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Frequently Asked Questions
What is the Health Insurance Marketplace open enrollment period for coverage starting in 2018?
The Health Insurance Marketplace open enrollment period is November 1, 2017, through December 15, 2017.
What is the Affordable Care Act?
The Affordable Care Act, also known as the health care law, was created to provide more Americans with access to affordable health insurance, improve the quality of health care and health insurance, and reduce health care spending in the U.S. Under the health care law, individuals:
- must have health insurance that meets the “minimum essential coverage” requirement, or
- must pay an “individual shared responsibility payment,” also known as a “penalty,” when filing their taxes if they can afford to buy health insurance, but choose not to buy health insurance, unless they meet certain requirements to qualify for an exemption from paying the penalty.
The Health Insurance Marketplace helps individuals find health coverage. On the Marketplace, some people may be eligible for lower costs on health premiums and out-of-pocket costs based on their income.
What happens if I do not have health coverage?
You do not have to pay a fee if you have coverage that meets a minimum standard (called “minimum essential coverage”). VA is required by law to notify the IRS of Veterans’ enrollment status in the VA health care system in 2017. Veterans who are not enrolled in the VA health care system and who do not have qualifying medical insurance, unless given an exemption, will be charged a fee on their 2017 federal income tax return, which most people will file in the spring of 2018. The fee is prorated based on the amount of time in the calendar year the Veteran does not have medical insurance that meets minimal essential coverage standards. VA is committed to ensuring Veterans are aware of the opportunities to meet the health care reform law’s minimum essential standards for coverage either through enrollment with VA or through the purchase of insurance offered by the Health Insurance Marketplace. The fee for 2017 will be:
- $695 per adult and $347.50 per child, or 2.5% of your taxable income, at a maximum of $2,085, whichever is higher
An IRS tool is available on the marketplace website to estimate your fee:https://www.healthcare.gov/fees/fee-for-not-being-covered/
Exemptions from the fee will be granted under certain circumstances. For more information on these exemptions, visit www.healthcare.gov.
Will VA notify the IRS of health care coverage provided to each Veteran and eligible beneficiary?
Yes. VA will send Veterans and eligible beneficiaries a letter and IRS form 1095B which will provide the details of the health care coverage provided by VA for the previous year. As required by law, VA also will notify the IRS.
If I am enrolled in a VA health care program, do I meet the requirement for health care coverage?
Yes. If you are enrolled in any of VA’s programs below, you have coverage under the standards of the health care law:
- Veteran’s health care program
- Civilian Health and Medical program (CHAMPVA)
- Spina bifida health care program
What are the benefits of enrollment in VA health care?
Enrollment in VA health care means you have:
- Medical care rated among the best in the U.S.
- Immediate benefits of health care coverage. Veterans may apply for VA health care enrollment at any time.
- No enrollment fee, monthly premiums, or deductibles. Most Veterans have no out-of-pocket costs. Some Veterans may have to pay small copayments for health care or prescription drugs.
- More than 1,500 places available to get your care. This means your coverage can go with you if you travel or move.
- Met the new requirement to have health care coverage that meets the minimum standard.
How do I enroll for VA health care coverage?
You may apply in one of three convenient ways: visit www.va.gov/healthbenefits/enroll, call 1-877-222-VETS (8387) or visit your local VA health care facility.
Can I continue to use VA health care with other programs, like private insurance or federal health care programs?
Yes. You can continue to use VA for all your health care needs, or complement your VA care with private health insurance or coverage by other federal health care programs, including Medicare, Medicaid, and TRICARE.
What is the Health Insurance Marketplace?
The Marketplace is a way to shop for and purchase private health insurance (for example, health coverage other than VA health care programs) that fits your budget and meets your needs. People who purchase insurance through the Marketplace may be able to lower the costs of health insurance coverage by paying lower monthly premiums.
I am enrolled in a VA health care program. Would I be eligible for assistance to pay health insurance premiums on the Marketplace if I choose to purchase health care outside of VA?
Since VA care meets the standard for health care coverage, you wouldn’t be eligible for assistance to lower your cost of health insurance premiums if you chose to purchase additional health care coverage outside of VA. However, you may still purchase private health insurance on or off the Marketplace to complement your VA health care coverage.
How will I know if I’m eligible for assistance to purchase health insurance outside of VA?
VA can’t make this determination. If you use the Marketplace, you will find out if you can get lower costs on your monthly premiums for private health insurance plans. Remember, if you are enrolled in a VA health care program, you don’t need to take additional steps to meet the health coverage requirements under the health care law.
Are my family members (who aren’t eligible for VA or other federal health care programs) eligible for assistance to purchase health insurance?
Your family members who are not enrolled in a VA health care program should use the Marketplace to get coverage. They may get lower costs on monthly premiums or out-of-pocket costs. They could be eligible for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). For more information, visit www.healthcare.gov.
Can I still enroll through the Health Insurance Marketplace even when we’re not in an open enrollment period?
Individuals with a qualifying life event can enroll in health coverage or change their coverage outside of the open enrollment period and have it be effective for that coverage year. This is called the Special Enrollment period. Qualifying life events include having a baby or getting married. Visit www.healthcare.gov/coverage-outside-open-enrollment to learn more about these qualifying life events and other circumstances for special enrollment.
Can I cancel my VA health care coverage?
Yes. However, acceptance for future VA health care coverage will be based on eligibility factors at the time of application, which may result in a denial of health care coverage.
Do I need to report to IRS that I had health care coverage in 2017?
Yes. Line 61 on Internal Revenue Service Form 1040, Line 38 on the 1040A and various other entries on IRS income tax forms require taxpayers to self-declare whether they had health care coverage in 2017.
Does my enrollment for VA health care satisfy the IRS requirement to have health insurance?
Yes.
Where can I get more information?
For information on VA health care and the Affordable Care Act, visit VA’s website at www.va.gov/aca, or call 1-877-222-VETS (8387), Monday through Friday from 8 a.m. until 8 p.m. eastern. For information on the Marketplace, visit www.healthcare.gov or call 1-800-318-2596.
