Getting out, military health issues - Marine Corps Times

Veterans’ benefits

Most military retirees, as well as veterans who did not stay in the military for a full career, must apply for enrollment in the Department of Veterans Affairs health system to receive VA health care under the Uniform Benefits Package.

Enrollment applications can be obtained through the nearest VA care facility’s benefits office or by calling toll-free (877) 222-8387.

The following veterans are not required to enroll:

• Those with a service-connected disability rated by the VA at 50 percent or more.

• Those who have been out of service for less than a year after being discharged for a disability incurred or aggravated in the line of duty, but that VA has not yet rated.

• Those seeking care from the VA only for service-connected disabilities.

In order of priority for care are the following:

• Priority 1: Veterans who have service-connected conditions rated 50 percent or more disabling or have been determined by VA to be unemployable due to service-connected conditions.

• Priority 2: Veterans with service-connected conditions rated 30 percent to 40 percent or more disabling.

• Priority 3: Veterans who are former prisoners of war; have received the Purple Heart; have service-connected conditions rated 10 percent or 20 percent disabling; were discharged from active duty for a disability incurred or aggravated in the line of duty; or were injured as a result of VA treatment or participation in a VA vocational rehabilitation program.

• Priority 4: Veterans receiving aid and attendance or housebound benefits and veterans who have been determined by the VA to be catastrophically disabled.

• Priority 5: Veterans who are receiving VA pension benefits; are eligible for Medicaid programs; or whose income and assets are below the established dollar thresholds.

• Priority 6: Veterans who have zero-percent service-connected conditions but are receiving VA compensation; are seeking care only for disorders relating to Ionizing Radiation and Project 112/SHAD; are seeking care for Agent Orange Exposure during service in Vietnam; are seeking care for Gulf War Illness or for conditions related to exposure to environmental contaminants during service in the Persian Gulf; served in World War I or the Mexican Border War; or served in combat in a war after the Gulf War or during a period of hostility after November 11, 1998, for two years following discharge or release from the military.

• Priority 7: Nonservice-connected veterans and zero-percent noncompensable service-connected veterans with income exceeding the threshold for the VA means tests established by law and below the Department of Housing and Urban Development’s geographic income limit, or with income below both the VA threshold and the HUD low-income limit, whose net worth plus income exceeds $80,000 and who agree to pay specified co-payments.

For more information on HUD geographic income limits, see www.huduser.org/datasets/il/il05.

• An eighth category of veterans, created by Congress in 2002, comprises higher-income veterans who seek care for illnesses unrelated to military service. Veterans who agree to pay specified co-payments and whose income and net worth exceed both the VA means test threshold and HUD’s geographic means test threshold are in this category.

Veterans who fit the description of this category and were enrolled before Jan. 17, 2003, can remain in the VA’s health care system. Enrollment for other veterans in this category has been suspended because the VA currently cannot provide timely care to all veterans already enrolled in the system.

A chart of VA income thresholds is online at www.va.gov/healtheligibility/Library/pubs/VAIncomeThresholds.

The process of determining whether a veteran qualifies for free care based on income alone is called “eligibility assessment.”

To qualify in this manner, veterans must have an annual income of $27,790 or less and an annual income plus net worth of not more than $80,000, if they do not have dependents.

For veterans who are married, or single with a dependent family member, the maximum annual income to qualify for free care is $33,350; also, their annual income plus net worth must not exceed $80,000.

For each additional dependent child, the income ceiling rises by $1,866.

Income levels are adjusted annually on Jan. 1 by the same percentage by which the VA raises its pension benefits.

When determining a veteran’s means, the VA uses HUD’s geographic means test, which takes into consideration where the veteran lives; the cost of living varies by location.

Veterans who do not qualify for free or reduced care must agree to pay the VA a co-payment equal to what they would pay under Medicare — $992 for the first 90 days of inpatient hospital care during a 365-day period. This need not be 90 days in a row.

They also must pay $10 for each day in the hospital. A patient is charged half the Medicare co-payment for each subsequent 90 days spent in the hospital in the same 365-day span.

Veterans with incomes above the means test threshold but below the VA’s geographically based income thresholds have reduced co-payment obligations — they pay 20 percent of the full inpatient rate.

Veterans who are not considered needy and are not being treated for service-connected medical problems are not charged for preventive care visits, such as flu shots and laboratory tests. But they must pay for other office visits. Outpatient primary care costs $15 a visit and outpatient specialty visits cost $50.

Contact: For more information on eligibility, go to www.va.gov/healtheligibility/eligibility.

The VA handbook “Federal Benefits for Veterans and Dependents,” can be found at http://www1.va.gov/opa/vadocs/current_benefits.asp, or contact VA at (877) 222-8387.