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Veteran’s Benefits – A Life Care Planning News Update

TOPVeterans of the United States armed forces may be eligible for a broad range of programs and services provided by the U.S. Department of Veterans Affairs (VA). In addition, their dependents and survivors may also be eligible for benefits. For more information about all the benefits available from the VA, read VA booklet “Federal Benefits for Veterans, Dependents and Survivors

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The VA provides health care benefits to veterans. The plan covers a number of health care services, including preventative services, diagnostic and treatment services, and hospitalization. It may also cover nursing home and other long-term care options.

WnoIsElegibleWho is Eligible?
To receive care, most veterans must be enrolled in the VA health system. Eligibility for the health system depends on a number of factors, including the nature of your discharge from military service, your length of service, whether you have service-connected disabilities, your income level, and available VA resources, among others.

To be eligible, you must not have been dishonorably discharged from the military. Your length of service may also be important. Former enlisted persons who started active duty before September 8, 1980, and former officers who first entered active duty before October 17, 1981, do not have a length-of-service requirement. Otherwise you must have 24 months of continuous active duty military service, though there are several exceptions for reservists, national guard members, service-connected disabilities, and hardship discharges, among others.

Certain veterans do not need to be enrolled in the VA health system to receive benefits if: you are 50 percent or more disabled from a service-connected disability, you are seeking care for a VA rated service-connected disability, or it has been less than one year since you were discharged for a disability that the military determined was caused or aggravated by your service, but the VA has not yet rated the disability.
The VA has limited resources, so if you are eligible for services, you will be assigned to a priority group. The priority groups range from 1-8 with 1 being the highest priority for enrollment. Previously, veterans assigned to priority 8 were not eligible for enrollment or care for non-service connected conditions. New regulations went into effect on June 15, 2009 that enable the VA to relax income restrictions on enrollment for health benefits.

WhatIsCoveredWhat Is Covered
The standard benefits package includes: Preventative care services, outpatient diagnostic and treatment services (including mental health and substance abuse treatment), inpatient diagnostic and treatment services, prescriptions, and long-term care (including nursing home care for some veterans).
Long-term care. The VA offers a number of long-term care options through its health plan.
All enrolled veterans are eligible for the following services:

  • Geriatric evaluation — provides either an inpatient or outpatient evaluation of a veteran’s ability to care for him or herself.
  • Adult day health care — a therapeutic day care program that provides medical and rehabilitation services to veterans
  • Respite care — provides either inpatient or outpatient supportive care for veterans to allow caregivers to get a break
  • Home care — nursing, physical therapy, and other services provided in the veteran’s home
  • Hospice/palliative care — provides services for terminally ill veterans and their families

Some services are limited to certain veterans: nursing home care and domiciliary care are not automatically available to all veterans enrolled in the VA health plan.
The following veterans automatically qualify for unlimited nursing home care:

  • Veterans who are seeking nursing home care for a service-related condition
  • Veterans with a service-connected disability rating of 70 percent or more
  • Veterans who have a service-connected disability of 60 percent and are unemployable

A service-connected disability is a disability that the VA has officially ruled was incurred or aggravated while on active duty in the military and in the line of duty. The VA must rule that your illness/condition is directly related to your active military service, and it assigns each disability a rating. The ratings are established by VA regional offices around the country.

The VA may provide nursing home care to other veterans if space permits. Veterans with service-connected disabilities receive priority.

There are also state-run veteran’s nursing homes. The VA provides funds to states to help them build the homes and pays a portion of the costs for veterans eligible for VA health care. The states, however, set eligibility criteria for admission.

A Domiciliary is a VA facility that provides care on an ambulatory self-care basis for veterans disabled by age or disease who are not in need of acute hospitalization and who do not need the skilled nursing services provided in a nursing home. Domiciliary care is available to low-income veterans with a disability.

There are no costs for certain veterans and low-income veterans. The following veterans are eligible to receive cost-free health care benefits automatically:

  • A service-connected veteran receiving VA compensation benefits
  • A veteran seeking care for a specific service-connected disability
  • Former POWs
  • Purple Heart Medal recipients
  • A veteran with conditions related to exposure to herbicides during the Vietnam-era, ionizing radiation during atmospheric testing, ionizing radiation during the occupation of Hiroshima and Nagasaki
  • A veteran who sustained a service-related condition while serving in the Gulf War, in combat in a war after the Gulf War, or during a period of hostility after November 11, 1998
  • A veteran with military sexual trauma
  • A veteran with cancer of the head or neck caused by nose or throat radium treatments given while in the military
  • A veteran who is participating in a VA approved research project

If you don’t fit into one of those catagories, the VA will ask you to provide your household income and net worth from the previous year. If your income is below certain thresholds, you will not have to make a copayment. In addition, you must not have more than $80,000 in property. Those whose income exceeds the threshold or who refuse to submit to the means test may have to make a copayment.

