What happens if a veteran cannot afford to make co-payments for VA healthcare? There are many reasons why it may be difficult to find the money for these crucial payments for care; an unexpected loss of income, increasing property taxes or other monthly expenses, changes in circumstance including death of a wage earner, loved one, or household member, etc.
No matter what the cause of an inability to make these co-payments, there is help available. The Department of Veterans Affairs official site reminds those using the VA healthcare system that no matter what the reason for financial hardship, those affected should reach out to the VA as soon as possible.
When you contact the VA, you’ll want to discuss options that can include payment plans, debt relief, co-payment exemptions, and even the possibility of outside assistance from certain veteran service organizations such as the VFW, DAV, etc.
Basics You Should Know About VA Copays
There are different copays for different types of VA medical care. These copays can include inpatient, outpatient, medication copays, co-payments for geriatric care, and more. The structure for these co-payments may vary depending on the nature and duration of care, the level of care required, etc.
Some veterans are exempt from co-payments due to the level of their disability, and others may qualify for specific co-payment exemptions within certain types of care or services–a good example of this is for those who would potentially owe co-payments on medication.
The VA official site states that for medications, those with a service-connected rating of 40% or less AND who have income which “falls at or below the national income limits for receiving free medications” it is strongly recommended that the veteran provides income information to the VA, “to determine if you qualify for free medications.”
Some VA services have no copay at all. They include:
- You won’t need to pay a copay for any of the services listed below, no matter what your disability rating is or what priority group you’re in
- Readjustment counseling
- Counseling and care for issues related to military sexual trauma
- Exams to determine risk of health problems linked to military service
- Care associated with combat service for Veterans after Nov. 11, 1998
- VA claim exams (also called compensation and pension, or C&P, exams)
- Care related to a VA-rated service-connected disability
- Care for cancer of head or neck caused by nose or throat radium treatments received while in the military
- Programs to help people quit smoking or lose weight
- Care as part of a VA research project
- Laboratory tests
Help With VA Copays For Veterans Experiencing Financial Hardship
There are several options you can explore with the help of the Department of Veterans Affairs. In all cases, you will need to apply for this assistance–it is not automatic.
Copay Repayment Plan
The Department of Veterans Affairs official site states clearly that veterans “have the right to establish a monthly repayment plan at any time during your enrollment in VA health care if you cannot pay your debt in full.”
Note the phrasing there–veterans have the RIGHT to seek this relief. Most repayment plans will have a maximum repayment term of three years, but the VA official site adds that the agency does take into account the size of the debt and the veteran’s means. The VA wants to establish a reasonable repayment plan based on the ability to pay.
To set up a payment plan, veterans will need to complete VA Form 1100, Agreement to Pay Indebtedness. You can obtain this form or a link to it by contacting the VA directly or visiting the official site at VA.gov. For patients who need to make new charges, contact the VA directly every 90 days to request a new repayment plan.
The VA Co-payment Exemption Option
Veterans who must make VA copays and experience a loss of household income may be eligible for an exemption from the copay altogether. The VA official site advises that you must apply for this benefit.
Those who qualify and are approved will have their VA priority group assignment changed to a higher group–future co-payments are waived for the rest of the calendar year in which the exemption was applied.
This is one reason why it’s best to contact the VA as early as possible–you’ll want to have the most months remaining in the year for your copayment exemption.
This type of exemption, known as a “hardship copay exemption”, does not apply to pharmacy charges. To request this benefit, you will need to fill out VA Form 10-10HS, Request for Hardship Determination and submit to the Department of Veterans Affairs.
VA Copay Debt Relief
The VA describes a veteran’s option to request debt relief from VA copays as a right. You can request one of the following options:
- Debt waiver (comes with a right to request a hearing)
- Debt write-off
- Debt compromise agreement
You may also have the option to decompromise (negotiate a lesser payment amount) part or all of your balance. If a request is granted in full or in part, you will not be required to pay the amount of the balance considered for debt relief.
Those who wish to negotiate one of the above must complete VA Form 5655, Financial Status Report, and you will need to put a formal request in writing complete with an explanation for why you are requesting debt relief.
Other Options For Copay Debt Relief
It’s a very good idea to explore all options for financial assistance if you are having trouble or anticipate having trouble making VA co-payments. One option open to veterans includes programs offered by Veteran Service Organizations such as the DAV and VFW. The Veterans Of Foreign Wars official site includes a page dedicated to such a relief program known as Unmet Needs.
The VFW defines the Unmet Needs program as an option ”to help America’s military families who have run into unexpected financial difficulties as a result of deployment or other military-related activity or injury.”
Unmet Needs offers qualifying veterans financial aid grants of (up to $1,500 in 2020, provided as a reference only) which is provided via a direct payment to the creditor. Such payments are NOT loans, they are administered as grants and the qualifying expenses of this particular program do include healthcare.
Every veteran service organization is different, and you may find different resources offered for different types of needs. You should also search your state government official site for resources offered by the state or by local townships for veterans who need financial help with medical issues. Your state-level Veterans Affairs office or official site (which is different than the federal level Department of Veterans Affairs) may have more information.
What Happens If You Do Not Reach Out To The VA
The Department of Veterans Affairs is obligated under federal law to refer delinquent copay accounts to the VA Debt Management Center or the Department of Treasury.
If your debt goes into collection status, you may find that your other federal benefits are subject to a decrease in order to recoup the delinquent amounts owed. That can mean reduced tax refunds, wage garnishment, reduced Social Security benefits, etc.
The VA official site warns that the Department of Treasury may refer a delinquent account to a private collection agency, “which will result in additional fees and interest being added to your account”. That is why it is very important to contact the VA and make arrangements as soon as you know you are experiencing financial hardship.
Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter for Air Force Television News
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