Veterans Choice Insurance Program for Addiction Treatment
American military veterans present a particularly sensitive group when it comes to substance abuse disorders. A high percentage of co-occurring mental health issues are characteristic of this population group. An additional factor that complicates the crisis is the fact that veterans treated with opioids for chronic pain, as well as those in medication-assisted treatment (MAT) for opioid abuse disorder, significantly underestimate their risk for opioid overdose. As much as 70% of them consider their overdose risk below that of the average US adult.1
A substantial percentage of military veterans also battle other psychiatric disorders (most commonly depression, anxiety, and PTSD) as well as medical health issues, and high rates of suicidal ideation. In fact, about 30% of military personnel suicides followed substance abuse (both drugs and alcohol), while 20% of deaths were attributed to alcohol or drug overdose. Heavy drinking is the most prevalent type of substance abuse among military veterans.2
Reducing substance abuse and mental health issues among veterans has been the main goal of a large number of services and interventions. Most of them include both behavioral and pharmacological approaches and therapies. Nevertheless, rates of SUDs in veterans are still rising despite numerous efforts undertaken by the VA and other agencies over the past 20 years.2
What Kind of Insurance Does the Veterans Choice Program (VCP) Provide?
Veterans Choice Program (VCP) was a temporary program, established in 2014, by the United States Department of Veterans Affairs (VA). The main goal was to enable access to community health care for eligible veterans. The greatest benefit of VCP was the possibility of receiving medical care from non-VA providers and having those services paid for by the VA.3
The VA Choice Program also offered flexibility to eligible veterans since they could choose to access medical care in their community, or within the VA healthcare system. They could use VCP for one type of care and still use the local VA medical facilities for another. This program provided a way for veterans to access medical services instead of waiting for an available VA appointment or traveling long distances to a VA facility nearby.3
The Veterans Choice Program was ended by The MISSION Act of 2018, and all VCP agreements officially expired on June 6, 2019 – the date of the “sunset” of the program. It has been replaced by a new program called the Veterans Community Care Program.4
Does VCP Insurance Cover Alcohol and Drug Treatment?
Aside from other healthcare services, VCP provides various substance abuse treatment options to veterans struggling with alcohol or drug misuse issues.9 This type of medical care is considered one of the essential health benefits under The Affordable Care Act (ACA).10
This law requires that all long-term insurance plans cover mental health care, SUD treatment, behavioral health treatment (psychotherapy and counseling), as well as mental and behavioral health inpatient services. VA healthcare covers both SUDs and related conditions, like anxiety, depression, and post-traumatic stress disorder (PTSD).7, 8
What Coverage Levels and Plans Does VC Program Insurance Offer?
When it comes to VA insurance coverage, all veterans are covered for most common medical services, but not everyone is eligible for some added benefits. The full scope of benefits might depend on:9
- The priority group to which every veteran is assigned during enrollment to balance out the demand and available resources.
- The advice of a VA primary care practitioner.
- The medical treatment standards for a specific condition.
Therefore, every individual’s benefits package is unique. What they all include are care and services regarding:9
- Illnesses and injuries.
- Prevention of potential future health issues.
- Improvement of functioning abilities.
- Enhancing quality of life.
Patients get referred to community care if VA is unable to provide specific services. This is one of the factors that make some veterans eligible to receive healthcare through a local community provider. It also depends on their particular needs and circumstances, and meeting eligibility criteria for VCP. However, one doesn’t exclude the other. Veterans can alternate between them depending on the type of care they need.10
How to Check Your Rehab Coverage Through Veterans Choice Program?
