VA Health Care Eligibility Update

An update from the VA on Affordable Health Care impact on Tricare For Life veterans…

1-DSCN0200Priority category three veterans–those with VA disability ratings of 10 to 40 percent–will continue to receive cost-free VA care for any condition. Even if eligible for TRICARE-for-Life, they will not be impacted by the reimbursement changes planned for some other TFL beneficiaries who receive VA care. The only VA costs Priority 3 users face is a co-payment of $8 on outpatient medications for non-service-connected conditions.

The fact is, veterans also eligible for TRICARE have an option when they enter a VA facility to elect to be seen as a veteran or TRICARE patient, says Daryl Claggett, the Veteran Health Administration’s deputy director of e-business solutions. If a patient with a service-connected disability rated 10 percent or higher elects to be seen as a veteran, all costs will be covered except co-pays for outpatient medications as described above.

If they enter as a TRICARE for Life patient, they would be seen only if TRICARE spaces are available and they would pay the higher outpatient costs planned for TFL users at VA facilities starting Oct. 1.

Veterans rated 50 percent or higher have no costs whatsoever at VA facilities, so there would be no reason for them to elect to receive VA care as a TRICARE patient. Older military retirees enrolled in the VA medical system who have no service-connected conditions or zero-rated disabilities, have found it useful in the past to use TRICARE-for-Life benefits at VA to eliminate most out-of-pockets costs. That will be a less attractive option starting Oct. 1.

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