Transitioning from active duty to discharge or retirement can be a jarring experience. On top of adjusting to a different day-to-day lifestyle, you must also consider things like veterans health insurance for you and your loved ones. While it might seem easier to opt for civilian insurance over dealing with the VA, as a veteran you are often entitled to free or discounted health care coverage.
Veterans health insurance options range from limited, but free, service-related care to full coverage for you and your family. However, navigating these options is neither simple nor stress-free. So what exactly are your options for veterans health care? And how do you or your family go about enrolling in these programs?
Is Veterans Health Insurance Different than Civilian Health Insurance?
The answer to this question is not as straightforward as it might seem. There are veterans health insurance options that are comparable to civilian health care programs. But there are also coverage options that are unique to the military world.
The military does have its own paid health insurance program, just like Blue Cross Blue Shield, Humana, or Aetna. Some veterans health care is even 100-percent free but at the cost of limited providers and inconvenient scheduling. In short, the most significant difference between veterans health care and civilian health care is that veterans often qualify for cheaper and more extensive coverage. However, veterans health insurance typically comes with much more "red tape" than the already confusing world of civilian health care.
Who Qualifies for Veterans Health Insurance?
The vast majority of retired or discharged service members qualify for some form of veterans health insurance. However, this coverage will only extend to spouses, dependents, and other family members if the veteran in question meets certain requirements. Some examples of criteria that would qualify the veteran's family for this coverage include service-related death, 100-percent VA disability, or extended service ending in retirement.
Retired veterans, as well as those with an honorable or a general discharge under honorable conditions, are typically eligible for some form of veterans health care. Prior service members with a dishonorable discharge, though, are instantly disqualified for VA benefits. This includes any form of health care or military-sponsored health insurance.
Where Can I Get Veterans Health Insurance?
One of the most complex factors in veterans health insurance is understanding all of the different coverage options. Not only do veterans have coverage options provided by the military, but they also have access to all of the same programs that civilians do. While this wide selection can be beneficial, it can overwhelm many veterans and their families when dealing with the already stressful process of finding health insurance.
Below we've broken down the most utilized veterans health care options, as well as some of the civilian health insurance programs currently available. This information should help demystify the world of veterans health insurance and get you one step closer to finding the right coverage for you and your family.
VA Health Care
VA Health Care is not really a form of veterans health insurance. Instead, this program refers to the integrated health care system available to all qualifying veterans across the United States. When using the VA Health Care system, your local VA medical center or hospital provide your health care. While this can be inconvenient or downright impractical for some veterans, the VA Health Care system typically comp these services. However, some veterans may need to pay a deductible based on their income.
In some cases, your local VA medical center cannot provide the health services you need. There are options to receive care at a non-VA hospital or clinic, but they are extremely limited. For this reason, many veterans opt for additional health insurance instead of solely relying on this health services program.
Unfortunately, VA medical centers around the country have encountered controversy in recent years. Many of the nation's VA hospitals have reputations for long wait times, unlicensed care providers, and unsafe clinic conditions. While many veterans receive excellent care at VA medical centers, others are wary of these horror stories and opt to avoid these clinics whenever possible.
Tricare is the most traditional form of military-sanctioned veterans health insurance. This program is available for active duty and retired service members as well as their families. However, not all veterans qualify as retired. Those discharged from the military, even an honorable discharge or a general discharge under honorable conditions, are not eligible for continued Tricare. As an extension, the spouses and dependents of these veterans also will not qualify.
For those who are eligible for Tricare, this veterans health care works much the same as any traditional health insurance program. Participants pay a monthly deductible, co-pays, and other routine expenses in exchange for protection against unexpected medical costs. And unlike the VA Health Care system mentioned above, participants can access health services at a range of in-network providers.
The Tricare program offers a range of various coverage options, each with a different cost profile and eligibility requirements. You can learn more about which Tricare coverage you qualify for, as well as the estimated costs, at the Tricare website.
When researching veterans health insurance options, you might come across a program called CHAMPVA. CHAMPVA stands for Civilian Health and Medical Program of the Department of Veterans Affairs. To receive coverage from CHAMPVA, beneficiaries must not qualify for Tricare. However, while this insurance is related to veterans health care, it does not actually cover veterans.
CHAMPVA helps subsidize health care costs for the spouses, children, and other dependents of veterans who meet specific disability requirements. While CHAMPVA does help pay for health services and supplies, it is generally the second payer following the beneficiary's primary insurance.
