VA Copays Are Going Up! Are You Affected? Take A Look!
Inflation is affecting everyone and everything, and the Veterans Administration is no exception. So, if you go to the VA for your healthcare, then pay attention, because you may be paying more. And, if you are in that category and you are 65 or older, there is something you can do.
First, the good news. If you get a flu shot each year, no matter what priority group you may be in or your disability rating, it will remain at $0 copay to you. Hey, we’ll take whatever we can get!
There are five (5) categories to look at and consider. They are:
Let’s look at these.
There are two criteria which decide what copays you pay, if any. They are your disability rating (if any) and priority group you fall under.
There are two kinds of disability ratings:
If a veteran who served during a war-time period has an injury or illness after active-duty service that prevents him or her from working (a stroke, for example), he or she can request a non-service-connected disability pension. This is also known as a VA or Widower’s pension.
However, this disability rating is NOT service connected, hence you will have copays if using VA healthcare, unless you are means tested and qualify via income level for free healthcare.
Urgent care is care for minor illnesses and injuries. To be eligible for urgent care coverage, you must have been receiving VA healthcare for 24 months. Once you qualify, there is no limit to how often you can receive urgent care at a VA health facility or an approved community clinic.
Outpatient care is considered primary or specialty care that does not require the veteran to remain in the hospital overnight. In essence, any care that is not considered urgent care.
If you have a 10% service-connected disability rating, YOU DO NOT HAVE TO PAY A COPAY. Non-service connected ratings or any condition not connected to your service may be required to pay the following copays (and I use may, because if you are means tested and qualify for no-cost care, you won’t pay a copay).
Other services in this category where you won’t pay a copay include for:
Inpatient care is care that requires you to remain in the hospital. If you have a 10% or higher service-connected disability rating, you won’t pay any copays.
If you belong to priority groups 7 or 8, you will either pay a full or reduced copay rate. However, if you live in a high cost of living area, you may qualify for a reduced rate, no matter in which priority group you belong. If you’re not sure if you qualify, you can call (877) 222-8387 (TTY: 711) to find out.
Medication copay rates vary by the priority group you belong to and which tier the prescription falls under. Unlike Medicare Advantage, where typically tiers 1 and 2 (the generic tiers) have a $0 copay, the VA has their own unique structure. It has a four (4) tier system with a Tier 0, versus a five (5) or six (6) tier Medicare Advantage structure. There is a $700 MOOP (Maximum Out Of Pocket Limit) for medications. Once you’ve spent $700 within a calendar year, you pay nothing until the following year.
NOTE: Also, if you receive any medications while in inpatient care, whether at a VA facility or approved community facility, you will pay NO copays, as it’s considered care provided by your hospital stay.
Elder care and long-term care are available through the VA. Like many Skilled Nursing Facility policies in Medicare Advantage plans, the first 21 days of a 12-month period are at no cost (20 days for Medicare Advantage plans). However, on day 22, the following copays may apply depending on the level of care you are receiving and income qualifications.
If you are not sure if you qualify for no-cost care, submit your financial information via form 10-10EC (click here to download the form).
If you fall under priority groups 7 or 8 and do not qualify for reduced or no-cost care, and you are either:
…you may consider using a Medicare Advantage plan. Why? Most Medicare Advantage plans offer:
So, there you have it. The new Copay Rates for 2023 and what you can do about it, if it affects your budget. If you have any questions, please feel free to leave a comment below or reach out to us via our CONTACT page. There is never a charge for any of our service! We would love to answer your questions and help you. Thank you for your service!
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