VA: Urgent Care Benefits

Thanks to the passage of the VA Mission Act of 2018, veterans who are eligible for VA health care benefits have expanded access to urgent care treatment as an option for minor medical issues. Updates to the program in 2019 allows veterans to access health services via “approved non-VA medical providers” according to the VA official site.

The Purpose Of The VA Mission Act

The VA Mission Act was signed into law in 2018 and provides for changes in the VA health care system including requirements that the VA “coordinate the furnishing of hospital care, medical services, and extended care services” to insure:

  • Scheduling of medical appointments in a timely manner.
  • Establishing a “mechanism to receive medical records from non-Department providers.”
  • Ensuring continuity of care and services.
  • Ensuring coordination “among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides.”
  • Establishing measures to prevent eligible veterans from having “a lapse in care resulting from errors or delays by the Department or its contractors or an unusual or excessive burden in accessing hospital care, medical services, or extended care services.”

The VA Mission Act, “subject to the availability of appropriations” must provide hospital care, medical services, and extended care services even if the VA itself “does not offer the care or services” a veteran needs under certain circumstances.

The availability of urgent care and walk-in care is one of the ways the Act has expanded the availability of care under the VA health care system.

Eligible Veterans can, thanks to the Act, receive care or treatment from an urgent care provider as long as that provider is a part of the VA network of authorized urgent care centers.

When The VA Will Pay For Urgent Care Services

Veterans who need urgent care may have that care paid for by the Department of Veterans Affairs when the following applies:

  • The medical care provided is not on the list of excluded services such as preventive medicine or dental care.
  • The Veteran is eligible for the urgent care benefit.
  • The care provider is part of VA’s contracted network of community providers.

Veterans who choose to use an urgent care facility that is not in the VA network should assume they will be required to pay the entire cost of such services.

VA Payment For Prescriptions Issued During An Urgent Care Visit

The Department of Veterans Affairs agrees to cover the cost of or fill the prescriptions given during an urgent care visit to a provider in the network.

Routine care prescriptions must be filled by the VA, and when prescribed medication with a supply of 14 days or less, eligible veterans are allowed to have the script filled at “a contracted pharmacy in the VA network or the prescription can be filled at a non-contracted pharmacy.”

In cases where a non-contracted pharmacy is used, the veteran is required to pay out of pocket and submit a claim to be reimbursed with a local VA medical facility. Prescription medication may or may not require a copay.

The Department of Veterans Affairs official site advises that an annual medication copayment cap applies for veterans in VA Priority Groups 2 through 8 (see below). The co-pay cap is $700 per calendar year. Veterans in VA Priority Group 1 have no medication copayment required.

How To Check If You Are Eligible For Urgent Care Under The VA Mission Act

The VA official site directs veterans to check with their local VA medical facility to check eligibility for these services and VA payment for them. Veterans who are eligible may locate an authorized urgent care facility near them by checking the VA provider locator tool on its official site.

To find an available urgent care provider in VA’s contracted network of community providers, Veterans will be able to use VA’s provider locator on VA.gov.

There Is A Difference Between Urgent Care And Emergency Care

The Department of Veterans Affairs notes a marked difference between urgent care and emergency care. The services offered for urgent care under the VA Mission Act include, according to the VA, “…minor injuries or illnesses that are not life threatening.”

Emergency care, which is not part of the scope of the Urgent Care benefit, is defined by the VA as any medical service required without delay to avoid threats to life or limb.

Urgent Care Services Provided Under The VA Mission Act

Qualifying veterans may seek urgent care from an in-network provider for “non-emergent symptoms” for conditions including flu, minor injuries such as sprained ankles or wrists, bruises, skin irritation, injuries that require splints or casts, earache, painful urination or related issues. Care may be given in two basic types of care centers in the VA network; Urgent and Retail.

The VA defines these two locations as follows:

  • Urgent care facilities may include locations “whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention” that is non-emergency care. Care at these locations may include splints, casts or other attention that may be more advanced than the services required from a Retail outlet.
  • Retail may be a walk-in clinic, pharmacy, or independent clinic. These may be inside a retail outlet such as WalMart or Target. The mention of these two retail chains does not imply they are actually part of the VA network-you will need to check with the VA to find authorized, in-network locations near you. Do not assume that WalMart or Target are authorized VA urgent care providers.

Remember, if you have a medical condition that is not well-understood or may be complicated to explain to a new care provider, it may be best to discuss treatment with your primary care provider first. Any situation that may be a threat to life or limb should not be dealt with using urgent care services; you may require emergency treatment instead depending on circumstances.

