Veterans Face Choices with Health Reform Law

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With the Patient Protection and Affordable Care Act set to take effect next year, many veterans are struggling to get the information they need to make important decisions about medical care. Medicare expert Diane Omdahl warns that many veterans are at risk of being misinformed, which may cost them thousands of dollars in enrollment penalty fees.

According to the U.S. Department of Health and Human Services, nothing in the law will affect access to the care veterans may already receive through the VA medical system or Tricare. Veterans enrolled in VA health care do not need to obtain additional coverage. Veterans receiving VA health care will have the option to enroll in an additional insurance plan through the new health insurance exchanges, which open in 2014.

Veterans who are happy with their current coverage do not need to make any changes. If they’re not happy, they can explore their options, said Omdahl, who also is co-founder of 65 Incorporated, a health care information company (www.65incorporated.com).

Under the health reform law, current guaranteed Medicare-covered benefits won’t be reduced or taken away, nor will the ability of seniors to choose their own doctors. However, veterans need to be aware of how the new health care law affects veterans and Medicare, Omdahl said.

For veterans who are eligible for Medicare Part D prescription drug coverage, enrollment in the VA health care system is considered creditable coverage for Medicare
Part D purposes. This means that VA prescription drug coverage is at least as good as the Medicare Part D coverage. Since only veterans may enroll in the VA health care system, dependents and family members do not receive coverage under a veteran’s enrollment.

There is, however, one significant area where VA health care does not qualify as creditable coverage: Medicare Part B. Because VA health care is not a health insurance plan, it is not considered creditable coverage for Medicare Part B, which covers outpatient services, including doctors’ fees. So while veterans may avoid the late enrollment penalty for Medicare Part D by citing VA health care enrollment, they cannot do the same to avoid the late enrollment penalty for Part B.

For the 56 percent of veterans with private insurance coverage, new consumer protections prevent insurance companies from dropping them if they get sick or injured. And there are no longer any lifetime limits on how much insurance companies will cover.

Veterans who are not eligible for VA health care or other coverage may be eligible to receive tax credits for insurance bought in the exchanges. This may also apply to their families. Those exchanges will provide access to much-needed care for the 1.3 million veterans who are neither insured nor eligible for VA health care.

Uninsured veterans may also benefit from the Medicaid expansion. But, according to the Robert Wood Johnson Foundation, of the veterans who are potentially eligible for that coverage, fewer than half live in states committed to expanding Medicaid.

  • hunger4justice

    Veterans who get only disability payments from the VA ARE NOT ELIGILBLE for subsidies on their premiums on the exchange. Income is defined as the MAGI, modified adjusted gross income, that specifically excludes VA payments from being counted. The effect is that their income is deemed to be zero and thus not enough to qualify for subsidized premiums. State’s were also supposed to follow the new rule for 2014 in determining eligibility for Medicaid so that receipt of VA benefits will no longer be counted against them. HOWEVER, some states have not and will not change to the MAGI definition and those vets will get neither. Ironically, if you work and get VA payments only the salary will be counted so a veterans could be bringing home 70 thousand or more and GET subsidies but the disabled vet who has no other income has been excluded. Coupled with the fact that Congress kindly made sure our kids do NOT get coverage until 26 under CHAMPVA or TriCare along with the fact that the VA is saying it may not pay our compensation in November if the shut down continues and I am really, really, really angry.

  • dan

    Does VA disability payment affect (counts toward) the national poverty threshold for Medicaid and Children Health Insurance Program? (CHIP)? Both myself and my wife are disabled Veteran and if our payment is counted, it is over the national poverty threshold and we’re having a newborn soon

  • JR

    I AM A 30% DAV (AGENT ORANGE) AND WILL BE MOVING TO MA. I AM 64, MY WIFE IS 62. OUR INCOME, WITHOUT VA DISABILTY, WILL BE 36600 PER YEAR. MY WIFE DOES NOT WORK. I PLAN ON USING THE VA SYSTEM WHERE I WILL LIVE IN CENTRAL MA. CAN I PUT HER ON THE ACA SYSTEM AND APPLY FOR SUBSIDIES USING OUR INCOME FILING JOINTLY?

    • HT

      This is what we experienced with ACA. Our family income was 70,000 a yr until I lost my job due to medication I take now for pain. I was in a transportation job so I took a 40,000 yr hit. I returned back to college using the GI Bill. When we had a 70,000 a yr household budget we received the subsidy making her health insurance on the market place 163/month, when our income dropped to 33,000/yr we made to little to receive the subsidy. Her insurance went up to 263/month and the deductible is $6,000 out of pocket compared to the 3,000 she had before. Doesn’t make sense when I thought the subsidy was to help the poor. Too rich for medicaid and too poor for subsidy. Just a heads up, also it depends on the state. Some states have chosen to expand Medicaid guidelines to catch folks like us in the gap and others haven’t. We just so happen to live in a state that hasn’t. Which I totally understand because it puts the burden of financially providing the care for people when the states are strapped as it is for funds to begin with. I’m a 60% DAV.

  • Karen Ward

    I’m a 90 percent disabled veteran. I will be turning 65 at the end of this month. I get healthcare with the V.A. I live 2 hours drive from the v.a. I would like to be protected if I had a health problem and needed to go to doctor in my hometown, or I’m in another state traveling and need medical treatment. Can anyone tell me what I need to get with medicare? I don’t want to be insurance poor.

  • Carl C

    Hello…..I live in Mass and im a 64 year old DAV [30 percent] and will be filing to collect SS benefits in about 2 years at age 66 so that i may get full benefit.
    Even then….because i have been self employed for many years i will only be getting around 1,000.00 a month plus what i get as a 30 percent DAV .
    Could someone please tell me if i am still going to have to pay from my small SS monthly benefit check about 125.00 a month for Medicare,even though all my medical needs are taken care of by my Local VA Hospitals??? I do not presently pay into any other health insurance program and i rely on the VA for all my medical needs.
    Any help or information on this matter would be greatly appreciated….Thank you,Carl.

    • DAV

      Hi Carl,

      Please feel free to email us at social@dav.org and we’ll forward your question to our Service Department.

  • Bruce

    The only medical problems I have are related to agent orange. Because of the terrible service I received due to a massive heart attack I want to pick up part b coverage. Now I have to pay a $50 per month penalty for the rest of my life because the VA is not considered credible coverage. Looks like I’m sentenced to death by the VA or pay out the nose for part b coverage. What hasn’t this been challenged in the courts. Also we take care of illegal aliens and screw the vets.