When deciding on the right kind of facility or choosing an appropriate program for your circumstances and needs, the first thing you should do is check your coverage levels. Veterans Choice is not a health insurance plan, and it doesn’t guarantee treatment coverage to all veterans.3
To find out about your options, you can reach out to VA by phone or use their online location database to find a suitable in-network provider. There’s a VCP hotline you can call at (866) 606-8198 or you can visit their website to verify your eligibility. Additionally, VA’s Community Care web page is a useful resource for currently available options.11
American Addiction Centers is one of the treatment providers that work with VA to help veterans recover from substance abuse. You can check your benefits coverage and find suitable addiction treatment options by reaching out to AAC over the phone or online, by filling out and submitting a verification of benefits form on the website.
What Types of SUD Treatment Does VC Program Cover?
Aside from medical, surgical, and mental healthcare, or necessary pharmaceuticals, VA’s standard benefits package also includes some SUD treatment options. However, long-term care and emergency care in non-VA facilities are not included in VCP.3
Since alcohol and drug abuse rates tend to be high among military veterans, various levels of care are required and addiction treatment will depend on the specific needs of each veteran. Some of them are fully covered, some only partially. Treatments that are generally covered include:5
- Detox that’s medically managed and used to help with withdrawal.
- Drug substitution therapies that entail the use of medications to reduce cravings and prevent relapse.
- Inpatient or residential care, an intensive, live-in treatment.
- Partial Hospitalization Programs (PHP) that enable the patient to live at home and attend appropriate SUD treatment during the day.
- Intensive Outpatient Program (IOP).
- Outpatient addiction treatment and counseling.
- Therapy and support groups.
- Aftercare care and relapse prevention.
Is Mental Health Treatment Covered by Veterans Choice Program?
The Affordable Care Act (ACA), signed into law in 2010, requires all health insurance providers to cover 10 essential health benefits. This includes mental health and SUD treatment.6 VA offers mental health resources and treatment options for common issues like:12
- Anxiety. Almost one-third of all adults experience some form of anxiety during their lifetime. VA offers counseling to manage anxiety triggers.
- Depression treatment options are also available to veterans, so they can overcome this difficulty and get back to their lives.
- PTSD, or posttraumatic stress disorder, can occur as a result of a traumatic event or experience. It can cause nightmares, sleeplessness, and anxiety that disrupt everyday life, so some people try to mitigate the symptoms by self-medicating. Effective treatment options are available through VA.
- Bipolar disorder can manifest through a range of symptoms, like mood and energy swings, for example.
- Suicide prevention is VA’s top priority when it comes to providing mental health care to military veterans.
Since a significant percentage of veterans suffer from both SUDs and co-occurring mental health issues, insurance may also cover dual diagnosis treatment. VA professionals treat SUDs co-occurring with mental health issues using evidence-based therapies and treatments. Local VA centers offer short-term behavioral interventions:2,13
- Cognitive Behavioral Therapy (CBT) helps develop more balanced and helpful thoughts about patients themselves, others, and the future.
- Motivational Interviewing (MI) places focus on detecting and strengthening motivation for change.
- Motivational Enhancement Therapy (MET) is a version of MI that focuses specifically on changing drug and alcohol abuse behavior.
Is It Possible to Go to Private and Luxury Rehab Centers With VA Choice Program Coverage?
Since the VA Health Administration is the largest integrated healthcare system in the U.S., the treatment options it may cover vary significantly on a case-to-case basis. The VA provides drug and alcohol rehab treatment depending on a veteran’s individual needs, so various levels of treatment may be covered.14
The facility you wish to go to needs to be in-network with the insurance provider so you can get full benefits. Also, VCP can be combined with other insurance options, so veterans can get combined coverage for private rehab centers. They might even cover treatment in luxury facilities that offer additional services and extra amenities since specialized US rehab centers accept various insurance and payment plans. VA is a well-integrated healthcare network that can cover treatment costs in collaboration with private insurance providers.3
If you wish to use the VA Choice Program, you need to provide the VA with your private health insurance information. After you do this, you’re no longer responsible for copayments associated with your private health insurance.15
In Which States Is Veterans Choice Program Available?
