Understanding Health Care Benefits for Veterans

Health care coverage tied to your employer means that when you no longer work there, you’ll no longer have this coverage.

If your job is terminated (or if you fall into another qualifying event), you’ll have 60 days to enroll in the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA provides a temporary extension of health coverage for up to 18 months. While the monthly premium is higher than what you paid as an employee, it can be extended to 36 months if you are eligible for a second qualifying event during this time (i.e., death of a spouse).

Understanding the network

Essentially, you’ll have one of two types of medical plans: the HMO or the PPO. 

The health maintenance organization, better known as the HMO, has a network of doctors, hospitals and health care providers in its network. By contrast, a preferred provider organization, also known as a PPO, offers more flexibility to see providers who are in and out of the network.

HMO costs tend to be less expensive than PPO costs. Typically, the HMO requires your primary care physician (PCP) to provide referrals to other physicians in the network before you see them, whereas the PPO does not require referrals.

Breaking down dollars and cents

Similar to how plans vary, payment structures vary as well. If your copay is $50 for a doctor’s visit, then you can expect to pay $50 during that appointment.

Or your payment may be part of a deductible that needs to be reached with a subsequent percentage known as coinsurance. For instance, if a plan has a $2,000 deductible, you’ll be out of pocket for $2,000, and then you’ll pay 20 percent beyond that during the year (or whatever the coinsurance percentage is for your plan). Amounts differ by plan.  

The key to understanding your plan involves comprehension of how payments work, especially when tests were done and a hospital stay was involved, and you receive a statement in the mail that indicates: “This is not a bill.”

When in doubt, call your insurance company to understand your out-of-pocket costs and when payments are due. Also, you may want to inquire about your prescription plan and costs for generic versus specialty drugs.

If your insurance company indicates that a test that your doctor performed was not necessary and is therefore not covered so you are responsible for the entire cost, you have the right to appeal. 

Consider your health care coverage as not only a patient and paying customer, but as an informed consumer to know your rights as well. Don’t forget to check out the AARP Veterans Health Benefits Navigator.

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