ACA Letter From the VA

[Buckeye]

I received an ACA information letter from the VA because I am enrolled in VA healthcare. DH and I also have a high deductible individual policy with Humana because we want to have choices and we don't trust the VA to cover emergency charges due to some random accident far from a VA facility.

It's a good letter except it leaves out the important tidbit of information that we become ineligible for any subsidy if we purchase individual insurance while still being enrolled in the VA healthcare system. Since they mentioned private health insurance in the paragraph copied below, they probably should have added a word of warning about the subsidy. I've added the emphasis on the mention of private health insurance.

How is my VA health care coverage affected?
Nothing in the health law changes your VA care benefits. You can continue to use VA for all of your health care needs or complement your VA care with private health insurance or coverage by other federal health care programs, including Medicare, Medicaid, and TRICARE.

I called the number provided on the letter and spoke to a VA representative. She confirmed we would be ineligible for the subsidy if we remained enrolled with VA and purchased individual insurance. She wasn't concerned the information was not specifically stated in the letter because "when people call to get information about ACA, we'll let them know about the subsidy."

I told her the letter explained things well so people may not feel the need to call in and ask questions. She agreed to notify whoever that it might be a good idea to include information about being ineligible for the subsidy in future mailings.

[Buck2520]

I got the letter also, but I thought it did mention somewhere that if you bought a policy from the exchange and had VA coverage, you would not be eligible for the subsidy. Will have to recheck the letter (if I didn't round file it). It did mention you could disenroll in VA coverage and buy a policy from the exchange. This seems to be their standard answer if you question them about wanting a private policy to guard against the possible emergency care loophole many of us fear.

[Buckeye]

Quote:

Originally Posted by Buck2520 I got the letter also, but I thought it did mention somewhere that if you bought a policy from the exchange and had VA coverage, you would not be eligible for the subsidy. Will have to recheck the letter (if I didn't round file it). It did mention you could disenroll in VA coverage and buy a policy from the exchange. This seems to be their standard answer if you question them about wanting a private policy to guard against the possible emergency care loophole many of us fear.

The only reference I saw to the Marketplace was for family members to obtain coverage but maybe your letter is different than mine.

I have attached a copy of the letter I received. Interesting that I received the letter Sept 9th and the letter is dated Sept 9th.

[Tadpole]

We received the letter to as did many of my friends. The letter was not the only thing in the envelope. A application was enclosed (my husband is already enrolled) and a FAQ was also enclosed. The FAQ had the question and answer about subsidies. I was a bit put off by the entire thing because, even though it said that if you signed up you would become ineligible for subsidies, it did so in an indirect, somewhere in the package sort of way. People might not read past the letter and the word "free". It seems heartless to try to sign up veterans that live at large distances from any facilities they can use under the VA system. They sign up and then realize they really need ACA but can't afford it because they lost the subsidy. (I guess you can un-sign up but I don't know.)

After our initial outrage, my husband and I got to talking. Signing up for VA health care is a way around the mandate but what happens if you are in an accident and end up in the emergency room of the local hospital undergoing surgery to reattach your leg? Do you await transport and risk the leg or does the VA act as your insurer at the local hospital or do you end up with one whopping uninsured bill?

[Buckeye]

Quote:

Originally Posted by Tadpole We received the letter to as did many of my friends. The letter was not the only thing in the envelope. A application was enclosed (my husband is already enrolled) and a FAQ was also enclosed. The FAQ had the question and answer about subsidies. I was a bit put off by the entire thing because, even though it said that if you signed up you would become ineligible for subsidies, it did so in an indirect, somewhere in the package sort of way. People might not read past the letter and the word "free". It seems heartless to try to sign up veterans that live at large distances from any facilities they can use under the VA system. They sign up and then realize they really need ACA but can't afford it because they lost the subsidy. (I guess you can un-sign up but I don't know.) After our initial outrage, my husband and I got to talking. Signing up for VA health care is a way around the mandate but what happens if you are in an accident and end up in the emergency room of the local hospital undergoing surgery to reattach your leg? Do you await transport and risk the leg or does the VA act as your insurer at the local hospital or do you end up with one whopping uninsured bill?