“Special Authority And Exposure”

In the above VA copayment rules for urgent care, there are certain exclusions (see above) for special authority and exposure cases. What does this mean? VA.gov defines “special authorities and exposure” as “those related to combat service and exposures.” This can include but may not be limited to:

  • Agent Orange
  • Military Sexual Trauma
  • Active duty at Camp Lejeune
  • Project Shipboard Hazard and Defense (SHAD/Project 112)
  • Southwest Asia Conditions)
  • Presumptions applicable to certain Veterans with psychosis and other mental illnesses
  • Exposure to ionizing radiation

VA Urgent Care Benefit Copayment Issues

You may be required to make a copayment for authorized VA urgent care services, and that co-pay may differ from other copayment requirements you have experienced under the VA health care system.

The nature and amount of the copayment you are responsible for depends on your VA priority group and the number of times you visit an in-network urgent care provider within the year.

  • Copayment Rules For VA Priority Groups 7-8: A modest copayment applies for each visit.
  • Copayment Rules For VA Priority Groups 1-5: No copayment for the first three visits during a calendar year. For all visits beyond the first three per year a modest copayment applies.
  • Copayment Rules For VA Priority Group 6: No copayment for the first three visits during a calendar year in cases where the visits are related to “special authority” or exposure. If the visit is not related to “special authority” or exposure, there is a modest copayment per any visit. For those who meet the “special authority” or exposure requirement, there is a modest co-pay for every visit after the third one.

For all VA priority groups, there is no copayment required for visits specifically for flu shots only. Furthermore, flu shot-only visits “do not count as a visit for the number of visits in a calendar year for eligible Veterans in priority groups 1-6” according to VA.gov.

 

7 Affordable Ideas for Military Care Packages

Care packages are the best way for loved ones to send a little piece of home to deployed service members. They’re also a fun way for families to stay connected while apart.

Unfortunately, collecting items to put into care packages can get expensive. But with some creativity and a little help from the discounts offered by your favorite stores, those care packages don’t have to make a huge dent in your budget. Here are 7 ideas to get you started:

1. Bake goodies.

Now that they’ve seen home through pictures, give service members a taste of home by baking some homemade yummies. But keep in mind that not all baked goods will survive the transit time and temperature changes en route to the care package’s final destination.

One way to overcome that is by baking a cake in a jar. This is basically a mini cake made inside a jar that promises to still be moist and delicious by the time it arrives on the other end.

Not a baker yourself? Cheryl’s Cookies and Brownies offers free shipping to APO/FPO addresses. Let them do the baking for you.

2. Contact the post office.

Before you can create a care package, you need shipping supplies. The United States Postal Service (USPS) offers a free “Military Care Kit” with the necessary supplies for sending packages overseas, including boxes, packing tape and customs forms. Visit the USPS website to get your free kit, which will be shipped to you and arrive at your doorstep within 5 to 7 business days. If you have any questions about what you can and can’t ship overseas, visit the USPS website.

3. Strike a pose.

What better way to send a little piece of home than to send pictures from home. Take pictures of the kids, the pets, the house, friends, anything you think your service member is missing.

How should you send them? You can send them the old-fashioned way by simply mailing prints of the pictures. If you plan to include a large number of photos, load them onto a USB flash drive. Join a photo-sharing site like Snapfish or Shutterfly and make albums, calendars and other gifts. Or you can load images on a digital picture frame so they can be easily displayed and viewed like a slideshow.

Want the photos you send to be professionally done? JCPenney offers military discounts at their portrait studios.

4. Pack non-perishables.

The best food to send is usually of the non-perishable variety, especially those snacks in cans or jars to prevent crushing. Beef jerky, tuna, trail mixes, Pringles, candy that won’t melt and well-packaged cookies and crackers are safe bets.

5. Provide entertainment.

Service members can always use entertainment when they have a chance to enjoy some down time. Include books, magazines and crosswords puzzles. Go to your local exchange and use their price matching policy for new ear buds, DVDs and iTunes gift cards. And check out Jo-Ann Fabrics, Michaels and A.C. Moore for pens, notepads, stationary and envelopes, the perfect hint for them to write letters back to you.

6. Personalize the package.

Homemade artwork from the kids is always a big care package hit. Not only is it a morale boost for your service member, but it also helps the kids stay connected with the parent they’re missing. Don’t forget to decorate the inside of the box!

