VA Community Care and Medicare: Explained

Learn About The VA Mission Act.

As of June 6, 2019, the Trump administration signed the VA Mission Act into law. This is a big step toward making sure that veterans have better access to health care. The law changed the older VA Choice Program into the bigger VA Community Care Program. This change aimed to give veterans benefits and more healthcare choices besides the VA medical facilities.

Because of this law, veterans who may have trouble getting veterans benefits administration services because of distance, wait times, or lack of services can now get care from providers outside the VA system. This project expands the types of care available and makes sure that all veterans can get the medical care they need, no matter how close they live to VA hospitals.

How Does The VA Mission Act Provide Veterans Benefits?

The VA Mission Act greatly improves the healthcare choices that veterans have. Veterans can still get care directly from VA facilities and doctors. Still, this program gives them an important alternative: they can get care from approved healthcare providers in their communities. Veterans who meet the requirements for this program and get approval from the VA can get medical care from non-VA doctors who are part of the VA’s community care network.

Service Coverage

The urgent care benefit covers non-emergency visits to urgent care facilities and walk-in health clinics for issues like coughs and colds, sprains, sore throats, painful urination, wheezing, bumps and bruises, ear pain, and mild skin irritations. The benefit does not cover preventative care or dental care.

Urgent care is a handy way to treat non-emergency symptoms, but free benefits for veterans should always talk to or see their primary care provider if they are worried that the community provider will not understand their complicated medical history or medications.

Also, right away, call 911 or go to the nearest emergency room if you think your life or health is in danger.

Urgent care does not replace a Veteran’s preventive health care if they are qualified. Veterans who are eligible should get this care from their main care provider. Veterans who are eligible may have to pay the full cost of care if they go to an urgent care center and get treatments that are not covered by this benefit.

Financial Impact: Understanding Priority Groups and Copays

The program also considers the financial impact on veterans by categorizing them into eight priority groups, determining whether they must pay copays for services.

Veterans who are eligible may have to pay a different VA co-payment for quick care than for other types of medical care. The amount of money the veterans benefits administration near me pays for urgent care depends on the Veteran’s priority group and how many times they go to an in-network urgent care provider in a year.

• Priority Groups 1-5. You do not have to pay anything for the first three visits in a year. The co-payment is $30 for the fourth visit and every visit after that in a year.
• Priority Group 6. You do not have to pay anything for the first three visits in a year if they are linked to special authority or exposure. The co-payment is $30 for the fourth visit and every visit after that in a year. The co-payment is $30 per visit, no matter which visit it is, as long as it has nothing to do with special power or exposure.
• Priority Groups 7-8. The co-payment is $30 per visit.
• Priority Groups 1-8. You don’t have to make a co-payment for a flu shot-only visit. Visits that only involve getting a flu shot don’t count toward the total number of visits allowed in a calendar year.

Qualifying for the VA Community Care Program

Veterans must meet certain requirements in order to be eligible for the VA Community Care Program. This makes sure that the program is only offered to people who really need it. Here are the qualifications:

Established in the VA System

Veterans must already receive care through the VA system to qualify for the Community Care Program.

Six Approved Qualifications

• Unavailability of Required Service: If a veteran needs a service not offered at a VA medical facility, they may qualify for community care.
• Residency in Certain Locations: Veterans who live in U.S. states or territories without a full-service VA medical facility, such as Alaska, Hawaii, or Guam, can access care through the community care network.
• Grandfather Provision: Veterans covered under the VA Choice Program can continue receiving care under the community care program.
• Access Standards: Veterans who cannot receive care within certain access standards—such as a 30-minute average drive time for primary care or a 20-day wait for an appointment—may qualify for community care. For specialty care, the drive time extends to 60 minutes, with a 28-day wait time limit.
• Best Medical Interest: If it is in the Veteran’s best medical interest to receive care outside the VA, they may qualify for this program.
• Quality Standards: The Veteran may be eligible for community care if the VA service line does not meet specific quality standards.

Please Note: It’s crucial to note that the VA must authorize any community care services before a veteran can access them.

Conclusion

The VA Mission Act created the VA Community Care Program, which is a big step forward in the health care choices for veterans benefits. This program solves many of the problems they have getting medical care by making the network of healthcare providers bigger and letting them get care closer to home. With the broad qualifying requirements and safety nets in place, the VA Mission Act makes sure that veterans get the care they need, whether it is through the VA system or community healthcare providers.

At LMS Insurance Group, our aim is to assist individuals in comprehending Medicare in order to make decisions that are best for their healthcare needs. Veterans interested in gaining further insight into these options are motivated to find out if they are eligible and make sure they can get the care they need without any delays or problems.