Guide To VA Health Benefits for Veterans
The U. S. Department of Veterans Affairs is committed to ensuring the best possible physical and mental health for America’s veterans. The VA devotes considerable resources each year to ensure that veterans have access to a wide variety of health care options.
If you are a U.S. military veteran, it’s certainly worth your time to familiarize yourself with the full range of health care resources the VA makes available to you. Today’s veterans receive a comprehensive medical benefits package, which generally is administered through the VA’s patient enrollment program.
10 VA Health Benefits for Veterans
The VA administers many different programs designed to make sure eligible veterans have access to health care coverage for high quality physical and mental health resources. We’ve outlined some of the most common health insurance benefits below:
- Mental Health Services
- Women Veterans Health Care
- Preventive Care
- Inpatient Hospital Services
- Outpatient Care
- Social Work Services
- Urgent and Emergency Care
- Community Care
- Long-Term Care
- Prescription Drugs
Through the Veterans Health Administration, the VA offers a range of health care services and health insurance options for eligible veterans. The VA operates a network of 168 medical centers, more than 1,000 outpatient clinics, 250 brick-and-mortar pharmacies, and seven mail-order pharmacies – which deliver roughly 80% of the program’s prescriptions. The VA employs more than 200,000 health care professionals to care for America’s veterans, including doctors, pharmacists, and other providers.
The VA health system covers approximately 9 million of the roughly 22 million veterans across the country.
1. Mental Health Services
The VA offers mental health services for veterans that include treatment for posttraumatic stress disorder, anxiety, psychological effects of military sexual trauma, depression, grief, substance abuse, and other needs. Services may take the form of therapy, peer support with other veterans, medication, counseling, or a combination of any of these. The VA’s goal is for the veteran to actively participate in shaping the course of treatment. More than 1.7 U.S. veterans take advantage of these services each year. It’s also important to note that mental health services are available to all U.S. veterans, regardless of whether they are enrolled in VA health insurance. Veterans have access to some mental health services, regardless of their enrollment status or eligibility, discharge status, or active duty service history.
To access these vital mental health services, a veteran may call or visit any VA medical center at any time during the day or night, call or visit their nearest VA health facility, or call or visit any Vet Center during its regularly scheduled clinic hours.
VA-provided mental health services also encompass the veterans crisis line: 800-273-8255. Help is available 24 hours a day for veterans who need immediate assistance with acute mental health needs. The crisis line is staffed by qualified crisis line responders, many of whom also are veterans themselves.
2. Women Veterans Health Care
Women are the fastest-growing group within America’s veteran population and have unique health care needs. Women who qualify for VA health insurance have access to high-quality women’s health services including birth control, preconception counseling, and menopausal support. Cervical cancer screens and breast cancer screens are also available, as well as general services, disease prevention, and nutrition counseling.
Women veterans can receive maternity care and other reproductive health services and treatment for sexual issues, urinary incontinence, and many other physical and mental health conditions.
Each VA medical center has at least one Women Veterans Program Manager, who can help women veterans understand and connect to the health resources they’re eligible for. In some cases, even if a woman veteran isn’t currently enrolled in VA health care benefits, she may still be eligible for some resources under the umbrella of women veterans health care.
3. Preventive Care
The VA strives to provide veterans with the tools they need to stay healthy and avoid illness or injury. Part of that process is good preventive care. The VA covers preventive care services, including regular health exams/check-ups, health and nutrition education, immunization against infectious diseases like the flu, and genetic counseling.
4. Inpatient Hospital Services
VA health insurance covers a veteran’s inpatient hospital services, including most surgeries and in-hospital medical treatments, and kidney dialysis. Most acute care is also covered for short-term, in-hospital treatment for severe injury or illness, or recovery after surgery. This may also include specialized care like organ transplants, intensive care treatment for both mental and physical health conditions, and intensive care for traumatic injuries.
In addition, through the VA’s specialty care services, eligible veterans have access to a wide array of specialized treatments ranging from bariatric surgery and dermatology to orthopedic surgery, organ transplants, and robotic-assisted surgeries.
5. Outpatient Care
Outpatient care typically covers medical services or tests that are carried out in a medical center without requiring the veteran to stay overnight. Many outpatient clinic procedures can be completed in just a few hours. This type of care may include diagnostic tests, such as lab tests, MRI or CT scans, wellness and prevention activities like weight-loss programs and counseling, some minor surgeries, chemotherapy, and rehabilitative services like physical or occupational therapy or drug and alcohol rehabilitation.
Many times, outpatient services can be accessed through VA community-based outpatient clinics or VetCenters.
6. Social Work Services
The VA typically provides the assistance of social workers as part of all patient treatment programs, including community outpatient clinics. These essential members of a patient’s medical team provide both social and clinical services to eligible veterans and their families, helping process the social, emotional, and economic stresses that accompany illness. Social workers may help veterans through individual, group, or family treatment as they move through their continuum of care.
In addition, VA patient advocates are positioned to advise veterans and their families who may need foreign language services to help them fully understand their health care benefits, medical conditions, and treatment plans.
7. Urgent and Emergency Care
VA health insurance coverage typically encompasses urgent and/or emergency care at VA facilities. In addition, care received for injuries and illnesses that need immediate attention, but aren’t life threatening, from urgent care locations that are part of the VA’s approved network of health care partners.
