Does VA Insurance Cover Treatment?
Many military service veterans across the United States struggle with substance abuse, co-occurring mental health problems, and behavioral disorders. The federal government provides access to healthcare for all military veterans, provided the veteran has not been dishonorably discharged. This medical care includes a full range of mental and behavioral health services, including medical services, inpatient treatment, and counseling to overcome addiction to many substances. This assistance is extremely important, with an estimated 20 percent of active duty service members meeting the criteria for heavy alcohol abuse, and 11 percent of service members who served in the conflicts in Iraq and Afghanistan having a diagnosed substance use disorder.
While some veterans may be reluctant to seek help, others may struggle with access to the treatment they are entitled to. For many veterans, their nearest VA hospital is far away; other veterans may struggle with chronic transience, and without a home address, they may not know which hospital they can work with. This overview of VA-associated health insurance and providers can help veterans and their families navigate treatment for substance use disorders. The VA website has a treatment finder to help any veteran get started, and the Substance Abuse and Mental Health Services Administration (SAMHSA) website’s treatment locator can specify VA-eligible locations.
Health Insurance Plans That Cover Substance Abuse and Mental Health Treatment for Veterans
There are specific health insurance plans and treatment programs that are designed to cover substance abuse and mental health treatment for veterans.
The United States Veterans Affairs Administration: This is a public medical care program provided to former military service members by the federal government. Applying for healthcare through the VA system is as easy as going to the website and starting the application process. Although the VA is not a health insurance program, whether or not a veteran has insurance does not preclude them from getting treatment at a VA hospital. If a veteran has insurance, VA hospitals bill the veteran’s private insurance for services. If they don’t have insurance, staff at the VA hospital may be able to help the veteran apply for Medicaid, if they are eligible, or determine if they meet specific low-income requirements using the financial assessment.
The VA is the foundation of healthcare treatment for veterans, but there are other health insurance programs veterans can work with, and to expand treatment access for veterans, the VA will contract with non-VA healthcare facilities.
According to Benefits.gov, enrolling in treatment through VA healthcare ensures comprehensive treatment for any and all veterans. There are two priority groups:
1. Priority Groups 1-3: These groups include veterans who have received a disability rating through the VA, former prisoners of war (POWs), and Purple Heart or Metal of Honor recipients.
2. Priority Groups 4-8: These groups include other veterans, such as those who have diagnosed chemical exposure, certain income levels, specific combat statuses, and other diagnosed medical conditions.
TriCare: This private insurance program is a regionally managed healthcare program for active duty service members, veterans of the US Armed Forces, their families, and survivors. This insurance program helps to cover substance abuse treatment through VA hospitals. As of July 2017, benefits through TriCare have been expanded to include:
- Emergency and non-emergency inpatient hospitalization
- Psychiatric residential treatment for children
- Partial hospitalization
- Outpatient and office-based mental health and substance abuse treatment
- Inpatient and residential substance abuse treatment
Ensuring private insurance covers these behavioral and mental conditions will help more veterans feel confident in the quality of their care as well as the financial support they receive to stay in treatment. This also provides greater flexibility for veterans who may not live near a VA hospital and need to access treatment through a closer rehabilitation program.
Medicaid: For many vulnerable populations around the US, Medicaid offers free or low-cost health insurance and supplements Medicare, private insurance, and other types of health coverage, including veterans’ benefits. Over 1.75 million veterans, or one in 10, uses Medicaid coverage to some extent. Two in five veterans surveyed in 2015 reported having Medicaid as their sole source of health insurance coverage; 41 percent reported Medicaid coupled with military or veterans’ benefits; 11 percent reported Medicaid and private insurance; and 9 percent reported both Medicaid and Medicare coverage.
Medicare: Older veterans likely qualify for both veterans’ benefits and Medicare; however, Medicare Part B and veterans’ benefits do not work together, so it is important to know how and when to apply to either program. Older veterans who go to a non-VA doctor and who have enrolled in Medicare will be automatically covered by Medicare Part A or B; however, these options are not billable to VA hospitals or VA program care. Medicare does not provide the same level of comprehensive treatment as VA hospitals do, but there are some programs that may be easier to access closer to home compared to traveling to a VA hospital for substance abuse services.
Overcoming Addiction or Co-Occurring Disorders as a Veteran
Working-age veterans who find employment in the public or private sector after leaving active duty likely have access to insurance coverage through their employer while aging veterans may consider applying for Medicare to help them. However, a significant number of veterans struggle with homelessness, suffer from severe mental illnesses, or have unstable financial lives due to substance abuse. These conditions make it difficult to maintain employment and consistent health insurance coverage. The VA will offer free or very low-cost treatment for these veterans while billing private insurance or charging copays for veterans who have consistent employment and other insurance options.
For many veterans, working with addiction specialists who understand the specific struggles unique to former soldiers, pilots, sailors, and more helps them feel comfortable with the quality of treatment they receive. Their individual needs can be better assessed by those who understand post-traumatic stress disorder, military life, and military families.
For veterans who cannot receive immediate treatment at a nearby VA hospital, doctors and addiction specialists all over the country are expanding their practice to treat veterans as a unique group with specific treatment needs. More private doctors are contracted through the VA to work with this federal program and provide mental, behavioral, and physical health treatment.