Civilian health insurance options
Just because you are a veteran doesn't mean that veterans health insurance is always the right option. US veterans still have access to civilian health care options. These insurance options include employer-provided coverage, Medicare, Medicaid, and more.
Many veterans opt not to use veterans health insurance because they are too far away from a VA health provider. Veterans health care does offer accommodations for members in this situation, including technological advances like Secure Messaging. But, either because of misinformation or other concerns, many veterans still feel that they don't have adequate access to VA-sponsored health services.
The insurance you choose will depend on your health care needs, as well as the people in your household that will or will not be covered by your insurance. Some civilian health care options offer better coverage for spouses and dependents. But you will need to look at the health care coverage which you personally qualify for to make an informed decision.
Most people with private health insurance receive coverage from their employer. While you can purchase insurance from providers directly, it is often prohibitively expensive. But for some veterans and their families, this additional cost is worth the peace-of-mind that comes with a comprehensive health care plan.
If for some reason you don't qualify for veterans health care, then civilian private insurance might be the best choice for you and your family. But if you are unable to afford one of these plans, you do have other options for civilian health insurance.
If you are a veteran over 65 or with a qualifying disability, you might qualify for Medicare. Medicare is a government-issued health insurance option that covers a variety of health services. Covered services can range from hospital stays, routine visits, and prescription costs.
Some Medicare coverage is free to retired individuals, including hospital stays when they meet certain requirements. However, coverage for other routine services is not. Participants must still pay a monthly premium to maintain their Medicare coverage, but this is often more affordable than private coverage. You can receive an estimate for your eligibility and monthly premiums at Medicare.gov.
While veterans can receive both VA benefits and Medicare coverage, they do not work together. For instance, Medicare won't cover any health services received at a VA facility. While you can still take advantage of veteran-specific benefits when enrolled in Medicare, understanding your coverage can be a little difficult.
According to the American Community Survey from the U.S. Census Bureau, as many as 1 in 10 veterans rely on Medicaid for health insurance. Medicaid is a state government-issued insurance option somewhat similar to Medicare. However, Medicaid offers a broader range of coverage for low-income, disabled, and pregnant individuals, as well as children.
Medicaid is an alternative to private health insurance that is available for free or for a low monthly premium. While understanding whether or not you qualify for Medicaid is sometimes unclear, the government offers plenty of resources to help determine eligibility.
The combination of VA benefits and Medicaid can also present some issues. Receiving VA benefits can impact your qualifying income for Medicaid coverage. Opting for Medicaid coverage will also affect your VA pension if you're currently receiving one. If you have any concerns about applying for Medicaid, the best option is to speak with your local VA office.
Does Veterans Health Insurance Cover Pre-Existing Conditions?
In some cases, pre-existing conditions may be exempt from coverage under veterans health insurance. VA Health Care may not cover conditions determined to exist before the veteran entered military service. CHAMPVA also does not cover pre-existing conditions until after six months of coverage.
Tricare, on the other hand, has no limitations for pre-existing conditions. Veterans and their families can receive full health coverage from the very beginning of their plan, regardless of previous medical care. This coverage also extends to pre-existing pregnancies.
How Much Does Veterans Health Insurance Cost?
As you can see above, the cost of your veterans health insurance will ultimately depend on your provider. Other factors may also play a role, such as military status, pre-existing conditions, income, and more.
VA Health Care is free to qualifying veterans. All services, supplies, and medications are included. VA Health Care does not cover unapproved services conducted at a non-VA hospital or medical center.
There are many different Tricare programs, but two of the most popular are Tricare Prime and Tricare Select. The costs of these two programs are subject to change with each year, but you can find examples of cost and co-pay schedules online. Keep in mind that these amounts are just estimates. You should contact your local Health Benefits Advisor for information about current costs.
CHAMPVA is a supplemental insurance program, so it helps covers costs not covered by the beneficiary's primary insurance. Generally, these costs include a $50 annual deductible and then 25 percent of health services. These costs count toward CHAMPVA's annual $3,000 catastrophic cap.
Private health insurance options will vary greatly in cost. The best way to find information on these programs and their overall costs is to utilize resources like Healthcare.gov.
Will I Meet the Affordable Care Act's Minimum Requirements?
As you may know, the Affordable Care Act requires that health insurance plans offer a minimum level of coverage. The VA Health Care program, Tricare, and CHAMPVA all meet these minimum requirements. Therefore, enrolled veterans and family members are not required to seek out additional coverage.
