VA New England Healthcare System
Veterans Choice Program Overview
Connecting you to timely and convenient access to
health care in your community
What is the Veterans Choice Program?
On August 7th, 2014, President Obama signed into law the Veterans Access, Choice, and Accountability Act of 2014. The Act improves the access of eligible Veterans to health care through non-VA local community providers by establishing the Veterans Choice Program.
Choice program provides eligible Veterans with the option of receiving care from private health care providers in their local communities.
The Choice Program covers hospital care and medical services under the Medical Benefits Package, which includes pharmacy and other benefits, such as beneficiary travel. For programs that have specific eligibility criteria, such as dental care, the specific eligibility criteria still applies.
All care under the Choice Program must be pre-authorized.
The Department of Veterans Affairs (VA) works each day to honor Veterans' service by providing timely and reliable access to health care and benefits – a responsibility we take very seriously.
Who is eligible for the Veterans Choice Program?
Under the updated eligibility requirements, a Veteran is eligible for the Veterans Choice Program if he/she is enrolled in the VA health care system and meets at least one of the following criteria:
- A Veteran is told by his/her local VA medical facility that they will not be able to schedule an appointment for care:
- Within 30 days of the date the Veteran’s physician determines he/she needs to be seen; or
- Within 30 days of the date the Veteran wishes to be seen if there is no specific date from his/her physician.
- The Veteran lives more than 40 miles driving distance from a VA medical facility with a full-time primary care physician.
- The Veteran needs to travel by air, boat, or ferry to the VA medical facility closest to his/her home.
- The Veteran faces an unusual or excessive burden in traveling to a VA medical facility based on geographic challenges, environmental factors, a medical condition, the nature or frequency of the care needed, and whether an attendant is needed. Staff at the Veteran’s local VA medical facility will work with him/her to determine if he/she is eligible for any of these reasons.
- The Veteran lives in a State or Territory without a full-service VA medical facility which includes:
- Alaska, or
- Hawaii, or
- New Hampshire (Note that Veterans are not eligible under this criterion if they live in New Hampshire and live within 20 miles of the White River Junction VAMC), or
- The United States Territories (excluding Puerto Rico which has a full service VA medical facility).
How to Get Started
To search for a provider of your choice, use the Health Net Federal Services link. From there, you can search for a Choice provider near you. Physician Compare from Medicare.gov is another search tool available for Veterans to locate providers of their Choice.
Authorization for care must be pre-authorized by Health Net Federal Services by calling 1-866-606-8198.
Eligible Veterans are authorized for a course of treatment, which must be considered medically necessary, for up to 60 days. The treatment will include any follow-up appointments, as well as any ancillary and specialty services.
Health Net Federal Services has the ability to negotiate individual Provider Choice Agreements for non-VA providers who do not currently belong to their existing Provider Community Network and at the Veterans Request. Veterans may choose their provider, but that provider must meet basic requirements such as be in compliance with federal and state regulatory requirements, provide current licensing information and agreed to submit copy of medical records.
Frequently Asked Questions
Can I still get my care at the VA? Absolutely, Veterans can still choose to receive their care from the VA. The Choice Program is simply another tool within VA to ensure you receive timely and locally convenient care.
Are my prescriptions covered? Yes. The Choice non-VA provider or Veteran must provide the episode of care authorization form with all Choice prescriptions to the VAMC Pharmacy. Choice non-VA providers are required to use the VA National Formulary process. VA does not accept verbal/telephoned outpatient prescriptions from non-VA providers or "transfer" prescriptions from non-VA pharmacies.
Urgent prescriptions may be filled at a local non-VA pharmacy for up to a 14 day supply and must adhere to the VA National Formulary.
Do I still have to make a copayment to the VA? Veterans who are subject to the copayment requirements will be subject to the same copayment requirements under the Choice Program. The amount of the copayment will be determined after the service is rendered. Once an offset has been applied for any payment made by the Veteran's other health Insurance, VA will bill the Veteran for the remainder of the charges. In addition, an eligible Veteran may be responsible for any copayments, deductibles or cost shares required by their other health insurance.
What if I have a PO Box or non-residential address? Veterans with a PO Box or non-residential address (such as Rural Route Delivery) or other non-residential address who wish to have their eligibility for the Choice Program based on distance should call VA at 1-877-222-VETS (8387). They will be asked to provide the address of their residence.
How is eligibility criteria determined for distance? As of April 24, 2015, a Veteran who lives 40 miles or less, is measured from the nearest VA medical facility (including Community Based Outpatient Clinics) based on driving distance using the "fastest route". In addition, the beneficiary travel mileage calculation will also now be made using the fastest route instead of the shortest route.
What can I do if the Choice Program is affecting my credit? For assistance, call 1-877-881-7618 and Press 1 between 9 a.m. to 5 p.m. Eastern Standard Time. VA will help you resolve adverse credit reporting and debt collection issues caused by use of the Choice Program.
Additional Resources and Fact Sheets
Want to get started?
Call Health Net Federal Services at 1-866-606-8198
If you have questions about other aspects of your VA medical care or want to learn more about enrolling in VA health services, please call 1-877-222-VETS or visit www.va.gov/health.