Tagged: veterans healthcare
- Veterans rated 30 percent or more service-connected.
- Veterans traveling for treatment of service-connected conditions.
- Veterans who receive a VA pension.
- Veterans traveling for scheduled compensation or pension examinations.
- Veterans whose income does not exceed the maximum annual VA pension rate.
- Veterans in certain emergency situations.
- A veteran whose medical condition requires a special mode of transportation and travel is pre-authorized. (Advanced authorization is not required in an emergency and a delay would be hazardous to life or health).
- Certain non-Veterans when related to care of a Veteran (Caregivers, attendants & donors).
- Full name (include middle initial)
- Full address (include zip code)
- Patient Full Social Security Number
- Full name of provider
- National Provider Identifier (NPI) Number
- Provider taxonomy code(s), if known
- Tax Identification Number (TIN/EIN)
- Professional Status of Provider (ex. MD, PhD, CRNA, etc.)
- Physical address where care was provided
- Mailing address where payment should be sent
- All appropriate medical coding
- Any other health insurance information
- After the Military
- a Base Installation Guide
- Benefits for Veterans and Dependents
- Getting Uncle Sam to Pay for your College Degree
- Guard and Reserve
- Military Children’s Scholarship
- US Military
- US Military Retired
- Veterans Healthcare Benefits
- Office visit notes supporting the prescription(s)
- Blood work results
- Other test results supporting the prescription(s)
First, the easy part: If you are enrolled in TRICARE, you do not need to do anything different under the Affordable Care Act. Your TRICARE benefits are fully qualified under the terms of the ACA and you don’t need to take any action as long as you are in TRICARE.
For honorably discharged veterans, however, the situation is quite a bit more complicated. Unless you meet certain unusual conditions* the Affordable Care Act requires you to obtain a qualified health insurance policy by March 31, 2014. If you fail to do so, you will be subject to a fine of $95 per adult individual and $49 per family member, up to a max of $285 per family, or 1 percent of family income – whichever is greater.
After Jan 1, 2015, those penalties go up sharply: To $325 per adult and $162 per child, up to a family maximum penalty of $975, or 2 percent of annual income, whichever is less.
The penalty increases again on January 1, 2016. The penalty for that year is $695 per adult and $347 per child, up to $2,085 per family, or 2.5 percent of income, whichever is greater.
I’m a Veteran. Does VA Insurance Count?
Yes, VA insurance counts. But you actually have to enroll in the VA health program to have it qualify. It is not sufficient just to be a veteran. You must take positive steps to make sure you’re enrolled with the VA. Not everybody qualifies. For example, if you’re a Guard or Reserve member, and you’ve never been mobilized, and your only active duty time was for training, you don’t qualify for VA coverage.
Generally, you will qualify if you either served 24 consecutive months on active duty, or for the full period for which you were called for active duty if you were mobilized, and you enlisted after September 7th, 1980.
However, if you didn’t make 24 consecutive months, or had to leave duty early because of a wound or service-related injury, you can still qualify. You aren’t going to get disqualified just because you got hurt.
How to apply for VA coverage.
You aren’t automatically covered just because you are an honorably-discharged veteran, even if you meet the criteria. To enroll, visit the VA Benefits Explorer page on the Web. From that page, you can do a trial run to see if you qualify for VA coverage, and specifically what benefits and price structure you qualify for. (There are no premiums for VA coverage, but you will have to pay some copays and there are limits).
What about family members?
In most cases, the veteran’s family members will not qualify to enroll in the VA health care system. Spouses and children will generally need to obtain qualifying coverage, either through an employer plan or through an individual plan. The individual plan can be purchased either via the online exchanges or through a licensed health insurance agent.
VA Priority Groups
If you qualify, the VA will assign you to one of eight priority groups, based on your location, income and the nature of your service. If you qualify for more than one group, the VA will put you in the higher of the available groups. The groups are listed below:
Priority Group 1
- Veterans with VA Service-connected disabilities rated 50% or more.
- Veterans assigned a total disability rating for compensation based on unemployability.
Priority Group 2
- Veterans with VA Service-connected disabilities rated 30% or 40%.
Priority Group 3
- Veterans who are former POWs.
- Veterans awarded the Purple Heart Medal.
- Veterans awarded the Medal of Honor.
- Veterans whose discharge was for a disability incurred or aggravated in the line of duty.