My letter says 'enclosures' but I'm pretty sure the letter was the only document in the envelope.

When I mentioned to the representative that we carried individual insurance due to emergency situations, she didn't understand why we would do that 'because you just need to notify the VA about the emergency within 72 hours and they will decide whether to cover the charges." I responded, "I could run up $100,000 in hospital fees in 72 hours and then the VA could decide not to cover me, right?" She responded, " Well, I suppose so."

[Buck2520]

Here is some information on VA care outside the VA system from another discussion thread a while back. Search threads for "ACA and VA care" for full discussion.


I recently sent in this message to the VA and got the following response. Guess it is settled for now. I will keep my VA coverage and obtain health coverage for my spouse on the exchange, even though we pay the same amount for one person as it would cost for two people.

Question to VA - I know you have been asked this already as it is timely topic. I know VA care qualifies under the ACA and I have read on your own site that if you have VA health care then you can still buy Insurance on the Health Exchange (and in fact VA wants veterans to maintain other health insurance). However, I also know that if you have VA health care you are not able to get the subsidy to help in buying health insurance from the exchange. I also know if you need emergency care outside of the VA system there is a process for the VA to pick up the cost, but there are so many loopholes for the VA to wiggle out of paying that it is pretty impractical to rely on the VA to cover all your health needs and cost. I would like to have private health insurance under the ACA (both to insure I have emergency coverage for needs outside the VA system, and to help the VA recover some cost for service) but I can’t afford to buy it without the subsidy because of my limited income. So is this issue being addressed at a higher level? What is the official answer, how is a Veteran supposed to rely on the VA when there is such a large doubt about receiving emergency care outside the VA system and we are not able to buy exchange insurance with subsidy help? Is this something that needs Congressional scrutiny or is it something the VA can address? Does the VA have an official answer? Is the VA attempting to address these issues?

This confirms receipt of the electronic message you just sent to the Department of Veterans Affairs (VA). The reference number for your question is #130807-001037

Here is the answer I got backdrops the VA

Recently you requested assistance from VA. Below is a summary of your request and our response. If you wish to reopen this issue, you may do so within the next 14 days by clicking on Reply, entering your new information, and then clicking Send. Thank you for allowing us to be of service to you. Discussion Thread Response via Email Via Email (Dept of Veterans Affais) 08/08/2013 12:02 PM

Mr Weir The short answer is, all Veterans have the ability to cancel their VA coverage. If they do so, and then wish to obtain it again in the future, they will need to meet the new requirements set by congress for enrolling vets. Currently, the subsidy program is set up to assist people that are unfortunate and cannot afford heath care or qualify for it thru other means. If a veteran has benefits thru the VA he is covered at all VA facilities. As to the emergency care, there are qualifications. They are quite basic and require little to qualify. 1. Be enrolled in the VA and have received care at a VA facility sometime in the last 2 years. If you keep up to date on your yearly physical this will be easily met. 2. Have no other coverage, including medicare, medicaid, or state funded insurance. If you have other insurance, they are expected to pay the bill. 3. You are financially liable for the care provided. If the hospital waives your charges, or care is received at a free clinic, there is no reason for the VA to pay. 4. You have no other legal recourse against a third party. If you are in a car wreck and are suing the insurance company, they VA will not pay the bill. If you are suing a homeowner, business, or property owner for an injury in which you received care, the VA will not pay the bill. 5. The care is preformed at an emergency facility, and a layperson would assume that delaying care could injure your life or limb. You cannot go into the ER for a stubbed toe and expect the VA to pay. You also cannot choose to use a primary care doctor based on personal preference and expect the VA to pay. 6. The VA will only pay for stabilization. Once you are stabilized you must contact the VA medical center for future plans. They may choose to transport you to the VA or they may choose to pay to keep you at the current facility. They will make that determination based on your needs, the resources of the VA, and the availability at the time. These rules are not meant for the VA to "weasel out of paying the bill" but so that veterans know the policy and procedure. If you wish to decline or cancel enrollment in the Department of Veterans Affairs (VA) Health Care System, you should contact the Enrollment Coordinator at your local VA facility. You will be required to submit a signed and dated written statement requesting disenrollment. Things to consider before asking to be disenrolled: 1. If you reapply you will be considered as a new applicant and enrollment will be based upon the criteria in place at that time. 2. If you are a Veteran who is required to be enrolled to receive VA health care: you will not be eligible for care of your non-service connected conditions. if emergency treatment is provided at a VA facility you will be billed at the humanitarian rate. you will not be eligible for non-VA emergency care. 3. Veterans who are 50% or more service-connected are not required to be enrolled in the VA health care system to receive benefits offered in the Medical Benefits Package.

