08 Sep Medical Benefits
In the three decades following the Vietnamese War, after dissatisfaction with the VA medical system being underfunded, the VA developed a larger, more efficient healthcare system in the United States. The VA medical system takes care of around 5.3 million patients a year with about two-thirds of physicians practicing in the U.S. getting their medical training at VA medical centers.
In fact, the VA trained more than 90,000 healthcare professionals in 2007, with 88 percent of VA employees working at VA medical centers.
In the following sections, an outline is provided for those who are eligible for VA medical care, including those that have sustained a medical condition during medical service. However it is important to note that this is not the only criteria that exists in order to be applicable for such medical care.
Medical Benefits Package
A new criteria inducted by Congress in 1996 improved healthcare benefits called the Veterans’ Health Care Eligibility Reform Act of 1996. This new paradigm promoted by the Veteran’s Health Care Eligibility Reform Act focused more on preventative measure to help upkeep long-term health and lower medical costs.
If eligible for medical benefits veterans have the convenience of receiving care at 155 VA medical centers and 881 outpatient clinics in the United States that employ over 16,000 physicians and 62,000 nurses.
Veterans are directed a VA medical center or outpatient center in proximity to where they live after enrolling in the program (more information in the section “Making a case for VA medical care”) that functions as their primary provider of healthcare. However, if the facility can’t provide timely care, they refer patients to alternative facilities that are able to provide care more expediently.
VA healthcare benefits are also available to you when traveling, which can be good for individuals who spend a lot of time in transit or away from their local VA medical center. Treatment is possible at any VA healthcare facility in the U.S. without having to reapply. Read more in the “VA Medical Care Eligibility and Enrollment” section further on.
Preventative care is underlined with the VA Medical Benefits Package with full range outpatient and inpatient services:
- Outpatient and inpatient medical, surgical, and metal healthcare, which also applies to those treated for substance abuse
- Over-the-counter and prescription drugs, medical and surgical supplies, with prescription from a VA physician
- Physical examinations, healthcare assessments, and screening tests
- Health education programs
- Emergency care in VA facilities
- Dental care (if eligible)
- Bereavement counseling
- Detailed rehabilitative services outside of vocational services mentioned in Chapter 11
- Consultation, counseling, training, and mental health services for the veteran’s immediate family members or legal guardian
- Medical equipment and prosthetic and orthotic devices including eyeglasses and hearing aids for those applicable
- Reconstructive surgery needed as a condition of a disease or trauma, which doesn’t include cosmetic surgery medically unnecessary
- Respite, hospice, and palliative care
- Pregnancy and delivery service to the capacity authorized by law (the VA can give services to a pregnant veteran up to delivery but can’t give free care to the child and the care provided after birth will be paid back to the VA by the veteran)
What’s not covered
The VA, by law, is prohibited from providing the following services:
- Abortions and abortion counseling
- Cosmetic surgery with the exception that it is deemed medically necessary by the VA during reconstructive surgery or psychiatric treatment
- Drugs, biologicals, and medical devices that are not permitted by the FDA unless the medical facility treating the veteran is conducting formal clinical trials
- Gender alteration
- Health club or spa membership
- In vitro fertilization
- Care not ordered and provided by licensed or accredited professionals
- Special private-duty nursing
- Hospital and outpatient care for a veteran who is a patient or inmate in an institution under the control of another government agency that is required by law to provide medical services
- Emergency care in facilities other than VA medical centers unless the veteran meets the criteria explained in “Emergency care in non-VA facilities” later in this chapter.
Military sexual trauma counseling
Veterans looking for counseling and treatment in defeating psychological disturbance brought on by sexual trauma during military service can visit VA vet centers. Related services are also provided at these centers.
Additionally, veterans are not required to enroll in the VA healthcare program in order to obtain these services. Veterans can be given care free of charge for conditions related to sexual trauma in the military.
Bereavement counseling is applicable for veterans—and their families—who are eligible and enrolled in the VA healthcare program. This kind of counseling is also available to parents, spouses, and children of armed forces personnel who have died during their service to their country, as well as to family members of Reservists and National Guardsmen who have died in the line of duty.
In order to receive bereavement counseling, veterans can visit VA healthcare facilities and VA vet centers located nearest to them.
Assistance for blind veterans
Some blind veterans, granted they are eligible, could be entitled to added healthcare benefits or admission to a VA blind rehabilitation center or clinic. Some services for blind veterans are:
- Total health and benefits review by a VA visual impairment services team
- Adjustment-to-blindness training
- Structural altercations to homes or home improvements
- Provided housing that has been specially adapted
- Low-vision aids their training
- Electronic and mechanical aids such as adaptive computers and computer-assisted devices that include reading machines and electronic travel aids
- Guide dogs (including the expense of training and the dog’s medical care)
- Talking books, tapes, and Braille literature
Prosthetics and adaptive automobiles
Those eligible and enrolled in the VA medical care program can receive VA prosthetic appliances, equipment, and devices. Some of these services include artificial limbs, orthopedic braces and shoes, wheelchairs, and crutches and canes.
Veterans can receive prosthetic items from the VA—even if they haven’t enrolled in the healthcare program—so long as they are applicable by sustaining a service-connected disability or they have a rating of 50 percent disabled by the VA.