- Veterans with VA Service-connected disabilities rated 10% or 20%.
- Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”
Priority Group 4
- Veterans receiving increased compensation or pension based on their need for regular Aid and Attendance or by reason of being permanently Housebound.
- Veterans determined by VA to be catastrophically disabled.
Priority Group 5
- Non-service-connected Veterans and noncompensable Service-connected Veterans rated 0%, whose annual income and/or net worth are not greater than the VA financial thresholds.
- Veterans receiving VA Pension benefits.
- Veterans eligible for Medicaid benefits.
Priority Group 6
- Compensable 0% Service-connected Veterans.
- Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki.
- Project 112/SHAD participants.
- Veterans who served in the Republic of Vietnam between January 9, 1962 and May 7, 1975.
- Veterans who served in the Southwest Asia theater of operations from August 2, 1990, through November 11, 1998.
- Veterans who served in a theater of combat operations after November 11, 1998, as follows:
- Veterans discharged from active duty on or after January 28, 2003, for five years post discharge
Priority Group 7
- Veterans with incomes below the geographic means test (GMT) income thresholds and who agree to pay the applicable copayment.
Priority Group 8
- Veterans with gross household incomes above the VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copays.
Veterans eligibility for enrollment:
Noncompensable 0% service-connected and:
- Subpriority a: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status.
- Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less
Veterans eligible for enrollment:
- Subpriority c: Enrolled as January 16, 2003, and who remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status
- Subpriority d: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less
Veterans not eligible for enrollment:
Veterans not meeting the criteria above:
- Subpriority e: Noncompensable 0% service-connected
- Subpriority g: Non-service-connected
*Exceptions apply if you are:
- A member of a religious group that is opposed to accepting benefits from an insurance policy
- You are an illegal alien
- You are incarcerated
- You are a member of an Indian tribe
- Your family is below the income threshold for filing an income tax return ($10,000 per individual and $20,000 for family members starting in 2013)
- You have to pay more than 8 percent of your income for health insurance, net of any tax credit or employer contribution.
You may also be exempt if:
- You were enrolled in Medicare, Medicaid or the Children’s Health Insurance Program (CHIP) at any time during the year
- You’re enrolled in TRICARE
- You’re in an employer-sponsored plan
- You have insurance of your own that is “Bronze” level or better,
- You have a grandfathered health plan that was in existence prior to the ACA.
Under the ACA, income is defined as total income in excess of the filing threshold. The penalty is pro-rated by the number of months without coverage. There is no penalty for gaps of 3 months or less. The penalty cannot be greater than the national average cost of a Bronze-level plan offered on the exchanges. (Source: Kaiser Family Foundation).
In a move that could cause a massive eastward migration of veterans from Hawaii and California and boost New England Cheetos sales numbers by double digits, the State of Maine has authorized the use of medical marijuana to treat post-traumatic stress disorder, or PTSD.
A competing therapy – thus far legal, though not yet proven – involves injecting an anesthetic directly into the spine with a horse needle.
We’ll take option A, thanks, and throw in a bag of Doritos.
Don’t look for the Bangor, Maine VA clinic to start handing out dime-bags like it’s going out of style, though. While a number of states have actually legalized marijuana under their own state laws, and a half-dozen states have specifically authorized medical marijuana as an approved treatment for PTSD, old Mary Jane is still illegal under federal law. Federal policy prohibits VA doctors from prescribing it or even assisting with documentation required to get other doctors to prescribe it.
Furthermore, marijuana is still listed as a Schedule I drug – a drug for which there are “no currently accepted medical uses,” according to the Controlled Substances Act. However, in 2010 and 2011, the Department of Veterans Affairs relaxed its existing policies against medical marijuana by affirming that veterans who were using marijuana under a legal state program could still participate in VA-sponsored therapeutic activities without fear of punishment.
“VHA policy does not administratively prohibit Veterans who participate in State marijuana programs from also participating in VHA substance abuse programs, pain control programs, or other clinical programs where the use of marijuana may be considered inconsistent with treatment goals,” stated the VA in a fit of clarity. “While patients participating in State marijuana programs must not be denied VHA services, the decisions to modify treatment plans in those situations need to be made by individual providers in partnership with their patients.”
