What Transitioning Service Members Need to Know About the Affordable Care Act
The Affordable Care Act (ACA), also known as Obamacare, includes a requirement for most Americans to carry health insurance. This requirement is often called “the individual mandate.”
Beginning in 2014, the ACA requires individuals to have a minimum level of health insurance, known as “minimum essential coverage” (MEC), for themselves and their dependents. Individuals who fail to have MEC may be required to pay a penalty (called a “shared responsibility payment”) when they file their tax returns.
After leaving the military, transitioning service members lose TRICARE coverage for themselves and their dependents. These new veterans and their families will no longer have MEC and must find new health care coverage. If you are leaving military service, one of your best options is to get your health care coverage from your new employer. Employer based health coverage is the most affordable option for many people, since employers typically pay a large percent of the monthly premiums. If you do not yet have a job lined up, or if your new employer does not offer health care insurance, you have several other options:
VA Health Care Program
As a veteran, you may be eligible for health care through the Department of Veterans Affairs (VA.) If you served in the military and were separated under any condition other than dishonorable, you may qualify for VA health benefits. Please see the VA website for details.
Veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND), have earned access to enhanced VA health care benefits. To take advantage of these enhanced benefits you must enroll in VA’s health care system within five years from the date of discharge or release.
Once you are enrolled in the VA’s Veterans Health Care Program, you have MEC and do not need to purchase private health care coverage for yourself.
Please note that in most circumstances, the VA does not provide health care for veterans’ family members. If you are a veteran enrolled in the VA health care program and you have dependents, you will have MEC but your family members will not. You will need to get health insurance for your dependents so they also have MEC.
DoD Temporary Health Care Coverage Options
The Department of Defense (DoD) offers two options for transitioning service members and their families to continue TRICARE coverage on a temporary basis: the Transitional Assistance Management Program (TAMP) and the Continued Health Care Benefit Program (CHCBP.) These programs are intended to act as a bridge between military health benefits and your new civilian health plan.
Under limited circumstances, you may be eligible for the Transition Assistance Management Program (TAMP). TAMP provides 180 days of premium free transitional health benefits after regular TRICARE benefits end. During TAMP, sponsors and family members can use one of several TRICARE health plans in addition to military hospitals and clinics. Other active duty programs such as the Extended Care Health Option (ECHO) are also available during the TAMP period. Please see the TRICARE website for more details.
Another DoD option you might consider is the Continued Health Care Benefit Program (CHCBP). This is a premium-based health care program that offers temporary transitional health coverage for 18-36 months after you separate from military service and lose TRICARE coverage. If you qualify, you can purchase the CHCBP within 60 days after you lose TRICARE. CHCBP provides coverage similar to TRICARE Standard. Current premiums are $1,275 for an individual and $2,868 for a family. These premiums are in effect from October 1, 2014 - September 30, 2015.
Both of these options should be presented during your Transition Assistance Program (TAP.) If you have additional questions beyond the information provided on the TRICARE website, please call your regional contractor.
ACA Health Insurance Marketplace
(new option for military families)
As part of the Affordable Care Act, you will also have the option of comparing and purchasing private health insurance plans (e.g, HealthNet, Kaiser Permanente, BlueCross BlueShield) using an online marketplace (also called an exchange.) The ACA marketplace is like an Expedia for health insurance. In addition to comparing plans, you can also use the marketplace to apply for coverage and find out how much of a federal subsidy (also called a tax credit) you can get to help you pay for it.
Please note that if you are a veteran enrolled in a VA health care program, you already have MEC. This means you do not have to purchase additional coverage to meet the ACA individual mandate requirement. It also means that you are not eligible for a federal subsidy to lower your cost of health insurance premiums if you choose to purchase private health care coverage outside of the VA. You may still purchase private health insurance on (or off) the marketplace to complement your VA health care, you just won’t get the subsidy.
Even if the veteran is using VA health care, family members who are not enrolled in a VA health care program can use the marketplace to get coverage and they are eligible for a subsidy to lower their costs assuming their family income is not too high.
The rules for Medicaid eligibility are different for each state. Most states offer coverage for adults with children below a certain income level, as well as pregnant women, some seniors and people with disabilities. Under the Affordable Care Act, Medicaid eligibility is expanding in many states. More people than ever will qualify for Medicaid starting in 2014. If you think your family might qualify for Medicaid, visit the ACA health insurance online marketplace. It will prompt you to apply for Medicaid if your income level is low enough to qualify.
With the introduction of the online marketplaces, the families of transitioning service members have a new way to shop for health insurance to replace TRICARE.
Posted November 11, 2014