COPAYMENTS ARE BACK: THINGS TO KNOW ABOUT THE VA MEDICAL CENTER CHANGE
Each Veteran has a unique package in terms of their healthcare benefits. Some will include services and care to help with injuries, prevent future health issues, improve mobility, and enhance the quality of life. This is a great help, as they are very reliant on pensions. However, there was a new strain that made some Veterans suffer when it was announced that the VA Medical Center would start to make copayments on prescriptions. Now, this new development is impacting Veterans who are on a tight budget. This is because it's the first time in two years that copayments are resuming.Now, they will have to carry this monetary burden whenever they visit the five affected VA Medical Center Stations. The good news is that the Veterans Affairs will be sending notices to those who will be affected by the change. These are generally patients in Ohio and the Pacific Northwest. The details of the change being made at the VA Medical Center will be sent out via mail and email. It is taking effect on October 1st.
How is this Change Impacting Veteran Copayments?
Those who are in the Group 1 category don't have to make payments for their medication; brackets 2-8 will receive a charge. Secondly, for Tier 1, the 1-30-day supply is $5, 31-60 is $10, and the 61-90 is $15. For the Tier 2 category, the first 30 days are $10, 31-60 days cost $16, and the 61-90 days supply is $24. Lastly, tier 3 offers $11 for the first 30 days, $22 for the 31-60 days, and $33 for the 61-90 days supply. Even though there is a copayment requirement at the VA Medical Center Station, the good news is that an annual cap of $700 was established in order to help those who are having financial hardships and are enrolled in priority groups 2-8 who might need enormous amounts of medication. If they exceed the annual cap, Vets will continue to receive medication without needing to make a copayment. The VA will keep Veterans in the loop about any changes they make regarding retroactive pay. This will encourage patients to contact Veterans Affairs regarding medical debt or pharmacy billing for clarification.Urgent care has no limit; however, there is an eligibility requirement. A Veteran should be enrolled in the health care system and must have received care from the VA for the past 24 months. Copay charges for a flu shot at your first visit will be waived regardless of your priority group. Outpatient care with a service-related disability rating of 10% or higher is exempted from copay. Inpatient care exempts those with a service-connected injury rating of 10% or higher. Lastly, if you are in the 7 or 8 priority group, you must process payments at total price or reduced rates.Those living in a high-cost area might be qualified for a reduced rate. Just contact 877-222-8387 from Monday through Friday, 8:00 a.m. to 8:00 p.m. Eastern Time.
The Five Affected VA Medical Center Stations
These affected medical centers of the copayment scheme are the Jonathan W. Wainwright Memorial VA Medical Center and Mann-Grandstaff VA Medical Center in Washington; Chalmers P. Wylie Veterans Ambulatory Care, which is located in Columbus, Ohio; and the Roseburg VA Medical Center and White City VA Medical Center in Oregon. This change will not affect the facility in North Chicago, Illinois, which is the Captain James A. Lovell Medical Center.The five VA medical centers suspended their copayment scheme in 2022. This is because they had to transition to the latest Oracle Cerner electronic health records system. Also, during the pandemic, Veterans Affairs refunded and canceled copays for its entire health system. Press Secretary Terrence Hayes mentioned that copayments will reflect on the affected Veterans' November statements. Pharmacy charges will appear on next month's statement. This change will also affect Vets who have pharmacy benefits and care from other VA medical centers.On the other hand, the department has yet to comment on whether they will pursue retroactive copayments. In a statement, he mentioned that Veterans Affairs will hold on to collecting the retroactive payments. This is while Congress and other Veterans service organizations are still working on the matter.Patients at the VA Medical Center must process pharmacy copayments. This includes those who can't work due to their disability, Medal of Honor recipients, and those rated 50% or higher for disability, with the exemption of those in Priority Group 1. The VA will do anything to help the Vets if they are having difficulty managing debt. They can quickly get in touch with the Health Resource Center at 866-400-1238.Related reads: