Healthcare

Basic Information

If you served in the active military and were separated under any condition other than dishonorable, you may qualify for VA healthcare benefits.  Current and former members of the Reserves or National Guard who were called to active duty (other than active duty for training) by a federal order and completed the full period for which they were called or ordered to active duty may be eligible for VA healthcare as well.  Most veterans who enlisted after September 7, 1980 or officers who entered active duty after October 16, 1981 must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible.  This minimum duty requirement may not apply to veterans who were discharged for a disability incurred or aggravated in the line of duty, for a hardship, or early out.

VA healthcare is not medical insurance, it simply means you are in the VA healthcare system and can receive medical treatment from the VA Medical Center or VA Clinic to which you are assigned. This benefit is only for the veteran, not family members.  VA healthcare will not pay for routine treatment at a non-VA medical facility unless you were pre-approved to receive this treatment.  This is called “VA Care in the Community.”  During a medical emergency, veterans should immediately seek care at the nearest medical facility. A medical emergency is an injury, illness, or symptom so severe that without immediate treatment, you believe your life or health is in danger. If this happens, you should ask the facility to bill the VA because if they bill Medicare or another insurance, the VA will not pay the co-pay for bill.

For information on specific VA Healthcare Benefits

Pre-qualifying Factors

There are factors that will automatically qualify you for VA healthcare.  They are:
– Purple Heart recipients,
– Former Prisoners of War,
– Have a compensable service-connected disability (10% or more) as determined by the VA,
– Served in a combat theater of operations after November 11, 1998,
– Discharged from the military for a disability incurred in the line of duty,
– Served in Southwest Asia during the Gulf War between August 2, 1990 and November 11, 1998,
– Served in Vietnam between January 9, 1962 and May 7, 1975,
– Exposed to radiation while in the military,
– Served on active duty at least 30 cumulative days at Camp Lejeune from January 1, 1957 through December 31, 1987.

If a veteran has no pre-qualifying factors, the VA will determine eligibility based on household income from all sources from the previous calendar year to include wages, social security, pensions, interest, dividends and any other source of income.  The current geographic income threshold (income limit) for Oneida County is:

Veteran Alone$42,130
Veteran Plus 1 Dependent$48,180
Veteran Plus 2 Dependent $54,175
Veteran Plus 3 Dependent $60,170
Veteran Plus 4 Dependent $65,010

These amounts do vary from county-to-county and state-to-state.  Your household income can be adjusted by previous calendar year household medical expenses to include, insurance premiums, Medicare, doctor and medication co-pays, dental, eye glasses, etc.

Application Process

The VA form 10-10EZ is the application used to apply for VA healthcare.  Your County Veterans Service Office can help you with the process; however, you must be able to provide all the information on the form such as other health insurance information, household income, and out-of-pocket medical expenses.  Taking the information from your income tax return is the best way to ensure this information is accurate.  You do not have to provide this information but if you don’t provide it and you do not have any pre-qualifying factors, you will not be accepted into the VA healthcare system.  If you do have pre-qualifying factors, you may be charged co-pays if you do not provide income information.

After your application is processed, you will be notified of your enrollment status and priority group assignment.  If you requested an appointment on your initial application, your preferred facility will schedule an appointment and notify you of the time and date.

For VA Healthcare forms click HERE.

Co-pays

If you are required to pay co-pays, they are as follows:

Primary Care Services$15
Specialty Care Service$50

Medication (per prescription for a 30-day supply)

Tier 1 (preferred generics)$5
Tier 2 (non-preferred generics and some OTC)$8
Tier 3 (brand name)$11
Annual Copay Cap$700

Phone Numbers

VA Clinic Rhinelander, WI                 (715) 362-4080
VAMC Iron Mountain, MI                  *(800) 215-8262
*If you do not know the extension you need, just press “0” for the operator.