Leadership from the Top
If there’s ever been a president who should be open to legalizing marijuana for this purpose, you’d think it would be Barack Obama, the notorious former head of the pot-smoking “Choom Gang,” while a high school student at the elite Punahou prep school in Honolulu, Hawaii. But this President has been widely seen to have led a crackdown on marijuana users now that he is president. Further confusing the matter, though, the DoJ announced it won’t challenge State marijuana laws and will focus only on serious trafficking cases.
Is marijuana effective? It seems to be – though conducting a full-scale clinical trial is very difficult due to federal restrictions. But a study done on rats from the University of Haifa indicates that a quick hit of marijuana just after a traumatic incident may even help prevent the development of PTSD symptoms…if you believe that people behave like rats.
Meanwhile, the folks down the road in Tel Aviv have discovered that sleep deprivation may also help mitigate the effects of PTSD.
How do you feel about medical marijuana and its potential usefulness in treating PTSD? Should research be allowed despite it being an illegal drug? Tell us in the comments.
VA benefits will cease as of November 1st, unless the President and Congress agree to fund the agency, or the government shutdown is resolved. That was the testimony on Wednesday, October 9th, from Secretary of Veterans Affairs Eric K. Shinseki to the House Committee on Veterans Affairs.
According to Secretary Shinseki, the Department of Veterans Affairs is due to pay out $6.25 billion in claims on November 1. But the Department has only $2 billion on hand to pay them with. The money would be used to pay tuition for GI Bill beneficiaries and for retroactive claims. Stipends of up to $1,700 per month for veterans attending school would cease. Claims processing for compensation, pension, education, vocational rehabilitation, and employment benefits will be suspended due to lack of funding. Once mandatory funds are depleted at the end of this month, nearly 5,600 Veterans a day will not receive a decision on their disability claims.
This is despite furloughing some 7,800 claims processors – an act that is already beginning to result in an increase in the stubborn backlog of past-due (more than 125 days old) claims. Half of those furloughed are veterans themselves, said Shinseki.
Additionally, if the shutdown continues through late October, compensation payments to more than 3.8 million Veterans will halt. These include thousands of Veterans who have the most severe disabilities. Payments will also stop for over 364,000 survivors and over 1,200 children receiving special benefits, such as children with spina bifida born to Vietnam Veterans and certain Korean War Veterans as well as children of women Veterans with birth defects, the Secretary said. Furthermore, pension payments will stop for almost 315,000 Veterans and over 202,000 surviving spouses and dependents.
The Secretary also said that while they still had 13,000 claims processors on the job, paid with left-over funds from FY 2013, that money would be exhausted by the end of the month. At that point, the Department of Veterans Affairs would have to lay off all but 1,500 employees. The remaining workers would be assigned to staff call centers and receive and time-stamp new benefits applications. But no more applications will be processed until the Department is funded again.
The House of Representatives has already passed a bill that would provide for partial funding of the Department of Veterans Affairs. However, Senate Majority Leader Harry Reid (D – Nevada) has indicated that his coalition will not allow the bill to come up for a vote. The President has also said that he would veto the bill if it came to his desk.
According to Shinseki’s testimony, however, full services to veterans would not restore completely even if the Department itself is fully funded. This is because the Department’s functions integrate with other federal departments that are themselves affected by the shutdown.
Shinseki’s full testimony is available here.
The House of Representatives moved to fund the Veterans Administration through the shutdown and into fiscal year 2014. The House passed the bill, H.J. Res. 72., on Thursday, October 3rd, with overwhelming Republican support. Democrat opposition was strong, but they still got 35 Democrats to sign on as well. The final vote was 259 in favor, 157 opposed.
The bill, dubbed the “Honoring Our Promise to America’s Veterans Act,” restores funding for disability compensation, monthly stipends under the GI Bill and survivors’ benefits.
The bill required a two-thirds majority for passage. It failed to pass on a first attempt on Tuesday, when just 33 House Democrats voted in favor.
The House of Representatives, controlled by Republicans, has passed a series of bills providing partial funding for various popular segments of government. This tactic puts Democrats in an uncomfortable position, as it forces Democrats to either go on record voting against funding popular government programs or provide their leadership, Sen. Harry Reid (D-NV) and President Obama, progressively less leverage with which to negotiate with Republicans to keep the Affordable Care Act intact.
