Do veterans have access to health insurance coverage through a Marketplace?View
Yes. The general eligibility requirements for veterans (as well as the general population) to purchase health insurance coverage through a Marketplace are:
- Legal residency status in the United States;
- Residency in the Marketplace service area (i.e., the boundaries of the Marketplace/state); and
- Not being incarcerated.
In general, veterans meeting these criteria are eligible to purchase health insurance coverage through a Marketplace during the annual open enrollment period and during a “special enrollment period”. Most individuals will only be able to enroll during the annual open enrollment period. A smaller number of individuals will be eligible for special enrollment periods.
Veterans who meet the definition of Indian under the Affordable Care Act (i.e., enrolled members in a federally-recognized tribe, including shareholders in an Alaska regional or village corporation) are eligible for monthly special enrollment periods and, as such, are able to enroll through a Marketplace throughout the year. (Family members of eligible AI/ANs may also enroll along with the eligible AI/ANs during a monthly special enrollment period.)
Information on the open enrollment period can be accessed here. (For coverage starting in 2015, the Open Enrollment Period is November 15, 2014-February 15, 2015.)
Information on special enrollment periods can be accessed here.
Do veterans have access to federal financial assistance--premium tax credits (PTCs) and cost-sharing reductions (CSRs)--through a Marketplace?View
Possibly, but it depends on individual circumstances.
General Policy: Under the Affordable Care Act (ACA,) to be eligible for federal financial assistance through a Marketplace (i.e., PTCs and CSRs), veterans (as is the case with the general population) must meet the following eligibility requirements:
- Qualify to purchase coverage through Marketplace;
- NOT otherwise have health insurance, qualify for certain federal health insurance programs that are considered “minimum essential coverage” (e.g., Medicare, Medicaid, etc.), or have an offer of affordable coverage through an employer (or the employer of a family member);
- Have a certain income level (e.g., for PTCs, household income between 100 percent and 400 percent of the federal poverty level, or $11,490 to $45,960 for an individual in 2014); and,
- Purchase coverage during the annual open enrollment period or during a special enrollment period.
As such, if a veteran is eligible for Medicare or Medicaid, the veteran would not be able to receive federal financial assistance through a Marketplace because those programs count as minimum essential coverage. Similarly, if a veteran is eligible for affordable employer-sponsored coverage, the veteran would not have access to PTCs through a Marketplace.
Indian Exception for CSRs: AI/ANs–including AI/AN veterans–meeting the definition of Indian under the ACA are eligible to purchase health insurance coverage (paying the full premium) at any level (e.g., bronze, silver, etc.) through a Marketplace and receive Indian-specific CSRs (referred to as a “limited cost-sharing plan variation”), even if they are not eligible for PTCs. The limited cost-sharing plan variation eliminates all cost-sharing (e.g., deductibles, co-payments, and co-insurance) for eligible AI/ANs served by Indian health care providers or referred to non-Indian health care providers through contract health services.
Veteran Exception for PTCs: For veterans (including AI/AN veterans), there is an exception to the “general policy” described above on eligibility for PTCs. Federal regulations at 26 C.F.R. § 1.36B-2(c)(2)(iii) state: “(iii) Special rule for coverage for veterans and other individuals under chapter 17 or 18 of Title 38, U.S.C. An individual is eligible for minimum essential coverage under a health care program under chapter 17 or 18 of Title 38, U.S.C. only if the individual is enrolled in a health care program under chapter 17 or 18 of Title 38, U.S.C. identified as minimum essential coverage in regulations issued under section 5000A.” (Emphasis added.)
This means that, rather than be barred from PTCs through a Marketplace, an individual eligible for a “veterans’ health care program” (VHCP; Title 38, chapter 17 or 18) may choose to NOT enroll in the VHCP and instead secure coverage through a Marketplace and access PTCs and CSRs, assuming the individual meets other PTC and CSR eligibility requirements. One important note is that TRICARE and CHAMPVA are considered employer-sponsored health insurance and not considered VHCPs for this purpose, meaningeligibility for TRICARE or CHAMPVA would prevent a veteran from accessing federal assistance through a Marketplace.
