The Health of Congressional Veteran Spending
With the media’s representation of the Vietnam War and exposure of human atrocities, military and more importantly, military veterans were not as highly regarded in the states as they were during previous wars. At the same time, the Department of Veterans Affairs (VA) healthcare system was earning the same ill reputation as Congress greatly reduced the healthcare benefits afforded to those who served our country. The VA medical system took a big financial blow as did those who fought for our freedom to make that financial blow.
Three decades later, the VA is responsible for the operation of the largest healthcare system in the country which treats upwards of 5.3 million patients annually. Two thirds of practicing physicians around the country have completed some portion of their training at a VA medical center. In 2007, VA medical centers trained 90,000 healthcare professionals. Now, 88% of employees for the VA system work in medical centers, making this system the largest benefit program available to our soldiers.
One of the most widely underplayed aspects of the VA medical system is that it treats more than just injuries sustained in the line of duty. In fact, all veterans are eligible for medical care under the VA criteria I outline.
Opening Up the Medical Benefits Package
Before now, the VA Medical system was reactive, only taking action when something was broken. In 1996, Congress passed the Veterans’ Health Care Eligibility Reform Act of 1996 which was responsible for creating a Medical Benefits Package—the standard health care package for all veterans. The new system was proactive, trying to keep anything from breaking.
Under this legislation, once veterans enroll they can receive healthcare at any of the acting 155 VA medical centers—or hospitals—as well as the 881 outpatient clinics around the states and U.S. territories. There is a full list of these available centers in Appendix B.
There are now over 16,000 physicians alongside 62,000 nurses who are employed at these VA medical centers and outpatient clinics.
Upon enrollment you will be assigned to the medical center closest to you. This becomes your primary healthcare provider from whom you receive the majority of your medical care. However, this does not mean all of your healthcare must be administered here. If the facility to which you are assigned does not meet your needs within a reasonable time period you can obtain a referral to another facility which is better equipped to meet your healthcare needs.
You can also utilize these healthcare benefits while you travel. If you are spending time away from the primary care facility to which you were assigned you can get care from any of the other VA medical centers around the states without reapplying.
The following sections give information on eligibility, requirements, emergency care, medications, and co-pays:
- What’s Covered?
- Determining Eligibility For VA Care
- Medication and Co-Pays
- VA Extended Care Programs
Disclosing Other Healthcare Coverage
If you have other healthcare insurance, the VA is required to bill your private health insurance provider for medical care, supplies and prescriptions provided for treatment of non-service-connected conditions. This includes your spouse’s healthcare insurance, if you are covered under it. When you apply for VA medical care, you are required to state if you have other healthcare insurance, including coverage through a spouse’s policy.
The VA can’t bill Medicare in most cases, but it can bill Medicare supplemental health insurance for covered services.
The Ins And Outs of VA Income Limits
The VA uses two financial means to determine veteran placement into Groups 7 and 8. You’re eligible for placement in Group 7 if your income is above the VA’s national income limit but below the geographical income threshold; if it’s above both standards, you can be placed in Group 8.
National Income Limits
The national income limits measure your household income and total assets against the national mean. The maximum household income limits also affect whether you receive free VA medical care or are subject to co-pays. Income is defined as all gross household income – money earned by you, your spouse, and any kids who live at home. This including Social Security, retirement pay, unemployment insurance, interest and dividends, workers’ compensation, black lung benefits, and any other miscellaneous household income.
Besides meeting certain income levels, your net worth must be $80,000 or less. Net worth includes assets such as the market value of property (excluding your primary residence), stocks, bonds, notes, individual retirement accounts, bank deposits, savings accounts, and cash. The VA also compares your financial assessments with geographically based income thresholds. If your income is above the VA national means test but below the geographic income threshold, you qualify to be placed in Group 7. Members of Group 7 receive a 20 percent reduction in inpatient co-pay rates.
Keep in mind that the rates used by the VA to determine eligibility and priority can change. For the latest rates, see www.va.gov/healtheligibility/Library/pubs/VAIncomeThresholds/VAIncomeThresholds.pdf.
Be Prudent With Your Policy Decisions
Once again, canceling a private health insurance policy that you already have in order to take advantage of the VA healthcare system is unwise. Members of your family who are covered under a private insurance plan won’t be covered by the VA. Also, there’s no guarantee that in the future Congress will fund the VA sufficiently to provide care for all enrollment priority groups. Should that happen while you’re enrolled in one of the lower priority groups, you may be left without healthcare coverage.
The geographic rates depend on where you live.
You can look up the latest limits online at www.va.gov/healtheligibility/Library/pubs/GMTIncomeThresholds.