Generally speaking, VCP is available to veterans across the U.S., if they are ‘Mileage Eligible’ (40+ miles) or live in a state or territory without a full-service VA medical facility. In the latter case, a veteran is eligible for VCP care if their residence is more than 20 miles from a VA healthcare facility or in one of the following locations:10
- New Hampshire (excluding veterans residing 20 miles from the VA White River Junction).
- U.S. territories (except Puerto Rico).
One exception is the Commonwealth of Massachusetts, where VCP operates as a brand of Medicaid. Because of the state Healthcare Reform Law of 2007, VCP and Medicaid collaborate as MassHealth Community Partners. Nevertheless, this collaboration provides medical assistance and healthcare to veterans across the state, from Suffolk County to Berkshire, as well as Worcester, Plymouth, and Essex. Care is available to veterans in all major cities like Boston, Springfield, Cambridge, Lowell, or Plymouth.17
What’s the VA Choice Coverage for Addiction Treatment?
Since the VA is the primary coordinator of benefits for VCP, veterans are no longer responsible for any co-payments to their insurance companies. This means that veterans are solely responsible for their VA copayment. However, keep in mind that if you do have private health insurance, you’re required to submit that information to the VA Choice Program.18
When getting VA-related treatment from a private doctor, veterans with private insurance that requires a copay aren’t liable for any in this case. Those who pay copayments to VA are subject to the same requirements under the VCP, while those who don’t have a VA copay can see a private doctor without paying anything. However, if you received treatment for any non-VA-related medical condition, you’ll receive a copay bill from your insurance company.3, 19
VA Choice Eligibility Criteria
Aside from being enrolled in VA healthcare, veterans have to meet at least one of the following conditions:3
- The veteran lives 40+ miles from the nearest VA medical facility.
- Traveling to the nearest VA facility creates other types of burdens, or getting to the nearest VA medical facility requires travel by air, boat, or ferry.
- Veterans are “waitlist-eligible” if the VA is unable to offer an appointment within 30 days.
- The VA doesn’t offer the required services.
- If there’s no VA medical facility that can provide full service in the veteran’s state, they are eligible for VCP care if they live more than 20 miles from a VA medical facility and are located in:3
- New Hampshire.
- U.S. territories (excluding Puerto Rico).
- If it’s in a veteran’s best medical interest or a VA service line isn’t up to relevant quality standards.10
The Process of Getting VA Choice Program Coverage for Addiction Treatment
The VA program covers services related to substance abuse. However, all elements of treatment and care under the VCP need to be authorized first. To access services for substance use issues, the first step is to apply for VA health care. When you sign up, there are two options:5
- In case you already have a VA primary care provider, they can help you with the screening process for SUDs and any related issues, like mental health disorders. After that, they will offer appropriate treatment.
- In case you don’t already have a VA primary care provider or have never used any of the VA services, to get all the necessary information and guidance, you can:
- Call the VA hotline at (800) 827-1000.
- Contact your local VA medical center or find it online, according to your location.
What if My VA Choice Doesn’t Cover All My Costs?
In case you don’t have VA healthcare benefits or are not fully covered for the type of treatment you need, you might be still able to get care:5
- If you’ve served in a combat zone, you can get free private counseling, substance abuse assessment, and other types of support at community Vet Centers.
- If you’re homeless or at risk of becoming homeless, you can get information at the VA website or contact the toll-free 24/7 National Call Center for Homeless Veterans at (877) 424-3838. A trained hotline counselor will provide information about available programs, and other services in your area. Since all medical information is private and protected by law, these calls are confidential.
Veterans whose treatment isn’t fully covered can ask about different payment options. Some rehab centers offer completely free or low-cost treatment to patients with low income, and some offer sliding fee scales. Of course, most of the SUD treatment facilities accept out-of-pocket payments, so borrowing money in time-sensitive circumstances is another option.20
If you need a general assessment of your treatment options and information about your insurance coverage and payment possibilities, you can reach out to AAC. Trained admission navigators can guide you through the intake process and answer any additional questions you might have about treatment.