By Larry Dandridge
Last week’s article in The Island News provided most of the answers to the following two questions “Can I get free VA health care as a Veteran?” and “Will I need to pay for any of my care, tests, or medications?”
Readers should remember, whether or not a veteran will need to pay copays and how much they pay depends on their disability rating, income level, military service record, and to which of the VA’s eight priority groups the VA assigns the veteran.
The VA provides free healthcare for conditions related to military service and for veterans with catastrophic disabilities and service-connected disability ratings of at least 50%, as well as for those veterans who cannot afford to pay for care.
The Island News readers should now understand that there is a huge amount of information available on what VA healthcare services are free and what healthcare, tests, and medications require copays. However, nothing can substitute for veterans and their family members using a Veterans Service Officer (VSO) to advise them, reading the information at www.va.gov in general, and reading the many websites referenced in this week’s and last week’s articles.
Steps to better understanding VA healthcare benefits, costs, and copays
Step 1 – Meet with a VSO: Ask the VSO to explain what your and your spouse’s/dependents’ VA benefits are, especially your service-connected benefits (like disability compensation) and healthcare benefits. Ask the VSO to help you apply for VA healthcare, disability compensation, and other veterans (federal and state) benefits.
Step 2 – Apply for VA Healthcare: Read everything at https://bit.ly/3BdTGxN and https://bit.ly/3B7x5Dz. These sites will explain eligibility requirements, the information you need to gather (DD214, insurance cards, last year’s gross household income, and your deductible expenses last year, etc.), and how to apply. Do this even if you have private health insurance, are retired military, and have Medicare and Tricare for Life. Do this if you have Medicare and Medicaid, are wealthy, are male or female, and are or were a private or a general.
Step 3 – Read everything: Read everything at https://bit.ly/3RrzmPi and the references at that website and then apply for all of your VA service-connected disabilities. Find or get a copy of your DD214 military discharge (Separation Papers) and other records and evidence that your VSO tells you to assemble. For example, gather copies of your social security account number, Purple Heart Awards, military medical records, VA medical records, civilian medical records, military personnel records, pictures, military performance appraisals, accident reports, line-of-duty investigation reports, etc. Make an inventory of all of your service-connected injuries, wounds, diseases, medical conditions, scars, and Hazardous Material (HAZMAT) Exposures (Agent Orange, Radiation, Burn Pits, Asbestos, etc.). Your VSO will guide you through this step-by-step.
Step 4 – Read everything: Read everything on VA Healthcare at www.va.gov. Especially read everything at the following VA websites:
- How the VA determines copays https://bit.ly/3N9QQjI.
- Copay rates https://bit.ly/3N9vBP8.
- How to review and pay your copay bill (online, by mail, or in person), how to request financial help, dispute charges, and more at https://bit.ly/3nlwfOY.
- VA health Benefits Annual income limits https://bit.ly/43YpB1n.
- Free mental health care https://bit.ly/3H8KAoE.
- Free services for military sexual trauma https://bit.ly/3V0zcAJ.
- Free health issues related to service history https://bit.ly/3HaXyCm.
- More free VA services https://bit.ly/3N9hhWL.
- Exposure to Hazards Materials https://bit.ly/3Rrz3E8.
- Copays for Maternity Care at https://bit.ly/3ne3jbL.
More on copays
Outpatient care copays are for veterans who are NOT exempt from copays due to their disability rating, income level, or special eligibility factors. See https://www.va.gov/health-care/copay-rates/.
Sample 2023 Copays
Sample 1 – Outpatient Care Copay Rates.
Outpatient Care Copay Rate for Primary Care Services is $15.
Specialty Care Services (Surgeon, Hearing Specialist, etc.) Copay Rate is $50.
Specialty Tests Copay (MRI, CT scan, etc.) is $50.
Sample 2 – Medication Copay Rates.
If a veteran is in priority group 1, he or she will not pay a copay for any medications. Veterans may be in priority group 1 if:
- The VA rated their service-connected disability at 50% or more disabling, or
- The VA determined that the veteran can’t work because of their service-connected disability (unemployable), or
- If the veteran received the Medal of Honor. Learn about Priority Groups at https://www.va.gov/health-care/eligibility/priority-groups/.
If a veteran is in priority groups 2 through 8, they may pay a copay for these types of medications:
- Medications the veteran’s provider prescribes to treat non-service-connected conditions, and
- Over-the-counter medications (like aspirin or cough syrup) that the veteran gets from a VA pharmacy.
The costs for any medications a veteran receive while staying in a VA or other approved health facility are covered by the veteran’s inpatient care copay.
The amount veterans pay for these medications will depend on the “tier” of the medication and the amount of medication they are getting, which the VA determine by days of supply. Once the veteran has been charged $700 in medication copays within a calendar year, the veteran will not have to pay any more that year. If the veteran has a service-connected rating of 40% or less and his or her income falls at or below the national income limits for receiving free medications, the veteran should provide their income information to the VA to determine if they qualify for free medications.
Copay charts are too many to publish in this article. Go to https://www.va.gov/health-care/copay-rates/ to see 2023 outpatient medication Tier copay rates, urgent care copay rates, inpatient copay rates, geriatric and extended care copay rates, and services that do not require a copay. All of the VA copay rates are reasonable compared to civilian healthcare costs.
Find a VSO
Find S.C. County VSOs at https://scdva.sc.gov/county-veterans-affairs-offices. Find at Ga. Veterans Service Offices at https://veterans.georgia.gov/locations/veterans-field-service-office-near-you. Read about VA Accredited representatives at https://www.benefits.va.gov/vso/. Some local VSOs are listed below.
- Beaufort County DAV Chapter VSO M. Vergantino, 843-301-2543 and mlv1030@gmail.com. Beaufort County VSO C. Wedler, 843-255- 6880, FAX 843-255- 9445 or 6880, cwedler@bcgov.net.
- Colleton VSO J. Smith, 843- 549-1412, cvao@colletoncounty.org; Jasper VSO A. Jenkins, 843-726-7727, ajenkins@jaspercountysc.gov; and Hampton VSO S. Johnson, 803-914-2085/2087, sjohnson@hamptoncountysc.org.
- Charleston VSO D. LeBlanc, 843-974-6360, vaoffice@charlestoncounty.org; Berkeley County VSO G. Baxley, 843-377-8506, gerald.baxley@berkeleycountysc.gov; A. Legion VSO Hollywood C. Tupper, 843 709-7523, Charles.R.Tupper@gmail.com; Dorchester VSO J. Brown, 843-832-0050, JKBrown@dorchestercountysc.gov.
- Savannah Ga. VSO M. Rivera, 912-920-0214, Ext. 412194, Miguel.rivera5@va.gov; Hinesville, Ga. VSO S. Daniels, Daniels@vs.state.ga.us, Isaac, 912-408-2948.
Final thought
The author cannot emphasize enough how important it is for all veterans and veterans’ spouses, dependents, and caregivers to read the information at https://www.va.gov/health-care/copay-rates/.
Larry Dandridge is a Vietnam War wounded warrior, disabled veteran, ex-Enlisted Infantryman, ex-Warrant Officer Pilot, and retired Lt. Colonel. He is a past Veterans Service Officer, a Patient Adviser at the RHJ VA Hospital, the Fisher House Charleston Good Will Ambassador, and the VP for Veteran Affairs for the local Army Association Chapter. Larry is the author of the award-winning book Blades of Thunder and a contributing free-lance writer with the Island News. Contact him at LDandridge@earthlink.net or 843-276-7164.