Unlike Medicaid program, there is no penalty for transferring assets before applying for veterans benefits, including long-term care. Remember, however, that if you do transfer assets it may affect your eligibility for Medicaid.

Even if your income is above the threshold, you do not have to make co-payments for the following services:

  • Special registry examinations offered by the VA to evaluate possible health risks associated with military service
  • Counseling and care for sexual trauma
  • Compensation and pension examination requested by the Veterans Benefit Administration
  • Care that is part of a VA-approved research project
  • Outpatient dental care
  • Readjustment counseling and related mental health services for Post Traumatic Stress Disorder
  • Emergency Treatment at other than VA facilities
  • Care for cancer of the head or neck caused from nose or throat radium treatments given while in the military
  • Publicly announced VA public health initiatives — i.e., health fairs
  • Care related to service for veterans who served in combat or against a hostile force during a period of hostilities after November 11, 1998
  • Laboratory services such as flat film radiology services and electrocardiograms

Outpatient co-payments. The following are the outpatient co-payments for non-service-related conditions:

  • Services provided by a primary care clinician are $15 (in 2012) for each visit
  • Services provided by a clinical specialist are $50 (in 2012) for each visit

Preventive care services (such as screenings and immunizations) are free.

Inpatient co-payments. The inpatient co-payment is calculated by adding:

  • $10 per day of hospitalization (in 2012), and
  • $1,156 for the first 90 days of hospitalization and $578 for each additional 90 days (in 2012).

There is a reduced co-payment rate (20 percent of the full inpatient rate) for certain individuals whose income is above the VA income thresholds, but below the Geographic Means Threshold (GMT).

Prescription co-payments. Prescription co-payments are charged only for outpatient treatment. The following veterans do not have to pay anything for medications:

  • A veteran who is 50 percent disabled or more with a service-connected disability
  • A veteran who has been determined by the VA as unemployable due to his service-connected conditions
  • A veteran who needs medication to treat a specific service-connected disability
  • Former POWs
  • A veteran whose income is below the maximum annual rate for a VA pension
  • A veteran who needs medication to treat conditions related to a veteran’s exposure to herbicides during the Vietnam era ionizing radiation during atmospheric testing, or ionizing radiation during the occupation of Hiroshima and Nagasaki
  • A veteran who served in the Gulf War, in combat after the Gulf War, or during a period of hostility after Nov. 11, 1998, and who needs medication to treat a service-related condition
  • A veteran who needs medication to treat a military sexual trauma
  • A veteran with cancer of the head or neck caused by nose or throat radium treatments given while in the military
  • A veteran participating in a VA approved research project

If you don’t fit into one of these categories, you must pay $9 (in 2012) for each 30-day or less supply of medication. If you are in one of the Priority Groups 2 through 6, there is an annual limit on the amount you have to pay for prescriptions. You will not be charged more than $960 during the calendar year. If you are in Priority Groups 7 and 8, you will have to pay the full co-payment amount, with no annual limit.

The Medicare prescription drug benefit. As part of the new Medicare law enacted in December 2003, Congress added a modest prescription drug benefit, which took effect January 1, 2006. The benefit is available to anyone who is eligible for Medicare Part A or B coverage. The benefit is completely voluntary, so you must decide whether you want to participate in a plan or not based on your own situation. If you decide to participate in the Medicare plan, your VA prescription drug coverage will not be affected.
Most Medicare beneficiaries must choose a plan or be subject to significant financial penalties for late enrollment. However, because the VA prescription drug coverage is considered “creditable coverage,” you will not face a penalty if you do not sign up for the Medicare plan. If you disenroll or lose your VA prescription drug coverage, you will have 62 days to sign up for a Medicare plan without being subject to a penalty.

Long-term care co-payments. The first 21 days of long-term care are free. Co-payments start on the 22nd day. Long-term care co-payments are calculated differently from other co-payments they are set based on the individual veteran’s financial status. Veterans must fill out a financial assessment to determine their co-payments. This is a separate form from the form veterans had to fill out to determine if they were eligible for free health care. This form assesses your current income as opposed to the previous year’s income. The co-payments will be adjusted for each individual veteran based on his or her ability to pay. Once you have submitted a form, a social worker will contact you to let you know how much your co-payments will be.

What to do if you can’t afford co-payments. There are several options if you cannot afford your co-payments. One option is to request a waiver. You will have to submit proof that you can’t financially afford to make payments to the VA.

If your income changed since you applied for free health care, you can request a hardship determination. This will change your priority group assignment. To do this, you will need to provide current financial information to the VA.

Another option is to request a compromise and make a partial payment. Most compromise offers that are accepted must be for a lump sum payment payable in full 30 days from the date of acceptance of the offer.