These partners may include walk-in retail health clinics – for minor illnesses like an earache or upper respiratory infection – or urgent care facilities for more concerning, but not life-threatening, illnesses or injuries that require treatment. These types of situations may include a need for wound care, splinting or casting, etc.
In some cases, emergency care received in a non-VA hospital, clinic, or other medical setting may also be covered under VA health insurance.
8. Community Care
In most cases, the VA prefers to cover medical services and procedures that are accessed through VA medical facilities. However, in some cases, this may not be possible, depending on the veteran and the specific medical needs involved. In these cases, the VA may cover care through another provider in the veteran’s local community.
Typically, a veteran must request approval from the VA before receiving care from a community provider to avoid being billed for any medical services accessed. VA staff members make eligibility determinations for community care.
To be eligible for community care, a veteran must either be enrolled in VA health care or be eligible for VA health insurance without needing to enroll. In addition, the VA will consider the veteran’s specific health circumstances and specific needs.
There typically are six circumstances that may automatically qualify a veteran for community care, as follow:
- The veteran’s medical condition requires a service not available in a VA health care facility
- The veteran lives in an area not serviced by a VA health care facility
- The veteran qualifies under the Grandfather Provision of distance eligibility for VCP
- The VA is unable to provide care within specified drive time and wait time standards
- Seeing a community provider is in the veteran’s best medical interests
- A VA service line cannot meet quality standards
Eligible veterans can make an appointment with a community provider within the VA’s approved network and receive necessary medical care. The community provider will send the bill for services to a third-party administrator or directly to the VA for payment.
9. Long-Term Care
VA health care services also help eligible veterans access long-term and residential health care. Such services include round-the-clock nursing care, pain management, and physical therapy. The VA also provides assistance with day-to-day tasks including bathing, dressing, taking medicine, and preparing meals.
Support is available for caregivers who may need skilled medical assistance or a break from caregiving so they can work, travel, or run errands.
The setting for this type of care may vary widely. Some services may be available in VA health facilities, while others may be accessed through state or community organizations that the VA has inspected and approved. Other services may be offered in the veteran’s own home using VA-approved health care providers.
To be found eligible for these health care benefits, the veteran must be enrolled in VA health care, and the VA must have determined that the veteran requires a specific service to advance ongoing treatment and personal care.
10. Prescription Drugs
All eligible veterans who enroll in VA health coverage also may receive coverage for prescription drugs – these prescriptions may be filled through the VA, through a civilian pharmacy, or by mail. There is no premium associated with this coverage, and co-payments are approximately $8 – the VA also may cap copayments for some veterans. With VA-provided digital tools, eligible veterans also may refill VA prescriptions, track shipping and delivery, and even create lists to organize medications online.
Eligibility Requirements for VA Health Benefits
Eligibility for VA medical benefits depends on several factors. First, the VA will consider active duty military service. Generally, veterans who served in the active military and received a discharge other than dishonorable will be eligible for VA health care benefits.
In addition, veterans who enlisted after September 7, 1980, or began active duty service after October 16, 1981, must have served 24 continuous months or the full duration for which they were called to active duty, with the following exceptions:
- The veteran separated from military service because of a disability that was caused or exacerbated by active-duty service
- The veteran separated from military service due to a hardship or “early out”
- The veteran served in the U.S. military prior to September 7, 1980
Higher Priority Groups
If any of the following are true, a veteran may be placed into a higher priority group, meaning they are more likely to be approved for VA medical benefits:
- The veteran receives disability compensation from the VA for a service-connected disability
- The veteran separated from service because of a disability resulting from service
- The veteran was discharged for a disability that became worse during the time of service
- The veteran is a recently discharged combat veteran
- The veteran receives a VA pension
- The veteran is a former prisoner of war
- The veteran has received a Purple Heart
- The veteran is a Medal of Honor recipient
- The veteran receives or qualifies for Medicaid benefits
- The veteran served in Vietnam between January 9, 1962, and May 7, 1975
- The veteran served in Southwest Asia during the Gulf War between August 2, 1990, and November 11, 1998
- The veteran completed at least 30 days of service at Camp Lejeune between August 1, 1953, and December 31, 1987
Applying for VA Health Benefits
The VA makes it easy to apply for VA medical benefits in several different ways. The easiest way is to apply for your VA benefits online. You also may apply over the phone at 877-222-8387, Monday through Friday, 8 a.m. to 8 p.m. If you apply over the phone, you can talk through the process with someone and get assistance with your application.
You can also apply by mail by downloading and completing the Application for Health Benefits. Once complete, you can mail it to the following address:
Health Eligibility Center
2957 Clairmont Rd.
Atlanta, GA 30329
You also may apply for your VA health care benefits in person – simply bring your completed application to your nearest VA hospital or clinic, or your state’s Department of Veterans Affairs.
What Happens After I Apply for VA Health Benefits?
After you submit your application, you should hear back within a week to learn whether your application has been approved. Once approved, you’ll also receive a welcome call from the VA, along with a welcome packet including a handbook and your VA medical benefits ID card. At that point, you will be able to begin making medical appointments and receiving the medical services and care you need.