Stock up on art supplies at Jo-Ann Fabrics, Michaels and A.C. Moore. You can also use those discounts to make care packages more festive for special occasions like birthdays, anniversaries and holidays.

If you’re a military spouse, are you sleeping in the last t-shirt he wore before he deployed because it smells like him? Well, he probably wants your scent close by too. Wear a shirt you know he likes on you or sleep on a pillowcase, then seal it in a Ziploc bag so he can get a whiff of home whenever he wants.

Your loved one may be far away, but care packages help make that distance feel a little bit smaller.

7. Include necessities.

Service members may have the ability to get toiletries and other necessities, but it might not be their favorite brands. Head over to a drug store and load up on shampoo, body wash, hand sanitizer, deodorant, sunscreen, toothpaste, lip balm, foot powder, throat lozenges, baby wipes and batteries. While you’re there, put some Ziploc bags in your shopping cart to house any items that could leak.

Preventive Dental Care Can Dramatically Impact Your Health

Why Dental Care Matters

You know many tips to stay healthy, such as eating fruits and vegetables, exercising regularly, and getting enough sleep, but did you know that practicing proper preventive dental care can also dramatically impact your overall health? Healthy dental hygiene can reduce your risk of developing dental problems, which can be associated with additional health issues.

Take, for example, gum disease, which has been linked to oral cancer, heart disease, diabetes, respiratory ailments, preterm birth, skin diseases, thyroid problems, and leukemia (1). Preventive dental services and routine dental care are critical components in helping to prevent serious health issues. A recent study conducted by Dominion Dental Services found that preventive dental care can be associated with reduced emergency room visits and hospitalizations for people with chronic medical conditions (2).

Preventive Dental Care

Preventive dental care includes semi-annual dental checks-ups and routine dental care. At the dentist’s office, preventive care usually includes teeth cleanings, oral exams, X-rays and fluoride treatments for children. Some insurance plans offer members incentives to encourage wellness, help prevent future costly restorative work, and lower out-of-pocket costs. For example, Dominion Dental Services’ standard and high plans offer a Prevention Rewards Program, in which each family member who receives two cleanings during the plan year from a participating Dominion network dentist receives a $20 office copay reimbursement.

At home, preventive dental care consists of daily brushing, flossing, and eating a balanced diet. It’s essential to brush your teeth twice a day for two minutes and floss daily to prevent cavities and gum disease. Additionally, a balanced diet can protect your teeth by providing them with nutrients. Limiting your sugar intake and drinking plenty of water also helps to prevent cavities and promote healthy teeth.

Early Detection

While brushing teeth twice a day and flossing daily assist in the prevention of dental problems, semiannual dentist visits are also necessary as they promote early detection of dental issues that cannot be spotted at home. Early detection allows for timely treatment, which can help to avoid more serious and costly issues that could arise the longer a problem goes undetected. Dental insurance can encourage preventive dental care, and research suggests that people with dental coverage are twice as likely to visit a dentist than those without dental insurance (3).

Coverage for Non-Preventive Dental Care

While most dental plans cover preventive care at no charge, calculating out-of-pocket costs for non-preventive dental services differs depending on plan type.

A Dental Health Maintenance Organization (DHMO) plan includes predictable, pre-determined fees designed for transparency. In a DHMO plan, there are specific co-payments listed for each covered service. If you know the dental procedures you need to have completed, you will know exactly how much you will pay for your dental care before you even go to the dentist.

A Preferred Provider Organization (PPO) plan covers procedures at a co-insurance percentage. With a PPO plan, your out-of-pocket costs may not be immediately evident. For example, a major service like a crown may be covered at 50 percent. To calculate your actual cost, you will need to determine how much your dentist will charge you for that procedure under the contracted arrangement with the dental plan. It is also important to understand your plan’s annual maximum as your plan will only cover up to that amount each year. Dominion’s DHMO plans have no annual maximum limit to the number of services you receive each year.

Many dental carriers provide a comparison tool that will allow you to compare features and your cost for specific procedures.

2020 Open Enrollment

This year’s open enrollment season for choosing a dental plan runs from November 11, 2019, through midnight EST December 9, 2019, for coverage effective January 1, 2020. Retirees who are currently enrolled in a Federal Employees Dental and Vision Insurance Program (FEDVIP) plan will automatically continue enrollment into 2020. If you want to cancel or change your dental plan in any way, you must contact BENEFEDS during open enrollment.

Ready to Learn More About Dental Coverage? Dominion Dental Services is the only HMO plan offered through the FEDVIP program. It has no annual maximums, deductibles or waiting periods.

