Introduction to Veteran Health Insurance 101
In 2016, the United States Census Bureau estimated the veteran population to be around 18.5 million. About half of these veterans are over the age of 65, making them eligible for Medicare. Of the other half, over 500,000 had no health insurance at all, according to the Census Bureau.
The number of uninsured veterans may seem small when compared to the total number of veterans overall, but it’s staggering when considering the health care options and facilities available to veterans. Some veterans may not meet a particular institution’s eligibility requirements for these services, which can include income level, veteran status and service-connected disability status, the Census Bureau reports. In other cases, veterans may not realize that they qualify for these services. Either way, many veterans may not be receiving the health care they need.
Graduates of the online Master of Public Health program at the University of Nevada, Reno, are aware of the challenges that face veterans attempting to obtain health insurance. The guidelines, restrictions and resources related to veteran health insurance are difficult to navigate, leaving these former armed service members with an unclear idea of what benefits they qualify for and how they can be used. This guide will explain several veteran health insurance options, resources for veterans when obtaining or using health insurance, as well as overall tips that can be helpful throughout the process.
Veteran Health Insurance Coverage Options
Not all veterans are given the same plan or package from the same provider when they leave the military. The health options veterans receive can depend on such factors as their time served or specific health conditions they may have. Below is a list of veteran health programs and what types of insurance, coverage or resources they offer.
TRICARE describes itself as the “health care program for uniformed service members, retirees and their families around the world.” This means that not only do uniformed service members qualify for TRICARE insurance, but their spouses and children do as well. Other individuals, such as National Guard/Reserve members or Medal of Honor recipients and their families, are also eligible. TRICARE offers 11 different coverage plans, each offering benefits that can address a veteran’s personal or family health needs.
Eligibility status for these veteran health insurance programs can differ, but for family members, it is required that they be registered in the Defense Enrollment Eligibility Reporting System, or DEERS. Military members or their families may lose TRICARE eligibility for a number of reasons, including service members who leave duty before completing their service or adult children who age out of the program. In addition to health plans, TRICARE also offers dental coverage and access to other programs, such as computer/electronic accommodations, chiropractic health and cancer clinical trials.
One of the requirements for CHAMPVA is that beneficiaries are not deemed eligible under any of TRICARE’s categories. CHAMPVA has specific guidelines for who can be eligible for veteran health insurance, only allowing coverage for the following individuals, according to VeteranAid.org:
- The spouse or child of a veteran who has been rated by a VA regional office as permanently and totally disabled for a service-connected disability.
- The surviving spouse or child of a veteran who died from a VA-rated service-connected disability.
- The surviving spouse or child of a veteran who was at the time of death rated permanently and totally disabled from a service-connected disability.
- The surviving spouse or child of a military member who died in the line of duty, not due to misconduct (in most of these cases, these family members are eligible for TRICARE, not CHAMPVA).
CHAMPVA also covers most health insurance services and supplies “that are medically and psychologically necessary,” according to the National Veterans Foundation.
This veteran health insurance plan covers access to care that can treat illnesses and injuries, improve a veteran’s ability to function and enhance his or her quality of life. This plan can also potentially provide additional benefits depending on priority group and advice of a VA primary care provider. These services can range from regular health exams to specialized surgeries. Care is offered at VA associations across the country. Certain VA health benefits can also be used with other health programs like Medicare, Medicaid and TRICARE. Additionally, VA health benefits can potentially be used in conjunction with other private, nonmilitary health insurance plans. For example, a veteran who receives health insurance benefits through his or her current employer may also be able to use benefits from VA Health Care.
According to VA Health Care’s website, this health coverage is available to veterans who enlisted after September 7, 1980, or entered active duty after October 16, 1981; were not dishonorably discharged; and served in the military. Special circumstances may also impact eligibility, such as if a service member was discharged because of a disability caused by or made worse through his or her duty service, was discharged for a hardship or “early out” or served before September 8, 1980. For members of the Reserves or National Guard, it is a requirement that these individuals have been called to active duty and completed the full period for which they were called to qualify for this insurance.
Even though veterans have access to specialized health resources, they are still eligible for larger, nonmilitary health plans like Medicare or Medicaid. Medicare is available to permanent legal residents who are 65 or older and individuals younger than 65 who meet certain conditions. According to its website, Medicaid is a program for “low-income people, families and children, pregnant women, the elderly and people with disabilities.” Veterans could qualify for Medicaid if they fall below a certain income level. These options alone, though, may not offer the extensive level of coverage or resources provided by earlier examples of insurance plans for veterans.
This is a specialized program offered by the U.S. Department of Veterans Affairs (VA) for “certain Korea and Vietnam Veterans’ birth children who have been diagnosed with spina bifida (SB).” According to the program’s website, provisions included are monetary allowances, vocational training and rehabilitation as well as health care coverage. Pharmacy benefits are also offered through the Meds by Mail program, in which medication is delivered to a beneficiary’s home.