[Buck2520]

Found my VA letter. There is a paragraph that says

"Since VA care meets the standard for health care coverage, you wouldn't be eligible for assistance to lower your cost of your monthly premiums for private health insurance plans."

Pretty clear you have to cancel your VA health care benefit if you want to buy health insurance off the ACA exchange, and get a subsidy (if you qualify) to help pay for it. There is always the possibility you could have trouble getting the VA to pay for emergency care outside their facilities, but there is a process to deal with this. Nothing is perfect, but this is what I have found out.

[Tadpole]

Thanks for your efforts Buck2520. Our house is not affected because we don't qualify for subsidies but I hope others less fortunate than us see and understand the paragraph before they think they have to sign up.

[lemming]

When you buy insurance as a backup to VA care is the premium the same as if you are buying a primary policy?

[Buckeye]

Quote:

Originally Posted by lemming When you buy insurance as a backup to VA care is the premium the same as if you are buying a primary policy?

Yes, it is a primary health insurance policy but we chose the highest possible deductible ($11,000+) knowing care at the VA was available for both of us, reducing the likelihood we would ever have to pay medical expenses equal to the entire deductible unless we were in an accident and ended up in the emergency room.

The high deductible policy is backup insurance to emergency room care with the VA and access to the VA is backup 'insurance' for having to pay the entire high deductible on our Humana policy. Using both together was a great situation.

We'll have to analyze the situation to determine whether it makes sense to forego any subsidy to maintain access to the VA (deductible 'insurance) along with a very high deductible policy. We don't have to worry about it in 2014 because we can carry our high deductible Humana policy until Dec 31, 2014.

The situation will get even more interesting when DH is eligible for Medicare in 2014. If he maintains VA access, I don't think he needs to purchase medigap or Part D insurance and that's a significant savings. Thanks for making me think about this now!

[Buckeye]

Quote:

Originally Posted by Buck2520 Found my VA letter. There is a paragraph that says "Since VA care meets the standard for health care coverage, you wouldn't be eligible for assistance to lower your cost of your monthly premiums for private health insurance plans." Pretty clear you have to cancel your VA health care benefit if you want to buy health insurance off the ACA exchange, and get a subsidy (if you qualify) to help pay for it. There is always the possibility you could have trouble getting the VA to pay for emergency care outside their facilities, but there is a process to deal with this. Nothing is perfect, but this is what I have found out.

I reread my letter and I don't see the above information included. I posted a copy a couple of posts back. Does my letter look different than yours? Or was the above info in a Q&A sheet (which I did not get).

[Buck2520]

Buckeye, yes it was on the FAQ page

[Buck2520]

Buckeye, here is the link to the online VA FAQ

www.va.gov/health/aca/FAQ.asp

[Buckeye]

Quote:

Originally Posted by Buck2520 Buckeye, here is the link to the online VA FAQ ACA Frequently Asked Questions -- VA, Affordable Care Act and You

It's a nice FAQ page. I hope I was the only one who didn't the FAQ page with my letter. To be safe, the VA should never mention purchasing complementary insurance (like they did in my letter) without mentioning in the same document the possibility of being disqualified for the subsidy.

