Virginia Health Services FAQS

Will the VA pay for my emergency care if you go to a non-VA health care facility?

Possibly. If you are geographically unable to access a VA medical facility, or if the VA is unable to provide the emergency care needed, the VA may cover your bill. See the “Emergency Care” section in your Medical Benefits Package for specific rules regarding emergency care in non-VA facilities.

What is a VA healthcare PACT?

PACT is an acronym that stands for “Patient Aligned Care Team” and represents veterans working together with health care professionals to create a plan for life-long health and wellness. It is a holistic approach to veteran health care.

Which VA health care programs meet the ACA’s requirement for health care coverage?

The Veterans health care program, the Civilian Health and Medical program (CHAMPVA) and the Spina Bifida health care program all satisfy the standards of the health care law.

Can you keep other federal or private health insurance plans if you sign up for and receive VA health care?

Yes. You may use private health insurance or federal health care plans in conjunction with VA health care, including TRICARE, Medicaid and Medicare.

Do any VA medical facilities in Virginia provide inpatient PTSD treatment?

Most Vet Centers offer outpatient PTSD services, but there are two options for more intensive PTSD treatment in Virginia. The Hampton VA Medical Center has a PTSD Domiciliary for intensive/inpatient PTSD treatment, and the Salem VAMC includes a Specialized Inpatient PTSD Unit.

Do Medicare beneficiaries with only Part B coverage meet the Affordable Care Act’s requirement to maintain minimum health insurance coverage?

No. Medicare Part A coverage meets the requirement of the ACA, but Part B coverage does not suffice on its own.

Are people with end-stage renal disease (ESRD) required to sign up for Medicare?

No. Signing up for Medicare is completely voluntary for people with ESRD.

Do participants in PACE (Program of All-Inclusive Care for the Elderly) pay deductibles or co-payments for health care services?

As long as the drug, service, care or procedure is approved by the PACE team of health care professionals, the participant will never have to pay co-payments or meet deductibles before receiving these services. If you have Medicare but not Medicaid, you will be responsible for paying a monthly premium for long-term care.

Will Medicare cover seeing another doctor to get a second opinion about a surgical procedure?

If you have Original Medicare coverage, you have Part B, which helps pay for a second opinion before undergoing surgery. You can find similar doctors who accept Medicare and make an appointment for a second opinion consultation.

How can you get government assistance with dental care for children while living in Virginia?

The Department of Medical Assistance Services (DMAS), offers Virginia’s Medicaid “Smiles for Children” program that provides comprehensive dental services to qualifying children up to age 20 who live in low-income families.

Does Medicaid have enrollment deadlines or Special Enrollment Periods, like Medicare?

No. You can apply for Medicaid any day of the year. There is no enrollment deadline.

What adolescent substance abuse programs are available on Medicaid in Virginia?

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is the substance abuse benefit package for Medicaid or FAMIS Plus members under the age of 21.

What type of substance abuse treatment can a teenager receive through EPSDT?

EPSDT offers individualized care solutions and diagnostic services to put together a treatment plan for teens whose substance abuse treatment is medically necessary. Teens with general Medicaid can participate in outpatient therapies, while adolescents who are enrolled in FAMIS Plus and a Managed Care Organization are eligible for inpatient substance abuse treatment programs.

What is the “Guaranteed Issue” in The Affordable Care Act?

The guaranteed issue in the ACA is the portion of coverage that makes it mandatory for health care plans to allow you to enroll regardless of your age, gender, health status or other factors that may appear to predict how much you will use health services in the future.

I just found out that my Medicare Advantage Plan company has decided to stop participating in Medicare. Can they do this? What do I do now?

Independent companies that provide Medicare Part C plans can decide to stop coverage in the coming year. If you received a notice about this, it should have included other Medicare coverage options. If not, your current plan should end on December 31 of the current year. You can choose another plan during Medicare open enrollment (October 17 to December 7) and your coverage will begin on January 1.

What health services are not covered under Original Medicare, or Part A and Part B?

Some items and services not covered by Original Medicare include dentures, most dental care services, eye examinations related to obtaining glasses, cosmetic surgery, acupuncture, hearing aids and fitting exams, long-term care, and any type of concierge or boutique medicine.

Does Medicare cover immunizations?

Medicare Part B covers annual flu shots, hepatitis B shots and pneumococcal vaccines. Other types of immunizations may be covered by your Part D prescription plan.

Is there another way to obtain assistance if you do not qualify for Medicare Extra Help to assist with your prescription drug costs?

Some drug manufacturers offer financial assistance to Medicare Part D plan participants. You can use Medicare’s Pharmaceutical Assistance Program Finder to help you afford the cost of prescription drugs. If your medications are for HIV treatment, contact the Virginia State Pharmaceutical Assistance Program for information on obtaining help.

What is Commonwealth Coordinated Care (CCC)?

CCC is a program that provides ombudsman assistance to full-benefit Medicaid and Medicare beneficiaries. They help resolve issues related to long-term care for senior citizens.

Virginia Department of Social Services