Eligible beneficiaries who wish to file a claim can do so by following the instructions on the program’s website.
Veteran Health Insurance Resources
After veterans sign up for a health insurance plan that is suited to their needs, they may still have questions about their coverage and benefits or about the assistance available to them in general. The following resources can help them with any concerns they have about their veteran health insurance.
This online platform allows veterans to refill their prescriptions, track and manage medical appointments, communicate with their health care team and access pertinent health records, all from the comfort of their own home. Additionally, My HealtheVet offers links to specific benefits information, offers helpful mental health tips and resources, and provides newsworthy items related to health and wellness.
Making the leap from active duty to civilian life can cause mental strain for many military members and soon-to-be veterans. This free program, offered by TRICARE, offers coaching, assistance and other mental health care services to military members, veterans and other individuals when they are:
- Relocating to another assignment
- Returning from deployment
- Transitioning from active duty to reserve component or reserve component to active duty
- Preparing to leave military service
- In need of their first or a new mental health provider
The program is available to all military members, regardless of time served or discharge status.
The Military Crisis Line offers immediate support via phone, text message and chat for military members who are experiencing a crisis and/or emotional or mental difficulties. The completely confidential service does not require the veteran to currently hold health insurance and is available 24 hours a day, seven days a week. For veterans or military members located overseas, there are also additional call-in options to reach the service. The Military Crisis Line also offers additional information about suicide prevention and mental health for each branch of the armed forces.
According to the VA’s website, post-traumatic stress disorder (PTSD) is a condition that has afflicted between 11% and 20% of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans and roughly 12% of Gulf War (Desert Storm) veterans. For Vietnam War veterans, it is estimated that around 30% have experienced PTSD at some point in their lives.
Access to veteran health insurance benefits has enabled many of these former service members suffering from PTSD to receive treatment. Unfortunately, the treatment makes it difficult for some veteran families to stay afloat and pay their bills. USA Cares helps pay essential household bills like utilities, food, mortgage and automobile payments to these families in need. Families interested in the program can apply online. USA Cares will then contact qualified families to discuss their needs and current hardship. The case will then be submitted for further review by an impartial committee. If approved, USA Cares will notify the family that checks are being sent to pay specific bills.
Military members can use this online video resource to discover the stories of other individuals who experienced combat or faced issues similar to their own, even before they leave the service or acquire health insurance. For example, someone who served in the Navy during the Vietnam War and experienced combat can listen to other individuals who share those traits offer their advice and experiences. Similarly, someone who served from 2001 to the present in the Marine Corps but did not experience combat can also discover specific, shared experiences, advice and guidance.
Veteran Health Insurance Tips
Even with the options available, there may be certain challenges or conflicts former members of the military experience when obtaining or using their insurance. These tips can help veterans navigate and resolve those issues.
Keep information updated in DEERS
Registering beneficiaries for DEERS is a requirement for TRICARE, but many military members can forget to update that information. This can prove troublesome when trying to use insurance after experiencing a qualifying life event, such as moving to a new city or marrying or divorcing a spouse. Make sure to update this information accurately and as needed.
Do your research and have all necessary documentation on hand when asking insurance questions
The military operates by clearly defined rules and procedures. Usually this leads to enhanced organization, but it also generates a lot of paperwork. This may lead to veterans and military members wasting visits to address insurance inquiries, simply because they didn’t have the proper materials on hand. Research your particular question and case far ahead of any appointment or consultation you may have.
For example, a veteran health organization may require that patients provide two forms of approved identification when making an appointment to discuss insurance-related questions. But, a veteran may be uncertain about what forms of ID are considered “approved.” Does it have to be specific government-issued forms of identification with a veteran’s name, birthdate and photo on it (a driver’s license or passport)? Or are other forms of ID (a birth certificate or Social Security card) acceptable? Doing the research and finding out that information ahead of time can save veterans unnecessary headaches or hiccups.
Don’t be afraid to ask questions or seek out other sources for answers
Just like there’s nothing wrong with being displeased by the diagnosis from one doctor and wanting to get a second opinion from another, there’s also nothing wrong with asking questions of individuals providing information related to health insurance or seeking out new answers within the available resources.
For example, a person who helps administer TRICARE plans is probably very knowledgeable about those programs but may not be aware of a new benefit added to a VA health care plan that could be a better option for a particular veteran. A health practitioner working with a CHAMPVA-insured patient in a rural area might direct the patient to get a prescription filled at a pharmacy that is 100 miles away, unaware that the prescription could be delivered through Meds by Mail.
The health practitioners and administrators who assist veterans with their health insurance concerns are knowledgeable and generally aim to help, but if there’s ever a situation where you feel a better option or alternative exists regarding your veteran health insurance, there are plenty of resources available to help you find that solution.
The online Master of Public Health program at the University of Nevada, Reno, provides students with advanced skills and knowledge in health program planning, outreach, management and execution to help former service members obtain necessary care and lead fulfilling lives.