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VA Health Care
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A quick overview of VA Health Care

VA Health Care Veterans Health Administration
     The VA Health Care system is a stand-alone, point of service provider for Veterans.  It is important to understand that, although being actively enrolled in VA Health Care meets the current ACA's requirement to have minimal essential coverage, it is NOT insurance.  It is simply access to a hospital system for Veterans.

    Once enrolled in the VA Health Care system, veterans can use the system as little, or as much, as they would like.  Having access does not limit the individual’s ability to use their private provider; it simply expands their health care options.  It is not uncommon for a veteran to use their private provider, of course subject to their private insurance coverage, and also use the VA system, which is subject to its own internal copay structure and utilization rules.  As VA is not insurance, in order to use the VA health care system, you would of course have to go to a VA facility to seek care and services.  There are exceptions to this, but they are case specific, so I won’t get into that level of complexity here.

    The VA health care system is "regionalized", meaning that there are several hospitals, and each of these hospitals have their own outreach clinics.  When a veteran enrolls in VA, they get to choose one of these hospitals or clinics to manage their care within the VA system.  Where we sit here in Waushara County, we have pretty much equal access to three different systems, and a veteran would choose one of them to manage their VA care.  Most commonly, we enroll veterans in Waushara County into the VA Medical Center in Tomah, and it has outreach clinics in Wisconsin Rapids, Wausau and Owen.  Alternatively, veterans could choose to be enrolled in the Milwaukee system, with its clinics in Appleton and Green Bay, or the VA Medical Center in Madison, with its outreach clinics in Beaver Dam and Baraboo.  Once a veteran is successfully enrolled, for the most part, their VA care is restricted to that medical centers clinical system.

     It used to be that any veteran who had served on Active Duty could seek care in the VA system, but as the role of the VA health care system changed over the years, from a system to address combat wounds, to pretty much a full service provider; Congress realized that there were too many veterans, and not enough VA.  This resulted in a change in enrollment criteria back in 2008.  Since then, veterans must meet certain time in service requirements and criteria specific to that service, or, they must meet specific financial criteria in order to enroll.  There are exceptions to just about everything, so it could be a worthwhile conversation to have.

So, are you eligible?  Here are the meat and potatoes of eligibility.

You may be able to get VA health care benefits if you served on active duty and separated under conditions other than dishonorable.

You should know, if you enlisted after September 7, 1980, or entered active duty after October 16, 1981, you must have served 24 continuous months, or, the full period for which you were called to active duty.  This minimum duty requirement may not apply if you:

·         Were discharged for a disability that was caused or aggravated by your active-duty service, or

·         Were discharged for a hardship or “early out,” or

·         Served prior to September 7, 1980

If you’re a current or former member of the Reserves or National Guard, you must have been called to active duty by a federal order and completed the full period for which you were called or ordered to active duty.  If you had or have active-duty status for training purposes only, you don’t qualify for VA health care.  (There are exceptions, so call me if you are interested in looking into it)

If you separated under conditions other than honorable, you may still be eligible to enroll if you meet certain exceptions.  These exceptions are case by case, and may be subject to individual determination by the VA.  Again, if you are interested in enrollment, give my office a call and we will set up an appointment to explore your particular case.

Enhanced Eligibility Status; you may qualify for enhanced eligibility status (meaning you’ll be placed in a higher priority group, which makes you more likely to get benefits) if at least one of these applies to you:

·         You receive financial compensation (payments) from VA for a service-connected disability

·         You were discharged for a disability resulting from something that happened to you in the line of duty

·         You were discharged for a disability that got worse in the line of duty

·         You’re a recently discharged Combat Veteran (discharged within the past 5 years)

·         You get a VA pension

·         You’re a former Prisoner of War (POW)

·         You’ve received a Purple Heart

·         You get (or qualify for) Medicaid benefits

·         You served in Vietnam between January 9, 1962, and May 7, 1975

·         You served in Southwest Asia during the Gulf War between August 2, 1990, and November 11, 1998

·         You served at least 30 days at Camp Lejeune between August 1, 1953, and December 31, 1987

If none of the above applies, you may still qualify for care based on your income.  Many veterans do not meet the enhanced enrollment criteria mentioned above, but that doesn’t mean the door is closed.  It just means we have to show that you meet certain financial criteria to open it.  If we can show that your income for VA purposes is below an annually adjusted geographic threshold, we are able to get you into VA health care, and if we can show that it is below some other limits, we can even change your cost of care in the VA system.  If we aren’t able to get you in based on income, my office will try to assist in developing to meet one of the above enhanced criteria (usually that means we work on a claim for service connected disability compensation.  It’s not a quick route into VA health care, but if we are successful, we get you into the VA system, and it’s a great modifier to some of your other veteran’s benefits).  Service Connected Disability Compensation is a great subject for a future article, so I will leave it there.

Bottom Line, if you are interested in discussing or applying for VA health care, give my office a call at (920) 787-0446.  We will set up an appointment to help you look into it.  As always, our advice and assistance is no charge, and you never know, we may be able to help you expand your options.


Waushara County
209 S. Saint Marie St.   Wautoma, WI 54982      
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