Enrolling in Veterans Healthcare
ENROLLING IN VETERANS HEALTHCARE
For most veterans, entry into the VA health care system begins by applying for admission. 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). The veteran must also submit a copy of his or her service discharge form. Some other paper work may be necessary. It is likely that the individual will be eligible unless they were given a dishonorable discharge; thus, even if the application process at first seems tiring, it is probably worth continuing. Sometimes people will say that you are ineligible even when you are eligible, so it is worth working with an attorney to clarify your eligibility status. Once enrolled, veterans can receive services at VA facilities anywhere in the country.
At this time, this program has not been directly affected by the “Sequester,” but at the Hook Law Center, we try to take a long-term view towards government programs. Thus, we would add that it is possible that this program will become harder to enroll in due to fewer administrative personnel, even if the program itself technically stays that same. The “Sequester” may dramatically affect the workforce of the Veterans Administration. It has already affected numerous federal agencies, so it is probable that there could be cuts in administrative staffs. This would lead to a increased processing time of applications. Thus, if you are eligible to enroll, time is of the essence.
During enrollment, veterans are assigned to one of the priority groups VA uses to balance demand with resources. Disability levels are rated on a percentage of functioning level.
Group 1: Veterans with service-connected disabilities rated at 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 at a 30 or 40 percent level.
Group 3: Veterans with service-connected disabilities rated at a 10-20 percent level, 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 in Vietnam; 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).
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 grant enrollment of these veterans, but it is still in some of the literature online. As the demand for services grows faster than funding, VA, in the future, may also exclude priority 7 veterans from enrolling in the system. We see this as an example of how the changing fiscal environment in Washington will affect this program.
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
• inpatient services,
• outpatient services or
• long-term care 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 means test or the geographic means test.
ABOUT THIS HANDOUT
This guide is provided as a courtesy to help you recognize potential estate planning issues. It is not intended as a substitute for legal advice. It is distributed with the understanding that if you need legal advice, you will seek the services of a competent elder law attorney. While every precaution has been taken to make this explanation accurate, we assume no responsibility for errors or omissions, or for damages resulting from the use of the information in this explanation.