Veterans Health Administration

10 Things to Know About the Choice Program

By Hans Petersen
Wednesday, July 22, 2015

The Veterans Choice Program is a new, temporary benefit that allows eligible Veterans to receive health care in their communities rather than waiting for a VA appointment or traveling to a VA facility.

1: Am I eligible for the Choice Program?

You must have been enrolled in VA health care on or before August 1, 2014, or be eligible to enroll as a recently discharged combat Veteran. You must also meet at least one of the following criteria:

  • You are told by your local VA medical facility that you will need to wait more than 30 days for an appointment from the date clinically determined by your physician, or, if not such date is provided, our preferred date.
  • Your residence is more than 40 miles driving distance from the closest VA medical facility.
  • You need to travel by plane or boat to the VA medical facility closest to your home.
  • You face an unusual or excessive burden in traveling to the closest VA medical facility based on geographic challenges, environmental factors, or a medical condition. Staff at your local VA medical facility will work with you to determine if you are eligible for any of these reasons.
  • You reside in a State or a United States Territory without a full-service VA medical facility that provides hospital care, emergency services and surgical care, and reside more than 20 miles from such a VA medical facility. Note: This criterion applies to Veterans residing in Alaska, Hawaii, New Hampshire, Guam, American Samoa, Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands. Also note that some Veterans in New Hampshire reside within 20 miles of White River Junction VAMC.

2: What do I do if I think I am eligible?

Call the Choice Program Call Center at 866-606-8198 to verify your eligibility and set up an appointment.

3: Can I call my non-VA doctor to make an appointment?

No, please call the Choice Program call center at 866-606-8198 to verify eligibility and set up an appointment.

4: How is the 40 mile calculation made?

This calculation is based on the distance from your permanent residence (or an active temporary address) to the closest VA facility, including Community-Based Outpatient Clinics and VA Medical Centers.

Does the 40 mile rule refer to whether the specialty need (for example, Orthopedic Surgery) is available within 40 miles, or 40 miles from any VA facility, whether or not the specialty, in this example Orthopedics, is available there?

The law is clear that eligibility must be based on the distance from the Veteran‘s residence to any VA medical facility, even if that facility does not offer the specific medical service the Veteran requires for that particular visit.

What are the criteria used to determine the 40 mile radius? Is it similar to the Dashboard used to calculate mileage reimbursement?

VA will calculate the distance between a Veteran‘s residence and the nearest VA medical facility using a straight-line distance, rather than the driving distance. VA is developing an interactive tool that will be available on beginning in early November for Veterans to determine their potential eligibility for the Choice Program based on their place of residence. Veterans will enter their address information into the tool, and the tool will calculate their distance to the nearest site of VA care, and provide that mileage and information on their eligibility for the Choice Program to the Veteran online.

5: If I am eligible for the Choice Program, can I receive Beneficiary Travel for travel to appointments with a Choice provider?

Yes, the Choice Act does provide the ability to pay for travel to the Choice preferred provider for Veterans who are eligible for Beneficiary Travel. However, the Choice Act did not provide any new Beneficiary Travel eligibility.

6: I didn‘t get my Choice Card, what do I do?

You do not need your Choice Card to access the Choice Program. If you didn‘t receive a Choice Card, simply call 866-606-8198 to find out if you are eligible and to make an appointment.

7: How do I get my prescription filled if I use the Choice Program?

The Choice Program non-VA Provider will issue a prescription with up to a 14 day supply of a National Formulary drug. You may have the 14 day supply prescription filled at any non-VA pharmacy of your choosing and may submit a request for reimbursement to VA. For prescriptions needed past 14 days, please follow standard procedures to fill a prescription at the VA pharmacy.

8: If I use the Choice Program, does that affect my VA health care?

No, not at all. You do not have to choose between the two—the Choice Program is here to make it easier to access the care you need, close to home. 9: Am I responsible for Medicare, Medicaid or TRICARE cost-shares? No, these plans are not considered Other Health Insurance for purposes of the Choice Program. You will not be billed for any of the cost-shares associated with these plans.

10: What about VA copayments? Will they be collected by the community provider?

VA copays will be billed by VA after the appointment. If you currently pay VA copayments you will be subject to the same copayment requirements under the Choice Program. Your VA copay will be determined by VA after the care is provided. Video Discussion of the Choice Program On June 25, VA hosted a Google+ Hangout to provide Veterans with information about the Veterans Choice Program which allows eligible Veterans to get health care in the community from non-VA doctors. You can watch a 20-minute recording of the event here:

At the eight-minute mark, hear an explanation of the “40-mile rule.” You can click here to get answers to all your questions about the Choice Program, like:

  • What if I live in Alaska or Hawaii or New Hampshire?
  • If I don‘t qualify for the Choice Program, are there other options?
  • My non-VA doctor is not part of the Choice Program, can he/she join?
  • Am I responsible for my private insurance deductible if I get care through the Choice Program? Since the Choice Program went into effect in November of 2014, more than 45,000 medical appointments have been scheduled.