(NOTE: Eligibility for certain TRICARE-related programs–such as Young Adult, Reserve Select, Retired Reserve, and post-TRICARE continuation coverage (e.g., CHCBP)–does not bar an individual from eligibility for federal assistance through a Marketplace. (For more information, see the “TRICARE and the Affordable Care Act Fact Sheet” here.)
For individuals who are eligible for a VHCP, they cannot actually enroll in the VHCP and simultaneously receive PTCs through Marketplace coverage. This means that, if individuals enroll in a VHCP, they would not be eligible for PTCs if they were to purchase and enroll in Marketplace coverage. However, if an individual is eligible but does not enroll in the VHCP, the individual may be eligible to secure health insurance coverage through a Marketplace and receive PTCs.
Because some (AI/AN and other) veterans may be eligible for low insurance premiums when purchasing coverage through a Marketplace as a result of eligibility for PTCs, they might find it advantageous to not enroll or to dis-enroll from a VHCP and enroll in Marketplace coverage instead. Some veterans may also find easier access to services by enrolling in coverage through a Marketplace, rather than relying solely on a VHCP. (See the Web site links below for information on coverage options for veterans.) Veterans considering dis-enrolling or declining to enroll in coverage options from the Department of Veterans Affairs (VA) may wish to first discuss any ramifications from doing so with an appropriate VA, TRICARE, and/or Marketplace representative prior to dis-enrolling or declining to enroll in a VHCP.
Are there special considerations for American Indian and Alaska Native (AI/AN) veterans?View
Under the Affordable Care Act, among other provisions, if a veteran is enrolled in the Veterans Health Care Program (VHCP), the veteran is not eligible for premium tax credits when enrolling in health insurance coverage through a Health Insurance Marketplace. A veteran might consider not enrolling in the VHCP in order to access comprehensive health insurance coverage through a Marketplace with the assistance of premium tax credits.
Here are some related questions:
Q3.a: If an eligible veteran doesn’t enroll in (or disenrolls from) the VHCP so they can secure premium tax credits through Marketplace coverage, what is the impact on the individual’s ability to access services at a VA? Can the individual still have access to VA facilities?
A3.a: This individual would have access to some services at the VA. Generally, these are services those that do not require VA health care enrollment such as dental care, Vet Centers or state home per diems subject to specific eligibility requirements.
Q3.b: Can the individual use their Marketplace coverage at the VA facilities when not enrolled in the VHCP in order to access a broad range of services?
A3.b: No. While the VA would prefer veterans not disenroll from the VHCP, this is an individual choice based on their personal circumstances. Potential impacts of disenrolling from the VHCP includes a risk that—if the veteran decides to enroll/re-enroll in the VHCP in the future—acceptance for future VHCP enrollment would be based on eligibility factors at the time application is made, which could be different.
In addition –
- As mentioned above in QE1, AI/AN veterans (and other AI/ANs) who meet the ACA’s definition of Indian are eligible for monthly special enrollment periods and, as such, are permitted to enroll in Marketplace coverage throughout the year, assuming they meet any other applicable eligibility requirements.
- As mentioned in QE2, AI/AN veterans (and other AI/ANs) may enroll in any metal-level plan through a Marketplace (including bronze plans, which have the lowest monthly premiums) and still receive substantial protections from cost-sharing. (The general population is required to enroll in silver-level coverage to receive extra cost-sharing protections. Do not enroll in “catastrophic coverage” as cost-sharing protections are not permitted in these plans.)
- AI/AN veterans (and other AI/ANs) may continue to receive services at an Indian health care provider regardless of their insurance status. And many Indian health care providers have agreements with the Department of Veterans Affairs (VA) to be paid for services provided to veterans, although the VA may require prior authorization in order to make payment for the services.
- AI/AN veterans, as well as all other AI/AN individuals eligible for health care from the Indian Health Service, have the option of choosing to not enroll in any health insurance coverage, including a veterans’ health care program, and receive an exemption from the ACA requirement that individuals have health insurance coverage.