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VA health care: cost and co-payments

SUN Columnist

Most nonservice-connected veterans and noncompensable zero percent service-connected veterans are required to complete an annual means test or to agree to pay VA the applicable co-payment. The means test is based on their family’s income and net worth. Some veterans are required to make co-payments for their care and medications. The following is a summary of cost and co-payments for VA Health Care:

Veterans are requested to provide health insurance information. VA is required to submit claims to insurance carriers for treatment of all nonservice-connected conditions. Reimbursement funds received from insurance carriers are retained at the VA health care facility where treatment was received. These funds are used to provide additional health care services to all veterans.

Means testing

Certain nonservice-connected and zero percent noncompensable service-connected veterans are required to fill out the financial worksheet, which we refer to as the “Means Test.” A means test is a gathering of financial information by which VA determines your priority group for enrollment, and whether or not you are required to make co-payments for the service you receive. The means test is based on prior year income and net worth. However, you can apply for an exemption from paying those co-payments to avoid a hardship if projections of your income for the current year will be substantially below the applicable income threshold.

Should you decline to complete the financial worksheet, you must agree to pay the applicable co-payment unless you are otherwise eligible for VA care. We would be unable to determine your priority and therefore could not offer you enrollment. It is possible, if you do not want to complete the financial worksheet, to declare yourself as a discretionary veteran. This means that you would accept placement in priority group 8 for enrollment and if enrolled you would be accepting responsibility for making the required co-payments.

Hardship determination

A hardship determination is a process by which veterans enrolled in priority group 7 and 8 may request a change in their enrollment priority group if their projected income for the current year will be substantially lower than their income from the previous year. Circumstances that might warrant hardship determination would be the loss of employment, business bankruptcy or out-of-pocket medical expenses.

Prescriptions

If you are being provided treatment, necessary prescriptions will be provided. For more information on the current co-payment rates, visit the Department of Veterans Affairs website. Service-connected veterans rated 50 percent or more, service-connected veterans receiving medications for a service-connected condition, or nonservice-connected veterans who meet the low-income criteria are exempt from the prescription co-payment. This income threshold changes annually.

Types of co-payments

• Medication: Prescription co-payment charges were established by Congress. The charge is $8 for each 30-day-or-less supply of medications provided on an outpatient basis for nonservice-connected conditions.

• Outpatient: The co-payments will be based on primary care visits ($15) and specialty care visits ($50).

• Inpatient: Congress determined the appropriate inpatient co-payment should be the current inpatient Medicare Deductible Rate ($840 in 2003) for the first 90 days that you remain in the hospital plus a $10 per diem charge.

• Long-term care: VA charges for long-term care services vary by type of service provided and the individual veterans ability to pay.

Veteran health insurance

Whether or not you have insurance does not effect your eligibility for VA health care benefits.

If you are receiving care for a nonservice-connected condition and have health insurance, your insurance carrier will be billed. VA does not bill your health insurance carrier for VA-adjudicated service-connected disabilities.

An adjudicated service-connected disability is one that VA has determined was incurred or aggravated in the line of active duty. The law requires VA to bill private health insurance companies for all nonservice-connected care a veteran receives.

VA’s budget and your future care could depend on the amount VA is able to collect from private health insurance carriers. By not giving us insurance information, you may be limiting your future care and that of many other veterans. Additionally, if you are a veteran who is subject to a co-payment and are receiving care for your non-service connected disability, providing VA your insurance information enables VA to submit a claim to your health insurance company.

Any payment received from your insurance will be applied to your outstanding co-payment debt. This may satisfy all or part of your co-payment responsibility. You will not be responsible for any unpaid balance that the insurance carrier does not pay except for VA co-payments. In addition, many insurance companies will apply VA health care charges toward the satisfaction of your annual deductible.

The office of Archuleta County Veterans Service Officer provides assistance to qualified military veterans, and their families, or a veteran’s survivors, in applying to and in obtaining U.S. Department of Veteran Affairs Program assistance, benefits, and claims. This assistance is provided within the guidelines, policies, and procedures established by the Colorado Department of Military and Veteran Affairs. This is a mandated program of the State of Colorado.

I am currently attending annual training in Denver. I will answer my cell phone when possible. I will be back in my office on Monday, April 28.

Further information 

For further information on VA benefits, call or stop by the Archuleta County Veterans Service Office, located at the Senior Center in the Ross Aragon Community Center on Hot Springs Boulevard.

The best way to contact me is to set up an appointment at home or in the office so I can schedule a specific time in order to answer and assist each veteran in Archuleta County.

I will be out of the office on the following days for regularly scheduled meetings:

• Vets4Vets: Tuesday mornings, 9 a.m.-noon.

• Arboles Community Center, first and third Thursdays. Back around 2 p.m.

• Pagosa Outreach Connection, 8:30-10 a.m. every Thursday.

• Home visits/Pine Ridge outreach, second and fourth Thursdays, back at 2 p.m.

The office number is 264-4013, fax number is 264-4014, cell number is 946-3590 and email is raytaylor@archuletacounty.org. The office is open from 8 a.m. to 4 p.m. Monday through Friday. Bring your DD Form 214 (Discharge) for completing applications to VA programs or benefits for which the veteran may be entitled to, and a copy for filing in the Archuleta County VSO office. If the office is closed, I am out assisting veterans; leave me a message and phone number to contact you.

Important numbers

• 799-VETS, www.Vets4VetsPSCO.org.

• Durango VA Outpatient Clinic: 247-2214.

• Farmington VA Center: (505) 327-9684.

• The Veterans Crisis Line offers free, confidential support to veterans in crisis, as well as their family and friends 24/7/365. Call (800) 273-8255, chat online or text 838255.

This story was posted on April 24, 2014.