VA Health Care Coverage and the Affordable Care Act

Medical care is one of the fastest growing expenses facing Americans. To help make medical care coverage more accessible for all, the government passed the Affordable Care Act — also known colloquially as “Obamacare.” The Affordable Care Act required Americans to maintain health care coverage by January 1, 2014, with the idea being that more…
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Medical care is one of the fastest growing expenses facing Americans. To help make medical care coverage more accessible for all, the government passed the Affordable Care Act also known colloquially as “Obamacare.” The Affordable Care Act required Americans to maintain health care coverage by January 1, 2014, with the idea being that more people covered by health insurance would reduce overall health care costs for the majority of Americans and make it easier for people to obtain health care coverage.

VA Health Care and Affordable Care ActUnder the Affordable Care Act, people have several choices regarding their health care coverage. They can choose to retain a health insurance plan that meets minimum essential health coverage standards, qualify for an exemption or elect to pay a fine when filing their taxes if they are eligible for affordable health insurance but choose to remain uninsured.

Most businesses with large numbers of employees are also required to offer health insurance coverage to their workers, which can also make health insurance more accessible.

VA Health Care Enrollment Satisfies the Minimum Essential Coverage

If you are enrolled in the VA health care system, then you should have the minimum essential health care coverage required by the Affordable Care Act. Eligible health care plans include the Veterans’ Health Care Program, Civilian Health and Medical Program (CHAMPVA), and the Spina Bifida Health Care program. However, it’s important to note that your entitlements under the VA system aren’t necessarily changed by the Affordable Care Act. Your benefits and coverage should remain the same as they were before the Act was passed. The health care law does not change VA health benefits or out-of-pocket expenses.

For many veterans, that means they will have limited health care coverage through the VA and may have to pay out-of-pocket expenses for care they receive through the VA. For example, many veterans with a service-connected disability receive free health care coverage for the condition for which they have a service-connected rating. But other medical conditions that don’t have a service-connected rating may not be covered. You may still be able to seek medical care at a VA hospital or clinic, but you would likely have to pay a copay or use a different insurance plan to pay for the medical care if you don’t meet certain income requirements or disability rating requirements for free medical care.

Are you eligible for VA Health Care? Many veterans are unaware they are eligible for VA health care benefits. Click here to learn more about VA health care eligibility. You can also check out our Veterans Benefits Guide to learn about other benefits you may be eligible to receive.

Penalties for Not Obtaining Health Care Coverage

Starting in 2014, the Affordable Care Act imposes penalties on individuals who have access to affordable health care but choose not to maintain coverage. You will have to pay this penalty when filing your taxes. The fee schedule is the larger amount of:

  • $95 or 1% of your taxable income in 2014
  • $325 or 2% of your taxable income in 2015
  • $695 or 2.5% of your taxable income in 2016

If you are eligible for VA health care coverage, then it’s a good idea to at least maintain your VA health care enrollment, regardless of whether or not you use the services. This will help you maintain the minimum essential health care coverage and avoid paying any penalties.

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  1. Robin says

    Is there a way to have va healthcare and affordable healthcare? Also if my wife qualifies for champ va but chooses to have the affordable care act would she be penalized for not filing taxes if she’s not working?

    • Ryan Guina says

      Hello Robin,

      These questions are outside of my area of expertise. I recommend speaking with a VA benefits counselor at your county VA office, the Department of Veterans Affairs, or a Veterans Service Organization such as the DAV, AMVETS, etc.

      They have trained benefits counselors who should be able to review your personal situation and provide individualized assistance.

      I wish you the best, and thank you for your service

    • Ryan Guina says

      Jeff, Thank you for contacting me. The best course of action is to contact the VA and ask them how to get a replacement. They may be able to mail you one, or they may have a way to get one online (I’m not positive as this is a new program). Best of luck, and thank you for your service!

  2. Norman Duncan says

    My income is all Social security and a disability VA pension not taxable. I do not file a tax return what happens to me.

    • Ryan Guina says

      Norman, Thank you for contacting me. Based on my understanding, you do not have to file taxes you do not need to worry about filing a 1095. Best of luck, and thank you for your service!

  3. Thomas Spitnale says

    I am a 100% permanently disabled per VA vet. I get all my medical treatment through the VA. My wife has CHAMPVA coverage. What do I need to do, i.e., who do I need to contact, so I will not be penalized for not having a health insurance policy for myself and my wife?

    • Ryan Guina says

      Thomas, As long as you are in the VA system and are eligible to receive health care coverage through it, you are covered. Your wife should be covered through CHAMPVA. Neither of you should be penalized under the new Affordable Care Act.

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