Prescription medication can be the make or break of one’s health. However, how it expensive it is can be a huge barrier for individuals to maintain their health. Fortunately, for veterans, there are a few ways for them to get their medication covered. Veterans have a special set of health issues that may require expensive or long-term pharmaceutical therapy. Those with chronic pain or other chronic issues may have to take medication for the rest of their lives. Other medications for mental health issues can also rise in cost as they frequently are changed to match where veterans are and where they want to be. The last thing that would help is to stop medication.
Especially, because if some medications are stopped abruptly then that can lead to severe consequences. Examples of medications include SSRIs, or selective serotonin reuptake inhibitors, glucocorticoids, or steroids, etc. They require a tapering. Other medications, like insulin, can be very expensive, but without them, a diabetic could die due to dangerously high levels of blood sugar. All of these are just a few examples of ways that stopping medications could lead to severe problems. That’s why it’s essential that veterans understand how to continue paying for their medication after they have served, if their benefits have run out, and/or if they are unemployed.
Below is an explanation of how veterans can pay for their medications and the health benefits that the VA offers.
Medication copayments
The Tiered Copayment Medication Structure policy went into effect in 2017 and established copayments for various tiers of prescriptions at set prices. The 30-day prescriptions at $5 are Tier 1 which are the top 75 generics. For Tier 2, medications cost $8 for all the other generics. The highest tier is Tier 3 which is for source/brand name medications. These medications cost $11. Veterans in Priority Groups 2-8 are limited to a $700 annual copayment cap. They are required to pay for each 30-day or less supply of medication for treatment of non service-connected condition unless they receive some other authorization.
Inpatient Copayments
For inpatients, or those who are hospitalized or in long-term care facilities, there are two copayment rates – full and reduced. The reduced rate is 20% of the full inpatient rate and applies for Veterans enrolled in PG 7. Both are computed over a year-long period. The copayment is charged in addition to the standard 90-day copayment regardless of the level of service (i.e. intensive care, surgical or general medical care). Each day of hospitalization will incur a per diem charge. These rates change constantly, so in order to stay up to date, then please visit: http://www.va.gov/healthbenefits/cost/copays.asp or call 1-877-222-VETS (8387).
Long-Term Care Copay Rates
Long-term care is based on three levels of care. in patient includes Community living Centers (nursing home) Care/Inpatient respite Care/Geriatric Evaluation and covers up to $97 a day. Outpatient includes Adult Day Health Care/Outpatient Geriatric Evaluation/Outpatient Respite Care and the coverage is $15 a day. Finally, Domiciliary Care which is established at $5 a day.
Copayments for long-term starts on the 22nd day of care and during any 12-month period, there is no copayment required for the first 21st days. Actually copayment charges do vary veteran to veteran, and is dependent on the financial information that was submitted on the VA Form 10-10EC, or the Application for Extended Care Services.
Cost-Free Care for Certain Veterans
There are actually many veterans that qualify for cost-free health care and/or medications. They are based on various qualifications including:
- Purple Heart Recipient
- Prisoner of War Status
- 50% or more Compensable VA service-connected disabilities
- Catastrophically disabled, determined by a VA provider
- Income below the income limit
- Qualifying factors including treatment related to military service
There are various other qualifications, all of which can be found here. If you meet any of these criteria, then it’s important you look into how to ensure that you officially qualify for these benefits. This can dramatically impact the course of your health because you are able to receive the services that you need without cost being a barrier. Even if you don’t think that you qualify, at least contact the VA and ensure that there are no benefits that you qualify for before finding other forms of coverage. You may save yourself a lot of money, time, and stress.
VA Programs that Assist with Copays
The VA offers many services to support Veterans. Veterans who have copayments associated with VA health care are responsible to pay for those obligations in a timely manner. If Veterans are unable to make their VA copayments, then they can make alternate arrangements including repayment plans, waivers, and compromises. When debts are 120 days old, it is referred to the department of Treasury for collection and the VA can no longer accept payments or provide financial assistance.
There are four possible options for Veterans who are unable to pay assessed copay charges. One is a hardship determination which provides exemption from outpatient and inpatient copyments for the remaining calendar year based on low income levels. The second is a waiver that veterans can request for part or all of their debt. If granted, the veteran will have all of the amount owed waived. The third is an offer in compromise. Veterans can apply for a compromised and propose a lesser amount and settle their debts by submitting a written request of the dollar amount they can play along with a Financial Status Report (VA Form 5655). The last is a Repayment plan which can be established by a Veteran who cannot repay their copayment charged when due. This can be done by submitting a VA Form 1100, or a Agreement to Pay Indebtedness.
If you need assistance in covering medical bills, reach out to see if the VA can assist you through one of these four options.
There are other options that that can assist Veterans with payment for their health costs. One of those costs may include home health. Diverse Health Services is a home health company that can help Veterans who may not be able fully live independently. We offer a variety of services including assistance with activities of daily living, medication dispensing, grocery shopping, food preparation, cleaning, etc. Please click our services tab to see if there is something that we can offer and if we are a good fit for your family. Payment may also be covered by some of the benefits offered by Veterans.
Resource: https://www.va.gov/healthbenefits/resources/publications/hbco/hbco_copayments.asp
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