Learn About Health Insurance for Veterans

Although navigating the world of health insurance options for veterans may be daunting, the rewards are worthwhile.

Veterans’ health insurance options can provide some of the most thorough care in the country. Plans aimed at veterans may also be subsidized by the U.S. government. Additionally, the Affordable Care Act requires that all Americans, including veterans, obtain some form of health care insurance. Therefore, finding a program made for your status as a veteran benefits you in numerous ways.

Guide to TRICARE Health Insurance

Nevertheless, figuring out what program best suits your needs is a challenging task. The U.S. healthcare system is exceptionally complicated. The Department of Veterans’ Affairs (VA), which manages the majority of veteran programs, is not any simpler. What you qualify for depends on a number of factors, including: what branch of the armed forces you served in, whether you were disabled while in service, the severity of your disability and your financial situation.

Other factors may be considered as well. The VA recommends that you apply directly for veterans’ health insurance benefits to learn what precisely you qualify for. The sections below detail the potential veterans’ health insurance options available to you.

Formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), TRICARE health insurance is available for active duty and retired service members and their families. TRICARE is not available to all retirees from the National Guard or Reserves. Only retired reserve or guard members who meet particular qualifications can apply for TRICARE. However, it is available to all retirees of uniformed services.

TRICARE has multiple health plans available for retired service members. The best plan for an individual veteran depends on what their needs are and which beneficiaries they wish to cover as well. Additionally, plan availability can vary by location. For example, TRICARE Prime is only available in Prime Service areas in the United States. Veterans of uniformed services may be eligible for the following programs:

  • TRICARE Prime – This health insurance plan is mandatory for active-duty service members but optional for retirees. The benefits of this plan include low or no co-pays for a number of critical services and medications as long as you stick to TRICARE network providers. If you go out of network, you’ll have to pay a point-of-service fee. To use this plan, you must live in a Prime Service area and use plan-approved medical providers. An assigned primary care manager will serve as your primary physician, and he or she will refer you to specialists as needed. As a retiree, you will have to pay annual enrollment fees, but you will have no deductible.
  • TRICARE Select – This plan offers more flexibility in what physicians you use. You have a co-pay for both in-network and out-of-network physicians, although the latter will be a bit more expensive. Additionally, there is no enrollment fee and a small annual deductible of no more than $300 per family. This plan may be more suitable if you have another health insurance plan or you do not want to switch to TRICARE network providers.
  • US Family Health Plan – This plan is similar to TRICARE Prime, but is available through different local health care networks. Only veterans in certain regions of the country have this option available to them. Options are available in the D.C. area, the New England area, parts of south Texas and Louisiana and Puget Sound in Washington state. Expenses are similar to the TRICARE Prime.
  • TRICARE For Life (TFL) – This program provides additional coverage for Medicare You automatically receive TFL coverage if you are enrolled in Medicare Parts A and B and pay Part B premiums. If you have Medicare, TRICARE will cover any medical services not covered by your Medicare program.
  • TRICARE Select Overseas – This program may be the only option available if you live outside of the United States. If you are enrolled in this program, you can choose in-network or out-of-network providers. You will have a deductible, a co-pay or cost share for any services you receive.

About the Department of Veterans’ Affairs Health Insurance

Although TRICARE coverage mostly depends on what plan you select, VA health insurance qualifications are more complicated. Your eligibility depends on how long you served, where you served, whether you were disabled in service and how severe your disability is. Factors that can influence your eligibility include your income, the number of dependents you wish to claim and other financial aspects. The VA recommends that you apply directly for health care benefits to determine what you are eligible for as a veteran.

The bare minimum qualifications to be eligible for VA health benefits include leaving active service under any condition except a dishonorable discharge. If you were dishonorably discharged, you are not eligible for VA health benefits. Additionally, veterans enlisted after September 1980 must have served 24 continuous months, or the entire period in which they were called to duty. Veterans with awards, who were discharged for disability or who have a service-connected disability may have enhanced eligibility. Veterans receiving pensions and veterans who served in specific stations also have enhanced eligibility. For example, veterans stationed at Camp Lejeune for 30 or more days between August 1953 and December 1987 will have a greater chance of qualifying for insurance.

The potential VA health care services available are vast, but not all veterans are eligible to receive these benefits. However, veterans that are eligible can receive the following health services:

  • Preventative care services – This includes routine medical exams, health education, immunization and counseling on individual risk factors.
  • Inpatient care services – This includes medical care, surgical care, dialysis treatment, acute physical care and mental health care. It also includes Intensive Care Units, transplant services, traumatic brain injury treatment and more.
  • Ancillary services – Ancillary care includes auditory, visual, dental, and other additional services that help diagnose or treat medical conditions. Nutrition services, physical therapy services, pharmaceutical services and even creative arts therapy may be included in your VA health care.
  • Specialty care services – VA health insurance includes access to specialists for all potential areas of care, from orthopedics and geriatric care, to dermatology.
  • Emergency medical care – The VA health care system is equipped to handle emergency treatment. However, if you cannot get to a VA center in an emergency, the VA can cover funding for emergency care sought at any medical facility.
  • Mental health care – Both inpatient and outpatient mental health services are available to veterans who require it. Veterans are far more likely than civilians to develop serious mental illnesses such as PTSD while in service. The VA therefore offers a wide array of mental health services for veterans who require them.

Eligibility for VA health benefits is determined when you apply. The only way to identify what coverage is available, what costs you might pay for that coverage and whether you should seek VA health care is to complete the application process. Even if you are eligible, you may determine that you will need additional coverage. This is because the VA will sort you into a priority group based on your need and level of disability. If you are not disabled and earn a high income, you may have to wait several months to receive basic services. In that case, you may prefer a private insurer or TRICARE health insurance.

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