Qualifications for adaptive automobile assistance from the VA include:
- Service-connected loss or permanent loss of use of one or both hands or feet
- Permanently impaired vision of both eyes to a particular extent.
- Entitlement to VA disability compensation or immobility (ankylosis) of one or both knees or one or both hips
In some cases the VA is responsible for providing payment for adaptive equipment (including its repair, replacement, and installment) as well as a one-time payment of not more than $11,000 toward an automobile or other vehicle.
VA dental care
Dental care is not provided for all veterans enrolled in the VA healthcare program. However, partial or full dental care from the VA is provided if a veteran qualifies under the conditions shown in Table 4-1.
(TABLE 4-1: ELIGIBILITY FOR VA DENTAL CARE)
|Table 4-1||Eligibility for VA Dental Care|
|If you…||You are eligible for…|
Eye and ear care with the VA healthcare program
Simply because a veteran is enrolled in the VA healthcare program and they can receive vision and hearing exams, they may not be qualified for free eyeglasses or hearing aids unless they:
- Received an increased pension for regular aid and attendance for being permanently housebound.
- Got disability compensation for a disability gained during service time.
- Are formerly a prisoner of war
- Obtained a Purple Heart medal
Receiving medicine from VA pharmacies
Common medications often prescribed to veterans are detailed on a VA list of approved medications called a formulary. These medications are provided for veterans by the VA so long as they’re prescribed by VA medical personnel. For convenience, a veteran can have their VA physician’s prescription filled at a VA medical facility pharmacy.
The VA, however, does not provide veterans with routine refills unless the veteran has a special situation, but there are two ways in which they can have them refilled:
- Through the routine refill program: Veterans are able to request medication refills by mailing a refill notice given to them at the time of their original visit to the pharmacy. The VA pharmacy mail-out program processes such an order.
It’s recommended to send refill orders approximately 20 days before the medication becomes depleted to be sure the medication is received quickly.
Inquire with the VA pharmacy that filled your original prescription as some VA pharmacies have toll-free automated telephone refill systems.
- Online through the VA’s website: Visit myhealth.va.gov. To organize prescription refills, as this site is to help veterans process their medications more efficiently. Register a user profile with https://www.myhealth.va.gov before using the service.
Filling a non-VA prescription
If a veteran has a prescription written by their private physician the VA doesn’t fill or rewrite it. However, it’s possible to have a prescription written by a private physician refilled with the VA if:
- You are enrolled in the VA healthcare program
- You have a primary-care provider assigned by the VA
- You provide the VA healthcare provider with medical records from the private physician
- Your healthcare provider agrees with the medication recommended by the private physician
The VA is not required to prescribe a medication suggested by a private, non-VA physician.
Emergency care in non-VA facilities
If a veteran is qualified to have emergency care in a non-VA medical facility if the service provided in relation to a disability or medical condition the VA determines to be related to military service. These particular conditions are mandatory to have the VA pay for emergency medical care outside of their own facilities.
Reimbursement for medical care obtained outside of VA facilities is only obligatory if similar treatment at a VA medical center was not available, any kind of delay would have exasperated a veteran’s condition or threaten their life, or the veteran in question is personally responsible for the services.
An injury sustained during service time that is aggravated by an outside source post service is not under VA jurisdiction unless the outside source is responsible. For example, if a wound is sustained during service and then injured further during a car accident, the VA is only obligated to pay for damage if the individual who collided with the veteran is not liable.
If veteran sustains an injury on accident in which the only individual liable is the veteran, then the VA is likely to cover medical costs unless another healthcare plan can pay that the veteran is already enrolled in.
It is possible for the VA to pay for a veteran enrolled in the VA healthcare program to receive non-VA medical care if they meet certain criteria by Congress. This particular benefit can recompense emergency care given for conditions sustained outside of military service for enrolled veterans with no source of payment for care otherwise.
These conditions follow below:
- The veteran received emergency care at a non-VA medical facility
- The veteran is enrolled in the VA healthcare system (as detailed in “Making your case at a board meeting”)
- The veteran has been cared for by a VA healthcare service within the past 24 months
- The veteran is financially liable to the provider of the emergency treatment
- The veteran has no healthcare insurance such as Medicare, Medicaid, state programs, or Tricare (detailed in Chapter 5)
- The veteran has no legal recourse against or obligation to a third party willing to pay the bill wholly or in part
- The VA or alternative federal facility (military hospitals) were unable to accommodate the veteran during the time of the emergency
- The condition of the veteran required speedy care and in postponing treatment for availability of a VA facility would have exacerbated the condition, threatening the health or life of the veteran, the VA is required to pay for treatment by a non-VA facility
If you have healthcare insurance currently it is recommended to refrain from canceling if you’re worried about being eligible for non-VA emergency treatment, epically since family members do not qualify for your benefits. If a veteran decides to depart from Medicare Part B, they are unable to reestablish it until January of the next year.
The VA will organize a transfer from a non-VA facility to a veteran’s rightful VA facility if the veteran is being treated in a non-VA facility and their condition becomes stable.
This being said, the VA only pays for emergency services until the condition of the veteran becomes stable, after which is veteran is responsible for payment if they chose to stay in the non-VA facility.