As of 2019, there is no longer a tax penalty for individuals who don't have health insurance meeting this minimum requirement. However, adequate health care coverage is still extremely important for the safety of you and your family.
Where Can I Receive Care with Veterans Health Insurance?
Like civilian health insurance, you cannot expect every health care provider to accept your veterans health insurance. Each health care option discussed above has its own system for connecting patients to providers.
VA Health Care is only provided at VA medical centers and hospitals unless a specific exception has been made. Veterans using this care option should never assume that non-VA health services are covered, as these exceptions are extremely rare. The Veterans Choice Program does allow for visits to community providers, but these visits must be pre-approved by the VA to receive coverage.
Tricare works much like any civilian health insurance plan. You may receive care at a VA hospital or medical center, but Tricare also maintains a network of community providers at a variety of non-VA hospitals. You can also choose to visit an out-of-network medical provider, but your out-of-pocket costs will usually be higher.
CHAMPVA does not use a network system, but it also isn't accepted at all medical providers. While you should always check with your chosen doctor before receiving care, the general rule is that anywhere that accepts Medicare will also accept CHAMPVA. If space allows, CHAMPVA beneficiaries can also opt to receive care at their local VA hospital or medical center. Keep in mind, though, that if you also rely on Medicare or Medicaid for health insurance that VA centers cannot accept this form of coverage.
How Do I Apply for Veterans Health Insurance?
The biggest obstacle to receiving veterans health insurance is often proving eligibility. Fortunately, the VA offers resources that can make this process a little easier. In some cases, and if you have all of the necessary documents readily available, such as your DD214 and copies of your tax returns, you can apply for coverage online.
If you need additional help, your local VA office or Health Benefits Officer can help you complete your application or appeal your eligibility. With some of these options, it might take a while to receive approval. But the peace-of-mind that comes with veterans health insurance for you or your family is well worth the wait.
How to apply for VA Health Care
To apply for VA Health Care, you can use the online application or apply by phone, mail, or in-person. You'll need to first collect your most recent tax return, social security numbers for yourself and your dependents. You'll also need information about any current health insurance.
Before starting your application for VA Health Care, it's a good idea to double-check that you meet the criteria for coverage based on your service history. If you're unsure about your eligibility or need help appealing your discharge status to become eligible, get in touch with your local VA office.
How to apply for Tricare
Applying for Tricare works similarly to applying for civilian health insurance, with the added step of proving eligibility. To prove eligibility for Tricare, your Defense Enrollment Eligibility Reporting System (or DEERS) information must be current. The information about you and your family members will help verify eligibility.
Once eligibility is proven, you can use the Tricare website to search for the appropriate plan and enroll in coverage. If you have questions about Tricare's plans or how to update your DEERS information, contact Tricare customer service or your local VA office for assistance.
How to apply for CHAMPVA
Before considering CHAMPVA as a supplementary health care option, remember that you cannot receive this assistance if you qualify for Tricare. Also, remember that CHAMPVA is not veterans health insurance. Instead, it is a program for the spouses and dependents of 100-percent disabled or deceased veterans.
If you meet the criteria for CHAMPVA coverage, you must mail or fax your application to the VHA Office of Community Care. Your application must include the CHAMPVA Benefits application form, Other Health Insurance Certification, and, if applicable, a copy of your Medicare card or proof of ineligibility for Medicare.
On average, approval for CHAMPVA benefits can take two to eight months. To expedite the process, you can also attach documents like proof of the veteran's disability or death rating, DD214, and children's birth certificates. These documents should be included with your original application at the time of sending.
Life After Service: Decoding Your Health Insurance Options
The world of health care is an ever-changing one, and this remains true for veterans health insurance. Fortunately, as a veteran, you and your family may qualify for quality health care coverage at discounted rates. And if not, you still have full access to private health insurance, Medicare, and Medicaid.
While veterans health insurance eligibility and enrollment may be confusing, the VA offers many resources to help veterans and their loved ones understand their options. You may have questions about the best coverage for you or need assistance proving eligibility for any given program. The best course of action is to schedule an appointment at your local Veterans Affairs office. This office can also help you navigate future changes to health insurance legislation and how this may affect your coverage.
For assistance or veterans advocacy outside of the VA, you and your loved ones may be able to turn to your local VFW chapter. You can also request help from organizations like the National Organization of Veterans' Advocates. As a veteran or survivor of a veteran, you are never required to navigate this life transition alone.