1. According to the American Dental Hygienists’ Association (2008) and Gust in, K.M. (2006, Dec.). Discussing ; ; Dental. National Provisioner. 220(12). 26-29.

2. Dominion Dental Services, Capital BlueCross and Geneia Medical/Dental Integration Study, July 2015-June 2017.

3. National Association of Dental Plan. The Haves and Have-nots: Consumer With and Without Dental Benefits. February 2009.

4.  National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, Gum Disease, & Other Dental Problems, 2019, niddk.nih.gov/health-information/diabetes/overview/preventing-problems/gum-disease-dental-problems.

5. American Dental Association. Pregnant? 9 Questions You May Have About Your Dental Health, 2019, mouthhealthy.org/an/pregnancy-slideshow.

At-Risk Populations

Preventive dental care is especially critical for at-risk populations, which includes people with diabetes and expectant mothers. For example, diabetics are at a higher risk for gum disease, and other oral health issues such as thrush and dry mouth, which can cause soreness, ulcers, infection and cavities (4). Additionally, it is estimated that up to 50% of pregnant women develop pregnancy gingivitis and dentists may recommend an additional cleaning to help manage it (5). Due to the higher risk for these populations, some dental plans such as Dominion Dental Services, provide these groups with an extra cleaning. If you are a diabetic or expectant mother, you may want to select a dental plan that covers an additional cleaning.

7 Ways to Keep Military Health Care Affordable

Revamping health care is constantly in the headlines as officials attempt to hammer out a way to make health care costs – one of the largest sources of debt and bankruptcy in the nation – more manageable for more Americans.

Free or reasonably priced health care coverage is one of the ways the American public decided to help compensate members of the military, their families, and military retirees for their service to the nation. Tricare offers a wide range of health plans for a variety of needs, and many of these plans allow for free medical care, or care at very low cost compared to the prices paid by civilians.

Nonetheless, co-payments, medications, dental and vision care can add up. Try these suggestions to help keep the cost of medical care manageable:

  1. Keep up to date with checkups. Don’t skimp on care to save a few dollars, especially if you have a health condition that requires regular monitoring. Be sure children get all necessary vaccinations, and take preventive measures such as getting a flu vaccination every year.
  2. See the right doctors. You want the best care possible, but also the best price. Whenever possible, by going to a military medical facility such as a hospital, clinic or sick bay, you’ll receive high-quality care at the lowest cost to you. If no military facility is near you, check with your health insurance plan to determine the best civilian option.
  3. Choose the right plan. Review all your options when choosing coverage under Tricare. Tricare offers several coverage levels that have different options to choose providers, etc., at different cost points. Carefully consider all your options, including what physicians you will want to see, how healthy you and your family are, and anticipated future medical needs, to determine the right level of care for you.
  4. Ask for the best deal. Talk to the manager of patient accounts about your situation. Your Tricare benefits might vary depending on your plan level and whether you or the physician’s office files your claim. For example, if you use the point-of-service option (POS) to visit a non-network, non-participating physician, they can charge you up to 15 percent more than the agreed-upon Tricare rate. If you plan to see a physician regularly, then discuss any options that can make your care more cost effective.
  5. Cut drug costs. First, seek to receive your medications from a military treatment facility, where they are free. Otherwise, ask your doctor if a generic medication will work as well as a brand-name one for you. If it is equally effective, a generic drug costs two-thirds less when ordered through Tricare’s mail-order pharmacy. If not, look into all options, including discount medications from warehouse club and discount/chain stores, to find the best deal on needed medicines.
  6. Deduct what you can. Develop a method — whether a spreadsheet, a shoebox for receipts, or a list in a notebook — to keep track of what you spend on medical care. If you spend more than 7.5 percent of your income, you could be eligible to deduct those costs from your income taxes.
  7. Save with an FSA. If your employer or your spouse’s employer offers a flexible spending account (FSA), take advantage of it. An FSA allows employees to have money deducted, pretax, from their paychecks for medical care. Look at canceled checks, bills or credit card statements to determine how much you spent on medical care (out of your own pocket, outside of health plan benefits) last year. One rule of thumb is to request withholding of about 80 percent of that amount, to be safe. Be sure you can spend the full amount you have deducted, because if you do not spend it, you lose it.

Medical care can be a challenging expense, especially when unexpected conditions arise. Fortunately, by planning as many cost savings as you can foresee, you can make a difference in the cost of care for you and your family.