Veterans Benefits

Last Updated: 4÷16÷2008

Medical Care

The Veterans Administration (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.

Who 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 eligibile 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. To see the priority list, click here. As of Jan. 17, 2003, veterans assigned to priorty 8 are not eligibile for enrollement or care for non-service connected conditions.

What 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:

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:

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.

Co-Payments

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

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. Click here to view the thresholds for income. 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:

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

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

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

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). Click here to see if you are below the GMT.

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

If you don’t fit into one of these categories, you must pay $8 (in 2008) 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.

For more information on the Medicare Prescription Drug Benefit, click here.

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.

How to Enroll for Health Benefits

You can fill out the form to enroll for health benefits online at https://www.1010ez.med.va.gov/sec/vha/1010ez/ or you can receive the form by calling 1–877-222-VETS (8387).

Once you complete and sign the form, mail it to your local VA health care facility. Click here to find the facility nearest you.

Disability Benefits

The VA offers two disability programs. Disability compensation is available only for veterans with service-connected disabilities, while the disability pension benefit is available to anyone who served during wartime and has a disability. The disability does not have to be related to military service.

Disability Compensation

If you have an injury or disease that happened while on active duty or if active duty made an existing injury or disease worse, you may be eligible for disability compensation. The amount of compensation you get depends on how disabled you are and whether you have children or other dependents. Click here to see the current compensation rates. Additional funds may be available if you have severe disabilities, such as loss of limbs, or a seriously disabled spouse.

Disability Pension Benefit

The VA pays a pension to disabled veterans who are not able to work. The pension is also available for surviving spouses and children. This pension is available whether or not your disability is service-connected, but to be eligible you must meet the following requirements:

In addition, your income must be below the yearly limit set by law; called the Maximum Annual Pension Rate (MAPR). The MAPR for 2008 are below:

Veteran with no dependents $11,181
Veteran with a spouse or a child $14,643
Housebound veteran with no dependents $13,664
Housebound veteran with one dependent $17,126
Additional children $1,909 for each child

Your pension depends on your income. The VA pays the difference between your income and the MAPR. The pension is usually paid in 12 equal payments.

Example: John is a single veteran and has a yearly income of $5,757. His pension benefit would be $5,424 (11,181 — 5,757). Therefore, he would get $452 a month.

Your income does not include welfare benefits or Supplemental Security Income. It also does not include unreimbursed medical expenses actually paid by the veteran or a member of his or her family. This can include Medicare, Medigap, and long-term care insurance premiums; over-the-counter medications taken at a doctor’s recommendation; long-term care costs, such as nursing home fees; the cost of an in-home attendant that provides some medical or nursing services; and the cost of an assisted living facility. These expenses must be unreimbursed. This means that insurance must not pay the expenses. The expenses should also be recurring — this means they should recur every month.

Aid and attendance. A veteran who needs the help of an attendant may qualify for additional help on top of the disability pension benefit. The veteran needs to show that he or she needs the help of an attendant on a regular basis. A veteran who lives in an assisted living facility is presumed to need aid and attendance.

A veteran who meets these requirements will get the difference between his or her income and the MAPR below (2008 figures):

Veteran who needs aid and attendance and has no dependents $18,654
Veteran who needs aid and attendance and has one dependent $22,113

How To Apply

You can apply for both disability benefits by filling out VA Form 21–526, Veteran’s Application for Compensation Or Pension. If available, you should attach copies of dependency records (marriage & children’s birth certificates) and current medical evidence (doctor & hospital reports). You can apply online at http://vabenefits.vba.va.gov/vonapp.



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