“Today, more than 160 House Democrats chose to put politics before the needs of America’s veterans and their loved ones,” said Rep. Jeff Miller (R – FL) in a statement. “November payments to veterans and their survivors for a variety of earned benefits are now in jeopardy in the event of a prolonged government shutdown. Our veterans have already gone above and beyond for our nation. The last thing they deserve is for the country they courageously defended to abandon them. It’s unfortunate that some in Congress seem to be fighting to ensure that happens.”
The bill is not a complete restoration. The House did not authorize funding for IT, nor the VA Inspector General’s office, the National Cemetery Administration and for state veterans homes.
The total funding package for benefits also results in a $6 billion reduction compared to its own 2014 funding appropriation back in June, according to reporting from Rick Maze at the Military Times.
The Democratic-controlled Senate does not, however, plan to take up the bill, so its own Senators will not be forced into the vote. The White House staff has also indicated the President will veto the bill if it reaches his desk.
The House Committee on Veterans’ Affairs has scheduled a hearing tomorrow, October 9th, at 10:30 AM, to gather information and testimony regarding the impact of the shutdown on veterans and their families.
If you haven’t been living under a rock, you know that most non-essential government functions have shut down effective the start of the 2014 fiscal year, because Congress and the President were unable to agree on a budget.
I say “most” non-essential government functions, because this Administration obviously deems it critically important to its functioning that we pay a number of federal workers to erect barricades to the open-air WWII Memorial, wire them shut, and threaten our older veterans with arrest if they visit.
Commissary workers, however? They aren’t considered essential at all. At least not in the United States, though overseas commissaries will remain open.
Military pay for active duty troops will continue through the shutdown. Congress and the President agreed to fund salaries for uniformed military and selected civilian employees at the beginning of this week. However, the Secretary of Defense, Chuck Hagel, interpreted the Congressional bill to exclude members of the National Guard, including full-time military technicians. This news came as a surprise to some Congressional Republicans who passed the bill: “I believe along with many others that he has improperly furloughed the National Guard employees,” said Candice Miller, (R – Michigan). “That was certainly not the intent of the act that we passed. For them to be furloughed — I quite frankly was stunned when he did that after we passed that bill.
Is retiree pay affected?
Not directly by the shutdown. Retiree pay comes out of a different pot of money than the one Congress is fighting over now. However, even if a budget is approved, we have another Congressional battle looming over the debt limit. Unless Congress approves additional borrowing, the federal government will no longer have access to the 40 cents out of ever dollar it’s been borrowing to finance spending. At that point, all bets are off, and nearly everything goes on the table. Military retiree pay could be reduced or even eliminated under that scenario. However, our view is that the threat of such a shutdown will drive both sides in Congress to strike a deal of some sort to avoid it.
If you are distressed by money problems, or feeling depressed and suicidal, rest easy: The counselors at Military OneSource are still phoning it in. They will be happy to refer you to other federal agencies which are now closed.
If you’re stressed because you have small children and you need assistance with child care, again, all bets are off. The DoD has helpfully suggested you call your local child care activity on base for further guidance. Generally, federal Child Development Centers will remain open, according to the Military Family Association. However, school-aged care programs may be rolled back or eliminated in your area unless attached to a CDC.
DoD schools remain open.
The exchanges will be open for business. AAFES and the Navy-Marine Corps Exchange do not receive federal appropriations, so don’t rely on Congress for anything.
Tuition Assistance – the same TA benefit that the DoD tried to strangle last spring to save money, will grind to a halt. No benefits will be disbursed for new classes until further notice.
Education centers are closed. This includes computer labs and counseling centers.
MyCAA, or My Career Assistance Accounts, are closed to new requests until further notice. However, military spouses with benefits approved before October 1 are good to go. You can attend class. More information available at the SECO website here. Or call 800-342-9647.
You may see a reduction of hours at military clinics and hospitals. However, inpatient, emergency and dental care operations at TRICARE clinics will continue, as will TRICARE’s private sector operations. So you should still be able to see a non-military doctor if that provider is within the TRICARE system.
If you have an appointment you made before the shutdown, TRICARE officials encourage you to call to confirm it. Your clinic’s hours may have changed since the shutdown.
TRICARE cannot process travel claims under TRICARE Prime or TRICARE Combat-Related Specialty Care during the shutdown. You can still file, a claim, but new claims won’t be approved until the shutdown ends.