I haven't met one other person who knows anything about the ACA. The accuracy and completeness of these informational documents is critical because people seem to have no other knowledge to bounce them against.

[fritz]

As Buck2520 mentioned - this linked thread discussed that the letter was on its way.

http://www.early-retirement.org/foru...are-67751.html

I had contacted the VA regarding the subsidy issue and the person I spoke with was not having a good day (was downright snotty about the whole scenario). She informed me that the letter was being sent out in "October" at that time. Oddly, a letter I received this week is dated March 13th and only addresses emergency care at non-VA facilities. It included the Non-VA emergency Care Fact Sheet. It is signed by Cynthia M. Kindred Acting Deputy chief Business Officer. I have not yet receive the letter dtd September 9th about the ACA addressing subsidy eligibility, but my son-in-law received it today so it's probably on its way

My concern is continuing to carry BCBS health insurance while staying with the VA ( I consider it a must-have). I don't think it will meet the ACA minimum requirement and Blue Cross Blue Shield will discontinue it and force me onto the exchange to buy a supplemental policy (at an unsubsidized higher price structure). I understand that in under three years when I become eligible for Medicare - the VA coverage will be a benefit to avoid certain charged Medicare coverages, but it might be a long time before I see a breakeven for the money spent for three years of supplemental insurance off the exchange while maintaining the VA coverage. It will be interesting to see the policies/coverages and price structures in October, and what BCBS will do with my existing coverage. I guess I could also re-apply for VA coverage at 65 (I qualify for priority six).

[fritz]

Quote:

Originally Posted by fritz As Buck2520 mentioned - this linked thread discussed that the letter was on its way. http://www.early-retirement.org/foru...are-67751.html I had contacted the VA regarding the subsidy issue and the person I spoke with was not having a good day (was downright snotty about the whole scenario). She informed me that the letter was being sent out in "October" at that time. Oddly, a letter I received this week is dated March 13th and only addresses emergency care at non-VA facilities. It included the Non-VA emergency Care Fact Sheet. It is signed by Cynthia M. Kindred Acting Deputy chief Business Officer. I have not yet receive the letter dtd September 9th about the ACA addressing subsidy eligibility, but my son-in-law received it today so it's probably on its way My concern is continuing to carry BCBS health insurance while staying with the VA ( I consider it a must-have). I don't think it will meet the ACA minimum requirement and Blue Cross Blue Shield will discontinue it and force me onto the exchange to buy a supplemental policy (at an unsubsidized higher price structure). I understand that in under three years when I become eligible for Medicare - the VA coverage will be a benefit to avoid certain charged Medicare coverages, but it might be a long time before I see a breakeven for the money spent for three years of supplemental insurance off the exchange while maintaining the VA coverage. It will be interesting to see the policies/coverages and price structures in October, and what BCBS will do with my existing coverage. I guess I could also re-apply for VA coverage at 65 (I qualify for priority six).

1st area in bold - just received the ACA letter from the VA dtd 9-23-2013 letting me know that I don't have to do anything as I'm covered.... (the enclosure states that the ACA subsidies do not apply to Veterans).

2nd area in bold - wife and I just received notice from Blue Cross Blue Shield that our individual health policies will be terminated 12/31/13 as they will no longer be available. If they don't hear from us by 12/15/13, they will automatically enroll us in new policies similar to the ones we already have, and I'm sure at a new price structure and w/o any ACA subsidies. We do have the option of choosing a BCBS policy off the exchanges. Our BCBS policy renewals also just showed up. They are for the periods of 10/15/13 to 12/15/13. Guess we'll be uninsured from 12/15/13 to 12/31/13 (but I'll bet there are other letters coming shortly to address this issue).......

Will really have to look over the ACA exchanges and consider my options as to staying with the VA. I hate to leave the VA, but BCBS not allowing me to continue on my old low cost, high deductible policy (even with the permanent preexisting conditions), and the VA not willing to properly address emergency care in non-VA facilities, leaves a very limited set of options. Hoping when the exchange opens tomorrow, there is an suitable option that allows me to stay with the VA