This question is for a dear friend so I may not have all the details but here are the relevant ones
Navy Seal is injured while in the military. Told he can continue with military in non-Seal role or retire. He is discharged honorably and sometime after he is divorced and marries a woman with 2 kids (not his bio kids).
Woman has had breast cancer (stabilized for now but with ongoing treatment for fluid buildup) and is currently paying just over 12,000 a year for a plan that has a 4000 per person deductible to cover her ex-military husband, herself and her kids. Kids are 21 and 18 she is 49 and he is 44. We were chatting about insurance at a company get together last night when she detailed this scenario and I asked she was not using her husbands military VA benefits to cover the family. At a minimum shouldn’t he be using his VA benefits. She did not know this was an option.
Do his VA benefits offers any coverage option for himself, her or the family that would be better than this high deductible plan?
Any information appreciated. I tried navigating the military insurance thicket via online links but did not have any luck deciphering the options for the above situation.
Was the service member medically retired, or did he simply resign or not reenlist? If he is medically retired, he and he spouse ought to be eligible for Tricare. From what you’ve written, it sounds like he did not retire (either medically or with 20+ years of service).
Assuming he isn’t eligible for Tricare, spouses normally are not eligible for VA medica benefits unless he is totally and permanently disabled.
These are general comments only. The VA Medical Center your friend goes to should have plenty of resources available to investigate the options for their particular situation, including some presence of a Veterans Service Organization that can be a little more of an advocate for his interests.
I’m no expert, but if I’m reading the page below correctly, your friend’s family would only be eligible for VA medical coverage if he were dead or permanently and totally disabled, or if they happened to have spina bifida.
There is a reference on that page to TRICARE benefits for family members, but that also seems to apply only if your friend died under particular circumstances.
But you know what? Medical insurance is expensive. He should probably talk to someone at the VA who can discuss whether he is missing out on some benefit he is entitled to.
As Ravenman said it really depends on his status. If he is retired, medically or otherwise, all those that are named as dependents in DEERS will be covered under his Tricare.
If as I suspect he left the military with a percentage of disability from the VA his eligibility for VA healthcare will vary greatly depending on his percentage of disability.
Unless you know what percentage he is rated at it will be difficult to answer completely.
ETA: as Ravenman said unless he is rated at 100% disabled his dependents will not be eligible under the VA.
I’m not sure, from her description he was injured and offered the option to continue in the military in some capacity as a non-Seal or leave the service so he left the military (honorably). The use of the word “retired” is mine and it might not accurately reflect how the military views this sort of separation.
Do you know him at all or just her? I hate to say it but after years of experience with it whenever anyone says “I was a SEAL” my initial reaction is to disbelieve.
This might just be a miscommunication because you are not in the direct loop. In the military you are not just brought into a room and told you can leave or change your job. There is a long process which includes many months of tests and treatment with a medical review board at the end. In the Army it’s called a MEB. Apparently the Navy calls it a PEB. It is a lengthy process and includes the chance to appeal the findings. Maybe he did go through that process. It is hard to believe he went through that process and received no information as to his benefits. If he was forced out because of an injury he would have been medically retired and received all the benefits of someone who put in 20 years. If he left without retiring but had a debilitating injury he would be rated by the VA and getting a check every month.
The “Seal” description is from his wife. He has never remarked that he is one or brought it up in conversation with anyone. He is also very, very fit and low key. He’s not said “I’m a ex-Seal” to anyone in our social circle, ever.
I gave the above info to my friend and told her I was pulling out from researching it and to do whatever research she needed herself as I don’t have enough precise info since the answer would be based on exactly how and why he separated from the military.
Her understanding of his exact separation status is no better than mine and she’s been married to him for some time. I told her that if her husband was injured, evaluated and released there should (hypothetically) be some bennies available at least for him and he should not need to be on the expensive, high deductible family plan, but again it’s all based on how the separation went down.
He’s a decent businessman so I’m surprised that he’s ignoring potential VA benefits, but I told her I’m out of it.
Again speaking in generalities, veterans with a service-connected disability of a sufficiently high rating are very high on the priority list for service at VA hospitals and clinics. These individuals would also be eligible for disability compensation, which is a monthly check from the VA that ranges from $150 or so at the low end to more than $2,500 a month for someone who is 100% disabled.
He’s very fit and in a business that requires a good deal of physical activity so whatever the disability level was for the injury (if any) it can’t be too great, and seeing as it was enough to keep him from being a Seal but not enough to keep him out of the military (it was his option to leave) I’m not clear on how the military would handle that.
I have a 20% VA disability for service related knee injuries. I get less than $300 a month and if anything further has to be done medically on my knees it will be paid for and done by the VA. That’s it. I don’t have a sufficiently high enough disability rate to get more. In fact it’s low enough that I’m able to stay in the National Guard.
There are people with surprisingly high ratings who ostensibly don’t appear to have much wrong with them but may have psychological ratings like PTSD or had a traumatic brain injury or something or have that with a combination of minor physical problems.
Also true. However, from what I can tell for your family to qualify for healthcare through the VA your disability rating has to be rated 100% disabled.
Loach covered the meat. A couple things that spring to my mind:
If he was offered a chance to reclassify IIRC there’s no gap in regs where he could refuse it and medically retire. Unless he had 20 years in uniform you can be pretty sure that if they were ready to keep him he’s not considered retired. My memory fit with Loach’s 100% disability to keep benefits. Without digging through regs for odd exceptions my memory says there’s no way they were going to let him reclass if he rated 100%. I had to process one of my troops out of the Guard when he finally got his determination back from the VA for his active duty time. He was at 35-40% and still medically fit for his position because no one issue was that serious (he had a bunch of small issues.) His total disability rating was just too high to serve in the Guard. ISTR the line was 30% in 2005-6. Essentially if the offer of reclass was made he almost certainly doesn’t rate family benefits through the VA.
Bottom line - If he was offered the chance to reclass and left anyway, That just about slams the door on family benefits through the VA. If he served 20+ years normal retirement Tricare coverage would apply.
Thank you to you, Loach and the others for the info. Assuming he did this and the family is out of the picture re benefits does he have access to VA insurance benefits that would allow him to be off the family high deductible plan.
Yes. If he has a significant service connected disability (eg, his Navy service is responsible for some ailment), he probably has a high priority for VA medical care. Even if he doesn’t, which doesn’t really fit into the story, he would still have eligibility for VA care.
ETA: note that VA care doesn’t equate to insurance. As a rule of thumb, one is expected to go to a VA clinic or hospital to receive care. You can’t just decide to go to your personal physician and have the bill sent to Uncle Sam.
Possibly, but there’s going to be a LOT that goes into that.
The VA looks at a number of factors in deciding where a veteran fits in to the hierarchy. He’ll be means-tested based on his most recent tax return information when he enrolls, and if his income is above a certain threshold, he will be allowed access, but it will be in a low category, so he’ll basically be seen on a space-available basis, i.e., after everyone who is higher has been seen. He will also have co-pays for visits and medications.
He’s going to want to sit down with a veteran’s service organization to decide if it’s worth it. They will have the information he needs.
I’ve never been military, but I doubt they’re going to cut him any special slack for having been a SEAL in the past. He’s just a discharged sailor at this point, no different than any other injured serviceman as far as the VA is concerned.
His discharge is going to be pretty much just the same as any other sailor whose term of enlistment was up (or whatever it’s called for officers, if he happens to be one).