Health Care Benefits for Veterans Receiving Pension

Veterans Receiving Pension

A great majority of veterans who are not service-connected disabled, who are not certain service medal recipients or who are not low income are not entitled to veterans health care.  This is undoubtedly true for a great many veterans who would qualify for pension because of expensive medical costs but would not meet any of the eligibility tests for healthcare.  The good news is that once a veteran qualifies for pension, that veteran can enroll in VA health care regardless of household income.  Why is that so important? 

Once in the system, there is no need for expensive Medicare supplement plans for the elderly.  There is also no need for buying a Medicare prescription drug plan.  VA charges no monthly insurance premiums for its healthcare.  The only charges are co-pays for office visits and hospital stays and co-pays for prescription drugs.  Prescription drugs are available at $8 for each prescription for a 30 day supply.  VA will also honor prescriptions from private sector doctors as well.

The most important thing to remember about co-pays is that a veteran receiving VA pension is classified a priority 5 veteran.  Priority 5 veterans receive free; inpatient care, outpatient care and long term care.  They have no copayments for medical services.  The priority 5 veteran must pay VA prescription drug co-pays unless that veteran has a household income below the current pension maximum income rate.  Also priority 5 veterans do not have to pay any more than $960 a year for their prescriptions from a VA pharmacy if they do have to pay for drugs.

Once in the health-care system, a veteran -- under certain conditions -- can have access to many long-term care services offered through the system.  In addition, a veteran on pension and receiving aid and attendance could also be eligible for home renovation grants of either $1,200 or $4,100 depending on the veterans disability ratings.  These grants are available through VA regional medical centers.

To understand VA healthcare please read the abbreviated description below or click here for a more detailed description of VA healthcare.

What is Veterans Health Care?

The Veterans Health Administration is the largest single provider of medical care in the United States.  It's 22 regions with 154 hospitals and their associated 875 outpatient clinics offer the following services.
 


The Best Health Care System in America

It comes as a surprise to some people who had experience with VA health care during the 1970s and 1980s, that this same system is now considered the best medical care in the United States. To illustrate this we quote below articles and comments from the several sources. 

BusinessWeek, July 17, 2006  "The Best Medical Care in the Nation How Veterans Affairs transformed itself -- and what it means for the rest of us"

". . . . Roemer seems to have stepped through the looking glass into an alternative universe, one where a nationwide health system that is run and financed by the federal government provides the best medical care in America. But it's true -- if you want to be sure of top-notch care, join the military."

"The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatment to percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers."

"To much of the public, though, the VA's image is hobbled by its inglorious past. For decades the VA was the health-care system of last resort. The movies Coming Home (1978), Born on the Fourth of July (1989), and Article 99 (1992) immortalized VA hospitals as festering sinkholes of substandard care. The filmmakers didn't exaggerate. In an infamous incident in 1992, the bodies of two patients were found on the grounds of a VA hospital in Virginia months after they had gone missing. The huge system had deteriorated so badly by the early '90s that Congress considered disbanding it."

"Instead, the VA was reinvented in every way possible. In the mid-1990s, Dr. Kenneth W. Kizer, then the VA's Health Under Secretary, installed the most extensive electronic medical-records system in the U.S. Kizer also decentralized decision-making, closed underused hospitals, reallocated resources, and most critically, instituted a culture of accountability and quality measurements. "Our whole motivation was to make the system work for the patient," says Kizer, now director of the National Quality Forum, a nonprofit dedicated to improving health care. "We did a top-to-bottom makeover with that goal always in mind.". . . .

Enrolling in the Veterans Health Care System

Those seeking a VA benefit for the first time must submit a copy of their service discharge form (DD-214, DD-215, or for WWII veterans, a WD form), which documents service dates and type of discharge. The veteran’s service discharge form should be kept in a safe location accessible to the veteran and next of kin or designated representative.

For most veterans, entry into the VA health care system begins by applying for enrollment.  Application is submitted through VA Form 10-10EZ, Application for Health Benefits, which may be obtained from any VA health care facility or regional benefits office, or by calling 1-877-222-VETS (8387). Once enrolled, veterans can receive services at VA facilities anywhere in the country.
Veterans who are enrolled for VA health care are afforded privacy rights under federal law. VA’s Notice of Privacy Practices is available at the VA health care Web site.

During enrollment, veterans are assigned to one of the priority groups VA uses to balance demand with resources. Changes in available resources may reduce the number of priority groups VA can enroll. If this occurs, VA will publicize the changes and notify affected enrollees. Veterans will be enrolled to the extent Congressional appropriations allow. If appropriations are limited, enrollment will occur based on the following priorities: (Please note that lower priority numbers generally mean no co-pays for medical services i.e. services are free)

Group 1:  Veterans with service-connected disabilities rated 50 percent or more and/or veterans determined by VA to be unemployable due to service-connected conditions.

Group 2:  Veterans with service-connected disabilities rated 30 or 40 percent.

Group 3:  Veterans with service-connected disabilities rated 10 and 20 percent, veterans who are former Prisoners of War (POW) or were awarded a Purple Heart, veterans awarded special eligibility for disabilities incurred in treatment or participation in a VA Vocational Rehabilitation program, and veterans whose discharge was for a disability incurred or aggravated in the line of duty.

