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 (

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


    • 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 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.

  • David

    I am currently at 70% disable and also classified as unemployable and using the V.A. for all my medical needs. I do not have a problem with treatment at the clinics or at the main hospital Audrey L. Murphy. I was concerned with the fact that I am turning 65 in August. I didn’t know if I should enroll with Medicare B. The A is free. I cannot see paying $120.00 a month when I am being seen at the V.A. I called and was informed that I don’t have to enroll but there is always a chance that congress my not appropriate funding for all veterans in the future (lowest priority) So what else is new! I am rolling the dice and and gamble that the V.A. will be around for me for and the deserving future veterans.

  • Gaston

    Bottom line – if you are happy with your VA care, enrolled in the full VA healthcare program, in a high priority group (Priority One or Two) I do not see why you would need Medicare or Tricare. So why waste money on medicare premiums? Of course the government will take your money, but what would you get in return if you use VA only? I have had Tricare for years and never used it once. Near as I can tell, upon reaching 65, Tricare requires you to enroll in Medicare Part B (at your expense) or you will lose Tricare. My wife uses Tricare and I asked Tricare if I did not maintain my Tricare coverage (because I did not enroll in Medicare Part B) would my wife lose her coverage. The answer was “no, she will maintain coverage on here own” unless at age 65 she does not enroll in Medicare Part B. In her case, it makes sense to enrolll in Medicare because she does not have VA coverage. Also, I asked if I enroll in Medicare in the future, will I resume my Tricare coverage and the answer was “yes”. The only reason to buy Medicare coverage is if I became unhappy with VA care. At that point, to start Medicare I would have to pay an additional percentage of premium for every year I delayed signing up for Medicare but my plan at this point is to never pay for Medicare. I will sign up for Medicare Part A because it is free.

  • Muleagain

    I’m 100% SC and use VA, however since some moron doctor red flagged me, the quality of care has dropped way down. So I dont know what to do, all the crap on medicare has me seeing red. So can I see a real doctor and get my drugs at VA?

    • Lisa

      My husband is 100% disabled Vietnam era veteran he also gets Social Security disability he’s 62 years old the only VA hospital for any kind of urgent care and also because he hasn’t used VA benefits for 2 years I told him he doesn’t even have like an open veterans file anymore with that said he also doesn’t know how to use his Medicare benefits and he does pay for Medicare Part B does he have to pay for Medicare Part B at 62 when he has 100% VA 100% Social Security benefits for the rest of his life I have listening to people say that if he enrolls in it because he’s never used Medicare the deductibles are so high that he probably never will use it along with the co-payment every month that he’s had it for 3 years so he’s already paid Medicare over $3,600 and never had any benefits does not know how to use them has no clue what to do the VA also tells him that he has to re-up sign up for health care benefits we live 70 miles away from the Roseburg Oregon VA Hospital have been have no car now they did build a new clinic in Eugene but they don’t allow you to sign up to them you have to sign up for Roseburg with that said he’s starting to get some medical problems perhaps maybe even cancer what should he do what is the answer I’ve been reading online hours about even buying more insurance for him but it doesn’t make sense they say if you pay us for instance if you pay us $10 a month for 2 years so that’s $240 we will give you $250 in benefits for Eye Care One Time so basically he needs to pay $240 extra insurance over Medicare Part B over is VA benefits and in two years they’re going to give him 10 extra dollars the benefits that to me is Ludacris we don’t understand Medicare we don’t understand that he has to pay for it and then also before it kicks in he has to pay don’t understand

  • Charles Seper

    The Part B penalty makes no sense. If I’m in the VA system, then I don’t need Medicare at all, yet I’m stuck with Part A whether I want it or not and will have to pay a penalty on Part B if I need it down the line (in case the VA decides they can’t afford me anymore or something.) The thing is, how is a person NOT being enrolled in Part B costing the government anything? It’s actually saving the government money if I’m not using Medicare. Why should I get penalized later on for saving the government money now?

  • Genrty

    Here’s what scares me. Even though I have part B and I’m covered for doctors visits and I have part A for hospitalization what if I drop my part B and only have my VA benefits to fall back on? For instance if I’m in a major accident or I get a major disease or illness will the VA take care of me at the same level that I would be taking care of if I paid for Medicare part B? That’s the question that I wrestle with any comments would be appreciated I know that they will bill the VA if I’m not mistaken if I am hospital is Ott hospital his eyes but I also know that the VA hospital is not the most helpful when it comes to trying to get answers about them paying bills to other outside institutions.

  • Kool Gravy

    I am a VET and am 64 and have my Medicare Red white and blue card because of a disability 10 years ago. I refused Part B then and I can not afford the 147.00 per month. Is there a way for me to get a waiver or subsidy for part B. ? ? I really need a local doctor.
    Any help would be very appreciated