• At the end of this presentation you will be able to:

o Explain the health care options available to Veterans

o Discuss how Veterans utilize the services available to them

Objectives

• A person who served in the active military, naval, or air service and who

was discharged or released under conditions other than dishonorable

may qualify for VA health care benefits.

• Reservists and National Guard members may also qualify for VA health

care benefits if they were called to active duty (other than for training

only) by a Federal order and completed the full period for which they

were called or ordered to active duty.1

• VA does not normally provide care for family members of Veterans

enrolled in VA’s health care program2

Who is eligible for VA health care?

Program Description

VA Coverage Services available for veterans in good standing at VA approved facilitates. Level of coverage is based upon placement into a priority group.

TRICARE A regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors.

CHAMPVA The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. *Pays secondary to Medicare

Veteran Health Care Programs1,2

Veteran HealthBenefits1,2

5

Inpatient Care Services• Medical

• Surgical

• Mental Health Care

• Dialysis

• Acute Care

• ICU

• Transplant Services

• Spinal Cord Injury Centers

• Traumatic Brain Injury

Benefits

Preventive Care• Periodic medical exams (including

gender specific)

• Health education + nutrition education

• Immunization against infectious

diseases

• Counseling on inheritance of genetically

determined diseases

Pharmacy•Medications prescribed by VA

physician (potential co-pay)

•Online refill system

•Mail order refills

Additional Services

• Geriatrics and Extended Care

Services

• Domiciliary

• Hospice

• Respite

• Home Health Care

• Home Telehealth

6

How VA and Private Insurance Interact1,2

Veterans are not responsible for any

unpaid balance that the insurance carrier

does not pay except for VA copay

Many private health insurance companies

will apply VA health care charges toward

the satisfaction of a veteran’s annual

deductible

VA is required to bill private health

insurance providers for medical care,

supplies, and prescriptions provided for

treatment of Veteran’s nonservice-

connected conditions

Payments from your private health

insurance carrier may allow VA to offset

part or all of the veteran's copay

VA does not bill Medicare or Medicaid

7

Veterans and HealthWhere do veterans receive their health care?

85%

Veteran Females 65+ have Medicare4

89%

Veteran Males 65+ have Medicare4

10%

Veteran Females 65+ report having received VA health care

11%

Veteran Males 65+ report having received VA health care

10%

Veteran Females 65+ report having Medicaid/ government assistance

4.5%

Veteran Males 65+ report having Medicaid/ government assistance

43%

Receive Medicare through an MA/MAPD Plan

76.4

14.6

Drug Coverage*

Indicate theyhavecoverage forpercriptiondrugs

*Reflects all Veterans surveyed

4,715,657 Veterans were enrolled in Medicare in 2004^

Veteran Males >655

No insurance

Current Employer (including

COBRA)

20%

44.5%

12%

8%

9.5%

Former Employer

Individually purchased

coverageFederal, State,

County, or local community

services

Who provides the (health care) coverage?

12%Family member

3%From something

else

Veteran Females >655

No insurance

Current Employer (including

COBRA)

18%

47%

5%

5%

10%

Former Employer

Individually purchased

coverageFederal, State,

County, or local community

services

Who provides the (health care) coverage?

17%Family member

5%From something

else

If the cost of health care to me increases, I will use VA more

60.5 %

I have a doctor outside VA who I really like and trust

63.6%

Member Perception: VA Health Care4

I would only use the VA if I did not have access to any other source of health care

58 %

Veterans who can afford to use other sources of health care should leave VA to those who really need it

49 %No plans to use VA for health care

32 %For

prescriptions

3%

As my primary source of health care

16 %In addition to non-VA care for some services

12 %As a ‘safety net’ to use only if I lose other sources of health care

35%

Some other way

2 %

Veterans like me who use the VA are satisfied with the health care they receive

50 %

How do you plan to use VA health care in the future?

The following information reflect aggregated responses by Veterans on the 2010 National Survey of Active Duty Service Members, Demobilized National Guard and Reserve Members, Family, and Surviving Spouses

Veteran HealthWhat services do veterans receive

and where?

1%

99%

0%

Utilization

Inpatient hospital discharges

Outpatient visits

Nursing home discharges

2012 Department of Veteran Affairs

Utilization v Expenditure3

20%

54%

7%

19%

Expenditure

Inpatient hospital

Outpatient care

Nursing Home care

All other

VHA and HEDIS Comparisons 20115

Clinical IndicatorVA Average

HEDIS Commercial

HEDIS Medicare

HEDIS Medicaid

Breast Cancer Screening 85 71 69 50Cervical Cancer Screening 93 77 N/A 67CMC LDL-C Control 71 59 57 42CMC LDL-C Screening 96 88 89 82Colorectal Screening 82 62 60 N/AControlling BP 81 66 63 61CDC Eye Exam 90 57 66 53CDC HbA1C Testing 98 90 91 83CDC LDL Controlled 69 48 53 35CDC LDL-C Screening 97 85 88 75CDC Nephropathy 95 84 90 78CDC HbA1C Poor Control 17 28 27 43

VHA and HEDIS Comparisons 2011, continued5

Clinical IndicatorVA Average

HEDIS Commercial

HEDIS Medicare

HEDIS Medicaid

Controlling High Blood Pressure - Total 78 65 64 57Medical Assistance with Smoking Cessation –Advising Smokers to Quit 97 77 N/A 76Medical Assistance with Smoking Cessation –Discussing Medications 94 53 N/A 44Medical Assistance with Smoking Cessation –Discussing Strategies 97 48 N/A 40Flu Shots for Adults (50-64) 65 53 N/A N/AFlu Shots for Adults (65+) 79 N/A 69 N/AImmunizations: Pneumococcal 94 N/A 69 N/A

1 Federal Benefits for Veterans 2013 Edition (Publication No. 978-0-16-091835-3). (2013, January 1). Retrieved January 7, 2015, from U.S. Department of Veterans Affairs website: http://www.va.gov/opa/publications/benefits_book/2013_Federal_Benefits_for_Veterans_English.pdf

2 Health Benefits. (n.d.). Retrieved January 08, 2015, from http://www.va.gov/HEALTHBENEFITS/cost/insurance.asp

3 Health, United States, 2012 (Rep. No. 201-1232). (2013, May 1). Retrieved January 7, 2015, from U.S. Department of Health and Human Services website: http://www.cdc.gov/nchs/data/hus/hus12.pdf

4 National Survey of Veterans, Active Duty Service Members, Demobilized National Guard and Reserve Members, Family Members, and Surviving Spouses (Rep.). (2010, October 18). Retrieved January 7, 2015, from Department of Veterans Affairs website: http://www.va.gov/survivors/docs/nvssurveyfinalweightedreport.pdf

5 VHA Facility Quality and Safety Report Fiscal Year 2012 Data (Rep.). (2013, December 1). Retrieved January 7, 2015, from Department of Veterans Affairs website: http://www.va.gov/HEALTH/docs/VHA_Quality_and_Safety_Report_2013.pdf

Works Cited