Group 4:  Veterans receiving aid and attendance or housebound benefits and/or veterans determined by VA to be catastrophically disabled. Some veterans in this group may be responsible for co-pays.

Group 5:  Veterans receiving VA pension benefits or eligible for Medicaid programs, and non service-connected veterans and non compensable, zero percent service-connected veterans whose annual income and net worth are below the established VA means test thresholds.

Group 6:  Veterans of the Mexican border period or World War I; veterans seeking care solely for certain conditions associated with exposure to radiation or exposure to herbicides while serving inVietnam; for any illness associated with combat service in a war after the Gulf War or during a period of hostility after Nov. 11, 1998; for any illness associated with participation in tests conducted by the Defense Department as part of Project 112/Project SHAD; and veterans with zero percent service-connected disabilities who are receiving disability compensation benefits.

Group 7:  Non service-connected veterans and non-compensable, zero percent service-connected veterans with income above VA's national means test threshold and below VA's geographic means test threshold, or with income below both the VA national threshold and the VA geographically based threshold, but whose net worth exceeds VA's ceiling (currently $80,000) who agree to pay co-pays.

Group 8:  All other non service-connected veterans and zero percent, non-compensable service-connected veterans who agree to pay co-pays. (Note: Effective Jan. 17, 2003, VA no longer enrolls new veterans in priority group 8).

Copayments for Medical Services -- Veterans Means Testing

VA uses means testing to determine a veteran’s level of copayments for medical services and in addition to accept or deny certain veterans applying for the first-time.  Prior to 2003 VA allowed veterans to apply for medical coverage with any income level who were not required to meet means testing.  These are veterans classified as priority 8.  VA will no longer accept applications from these veterans.  As the demand for services grows faster than funding, VA, in the future, may also exclude priority 7 veterans from enrolling in the system.

Although there are exceptions, as a general rule, veterans in priority categories 2 through 6 do not have to pay co-pays for the following services

 
In other words these services are free.

Veterans in priority categories 7 and 8 generally do have to pay co-pays but there are some exceptions if the veteran meets VA's mean test or the geographic means test.

In some states VA's mean test for maximum income is less than the geographic means test and in other states it is just the opposite.

Veterans Means Test for Co-Pays (Low Income Financial Test ) -- Financial Test Year 2010


Veteran with

Free VA prescriptions and travel benefits (maximum allowable rate) Pension Rates

Free VA Health Care
(0% service connected {noncompensable} and nonservice-connected veterans only)

Medical Expenses Deduction (5% of maximum allowable pension rate from previous year)

0 dependents

$11,830 or less

$29,402 or less

$559

1 dependent

$15,493 or less

$35,284 or less

$732

2 dependents

$17,513 or less

$37,304 or less

$828

3 dependents

$19,533 or less

$39,324 or less

$923

4 dependents

$21,553 or less

$41,344 or less

$1,019

For each additional dependent add:

$2,020

$2,020

5% of Maximum Allowable Pension Rate

Medicare Deductible: $1,068

Income & Asset net worth: $80,000


The GMT Income Threshold Test (geographic means test) could be higher or lower than the VA's means test. To obtain GMT income thresholds per state for purposes of qualifying under an enrollment priority go to http://www.va.gov/healtheligibility/Library/pubs/GMTIncomeThresholds/

Copayment Rates

Outpatient Services*

Basic Care Services—services provided by a primary care clinician     $15/visit

Specialty Care Services—services provided by a clinical specialist such as surgeon, radiologist, audiologist, optometrist, cardiologist, and specialty tests such as magnetic resonance imagery (MRI), computerized axial tomography (CAT) scan, and nuclear medicine studies     $50/visit

*Copay amount is limited to a single charge per visit regardless of the number of health care providers seen in a single day. The copay amount is based on the highest level of service received. There is no copay requirement for preventive care services such as screenings and immunizations. 

Medications 

For each 30-day or less supply of medication for treatment of
nonservice-connected condition     $8

(Veterans in Priority Groups 2 through 6 are limited to a $960 annual cap) 
VA does not charge a copay for medications used for treatment of —


Inpatient Services** 

Inpatient copay for first 90 days of care during a 365-day period     $1,068

Inpatient Copay for each additional 90 days of care during a 365-day period     $534

Per Diem Charge     $10/day

**Based on geographically-based means testing, lower income veterans who live in high-cost areas may qualify for a reduction of 80% of inpatient copay charges. 

Long-Term Care# 

Nursing Home Care/Inpatient Respite Care/Geriatric Evaluation maximum of $97/day 

Adult Day Health Care/Outpatient Geriatric Evaluation or Outpatient Respite Care maximum of $15/day 

Geriatric Evaluation
Domiciliary Care maximum of $5/day 

#Copays for Long-Term Care services start on the 22nd day of care during any 12-month period—there is no copay requirement for the first 21 days.  Actual copay charges will vary from veteran to veteran depending upon financial information submitted on VA Form 10-10EC.