Given how much the Veterans Health Administration (VHA) has been in the news for unnecessary wait times and inappropriate scheduling practices that have negatively impacted many veterans, you may not see any value in educating your clients regarding potential VA health benefits. However, VA health benefits might offer more economical health care and/or may be an option for your clients who are underinsured. Another advantage is greater access to health care nationwide, as you may seek care at any VA health care facility once enrolled in the VA health care system.
When you enroll in VA health care, you are eligible for what is termed a Medical Benefits Package. This package consists of hospital, outpatient, and extended care services providing basic and preventive care, as well as prescription drugs, emergency care and even in some cases, services like: rehabilitative services; professional counseling and mental health services; durable medical equipment, including eyeglasses and hearing aids; home health services; reconstructive (plastic) surgery; hospice care; and dental care. What exactly is available to the recipient of VA health benefits will depend on the veteran’s unique eligibility status and whether such care or services are deemed medically necessary by VA health care providers. You receive a booklet called the Veterans Health Benefits Handbook after enrollment that gives you the specifics of your individual Medical Benefits Package.
Who qualifies for them?
If your client served in the active military, naval or air service and was discharged under any condition other than dishonorable, the client may qualify for VA health care benefits. There is a minimum duty requirement for veterans who enlisted after September 7, 1980, but there are also many exceptions both before and after this date, so you should consult 38 CFR §17.31 Duty periods defined for the definitions of duty periods applicable to eligibility for medical benefits.
Although family members, with very limited exception, cannot access the VA health care system, family members of veterans may be eligible for CHAMPVA. This is a program that provides health insurance coverage to dependents of a qualifying sponsor who is, or was at the time of death, rated permanently and totally disabled due to a service-connected disability or who died of a service-connected disability.
How do you enroll?
You can apply for VA health care by completing VA Form 10-10EZ Application for Health Benefits and submitting it in person or by mail to the enrollment coordinator at any VA Medical Center. The 10-10EZ form has sections to complete with information about military service, health insurance, and finances. Private health care insurance does not affect eligibility for VA health care. The instructions for the financial section specify that only non-service-connected and service-connected veterans rated at 0% must provide this financial information. However, they go on to state that those receiving VA pension or compensation and/or Medicaid benefits, among others, are not required to disclose financial information. In fact, after a claimant is approved for non-service-connected pension, he/she should be automatically mailed enrollment information for the VA health care system. The financial information is used to determine eligibility and copay responsibility for VA Health Benefits and – with the exceptions noted above – may be a requirement of enrollment.
As part of enrollment, the applicant is assigned to a Priority Group based on the severity and nature of the applicant’s disability and/or income. There are eight Priority Groups for enrollment, from highest priority at #1 to the lowest at #8:
- Veterans with service-connected disabilities 50% or more disabling, or those unemployable due to service-connected conditions;
- Veterans with service-connected disabilities 30% or 40% disabling;
- Veterans who were Prisoners of War (POWs), were awarded the Purple Heart or Medal of Honor, whose discharge was for a service-connected disability, with service-connected disabilities 10% or 20% disabling, or special eligibility under Title 38, U.S.C. § 1151;
- Veterans receiving aid and attendance or housebound VA benefits or who have been determined by the VA to be catastrophically disabled;
- Non-service-connected veterans and non-compensable service-connected veterans rated 0% disabled with annual income below the VA’s and geographically (based on your resident ZIP code) adjusted income limits, veterans receiving VA base pension benefits, or eligible for Medicaid programs;
- Compensable service-connected veterans rated at 0% and various categories of veterans whose military service meets certain requirements;
- Veterans with gross household income below the geographically adjusted income limits (GMT) for their resident location;
- Veterans with gross household income above the VA and the geographically adjusted income limits for their resident location.
The Priority Group assignment will determine what the VA Health Benefits enrollee will pay, if anything, in copayments for their health benefits. Generally, the cost of care is free when related to service-connected disabilities, but there may be a copay for all other services, to include prescriptions.
Despite the fact that, when the VHA makes headlines, it’s often not for a good reason, the news isn’t all bad. The VA has taken corrective action to identify and resolve the issues that have plagued the VHA, including requesting the VHA to conduct an audit which then led to the Accelerating Access to Care Initiative. The VA also publishes comprehensive monthly updates detailing pending and completed appointments and average wait times that allow for oversight, and also allow a beneficiary to select a VA Medical Center with lower wait times when there is more than one in their area. For further information on Veterans Health Benefits beyond this overview, consult the website of the Veterans Health Administration at https://www.va.gov/health/.
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By Sabrina A. Scott, Paralegal, The Elder & Disability Law Firm of Victoria L. Collier, PC and Director of VA Services for Lawyers With Purpose.
Victoria L. Collier, Veteran of the United States Air Force, 1989-1995 and United States Army Reserves, 2001-2004. Victoria is a Certified Elder Law Attorney through the National Elder Law Foundation; Author of “47 Secret Veterans Benefits for Seniors”; Author of “Paying for Long Term Care: Financial Help for Wartime Veterans: The VA Aid & Attendance Benefit”; Founder of The Elder & Disability Law Firm of Victoria L. Collier, PC; Co-Founder of Lawyers with Purpose; and Co-Founder of Veterans Advocate Group of America.