2. • 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

3. • 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?

4. 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

5. Veteran Health
Benefits1,2
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. 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. 7
Veterans and Health
Where do veterans receive their health care?

8. 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 they
have
coverage for
percription
drugs
*Reflects all Veterans surveyed
4,715,657 Veterans were
enrolled in Medicare in 2004^

9. Veteran Males >655
No insurance
Current
Employer
(including
COBRA)
20%
44.5%
12%
8%
9.5%
Former
Employer
Individually
purchased
coverage
Federal, 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
coverage
Federal, State,
County, or local
community
services
Who provides the
(health care) coverage?
17%Family member
5%
From something
else

10. 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

11. Veteran Health
What services do veterans receive
and where?

12. 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

13. VHA and HEDIS Comparisons 20115
Clinical Indicator
VA
Average
HEDIS
Commercial
HEDIS
Medicare
HEDIS
Medicaid
Breast Cancer Screening 85 71 69 50
Cervical Cancer Screening 93 77 N/A 67
CMC LDL-C Control 71 59 57 42
CMC LDL-C Screening 96 88 89 82
Colorectal Screening 82 62 60 N/A
Controlling BP 81 66 63 61
CDC Eye Exam 90 57 66 53
CDC HbA1C Testing 98 90 91 83
CDC LDL Controlled 69 48 53 35
CDC LDL-C Screening 97 85 88 75
CDC Nephropathy 95 84 90 78
CDC HbA1C Poor Control 17 28 27 43

14. VHA and HEDIS Comparisons 2011, continued5
Clinical Indicator
VA
Average
HEDIS
Commercial
HEDIS
Medicare
HEDIS
Medicaid
Controlling High Blood
Pressure - Total 78 65 64 57
Medical Assistance with
Smoking Cessation –
Advising Smokers to Quit 97 77 N/A 76
Medical Assistance with
Smoking Cessation –
Discussing Medications 94 53 N/A 44
Medical Assistance with
Smoking Cessation –
Discussing Strategies 97 48 N/A 40
Flu Shots for Adults (50-64) 65 53 N/A N/A
Flu Shots for Adults (65+) 79 N/A 69 N/A
Immunizations: Pneumococcal 94 N/A 69 N/A

15. 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