA’s national formulary system.
- Prescriptions written by non-VA doctors will not normally be filled or re-written by the VA except for veterans with special eligibility.

In addition, VA health a variety of other benefits whose availability may depend on facility or eligibility category, including:

Medical travel
Hearing aids and eyeglasses to limited classes of veterans
Services to blind veterans
Cash payments for home improvements necessary for the continuation of treatment or for disability access to the home and essential lavatory and sanitary facilities
Domiciliary care (rehabilitative and long-term, health-care) for veterans who require minimal medical care but do not need the skilled nursing services provided in community living centers
Domiciliary care (rehabilitative care) for veterans who are homeless
Outpatient dental treatment, including a full spectrum of diagnostic, surgical, restorative and preventive procedures
Reimbursement or payment for medical care provided to certain enrolled or otherwise eligible veterans by non-VA facilities only in cases of medical emergencies where VA or other federal facilities were not feasibly available.
VA also provides nursing home services to veterans through three national programs: VA owned and operated Community Living Centers (CLC), state veterans’ homes owned and operated by the states, and the contract community nursing home program. Each program has admission and eligibility criteria specific to the program.

The following health benefits and services are not covered by VA:

Abortions and abortion counseling;
In vitro fertilization;
Drugs, biological, and medical devices not approved by the Food and Drug Administration 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, biologicals, or medical devices are prescribed under a compassionate use exemption;
Gender Alterations;
Hospital and outpatient care for a veteran who is either a patient or inmate in an institution of another government agency if that agency has a duty to give the care or services;
Membership in spas and health clubs

Do Veterans Have to Pay for VA Health Services?

Some veterans must make copays to receive VA health care and/or medications, the amounts depending on service and priority group. As well, VA is required to bill private health insurance providers for medical care, supplies and prescriptions provided for treatment of veterans’ non-service-connected conditions. Generally, VA by law cannot bill Medicare, but can bill Medicare supplemental health insurance for covered services.

VA Health Reform

Analysis

VA Office of Inspector General. Veterans Health Administration – Interim Report. Review of Patient Wait Times, Scheduling Practices, and Alleged Patient Deaths at the Phoenix Health Care System (5.28.14). “The issues identified in current allegations are not new. Since 2005, the VA Office of Inspector General (OIG) has issued 18 reports that identified, at both the national and local levels, deficiencies in scheduling resulting in lengthy waiting times and the negative impact on patient care. As required by the Inspector General Act of 1978, each of the reports listed was issued to the VA Secretary and the Congress and is publicly available on the VA OIG website. “
CNN Timeline. This documents troubles in the VA health system dating back to 1921.
Hsieh, Paul. Three Factors That Corrupted VA Health Care And Threaten The Rest of American Medicine. Forbes.com (5.30.14). Drawing on a New York Times article, the author summarized the three factors as: 1) doctor shortage; 2) perverse incentives; and 3) culture of dishonesty.
The Veterans Administration is a Socialized Healthcare System (WasteWatcher, June 2014)
Fatally Long Waits and Red Tape (WasteWatcher, June 2014).