Health Care Benefits (continued) >>
Care Enrollment | Priority
Groups | Special
Access to Care | Financial
Assessment | Services
Requiring Copayments | Outpatient
Visits Not Requiring Copayments | Billing
Programs | Readjustment
Counseling Services | Prosthetic
and Sensory Aid Services
Services and Aids for the Blind |
Home Improvements and Structural Alterations
and Drug-Dependence Treatment | Compensated
Work Therapy | Outpatient
For most veterans,
entry into the VA health care system begins with applying for
enrollment. Veterans do not have to be enrolled if they:
(1) have a service-connected disability of 50 percent or more;
(2) want care for a disability that the military determined was
incurred or aggravated in the line of duty, but which VA has not
yet rated, during the 12-month period following discharge; or
(3) want care for a service-connected disability only. To permit
better planning of health resources, however, these three categories
of veterans also are urged to enroll.
veterans must complete VA
Form 10-10EZ, Application for Health Benefits. The form may
be obtained from any VA health care facility or regional benefits
office, or by calling the VA Health Benefits Service Center toll-free
at 1-877-222-VETS (8387). It is also available through the World
Wide Web (http://www.va.gov/1010ez.htm).
Veterans may complete the form in person at a VA health care facility,
or at home and mail it to a local VA health care facility for
processing. Once enrolled, a veteran is eligible to receive services
at VA facilities anywhere in the country. Additional information
can be found on the VA Web site (http://www.va.gov/elig/).
will be enrolled to the extent Congressional appropriations allow.
If appropriations are limited, enrollment will occur based on
the following priorities:
Group 1: Veterans with service-connected disabilities
who are rated 50 percent or more.
Group 2: Veterans with service-connected disabilities
who are rated 30 or 40 percent.
Group 3: Veterans who are former POWs or were awarded
a Purple Heart, veterans with disabilities rated 10 and 20 percent,
and veterans awarded special eligibility for disabilities incurred
Group 4: Veterans who are receiving aid and attendance
or housebound benefits and veterans who have been determined by
VA to be catastrophically disabled, although some may be responsible
Group 5: Veterans who are determined to be unable to
defray the expenses of needed care.
Group 6: All other eligible veterans not required to
make copayments. This includes veterans of the Mexican border
period or World War I; veterans seeking care solely for certain
conditions associated with exposure to radiation, 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 nevertheless
compensated, including veterans receiving compensation for inactive
Group 7: Nonservice-connected veterans and noncompensable
zero percent service-connected veterans with income above VA's
national means test threshold and below VA's geographic means
test threshold for the fiscal year ending on September 30 of the
previous calendar year, 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
Group 8: All other nonservice-connected veterans and
zero percent noncompensable service-connected veterans who agree
to pay copayments. (Note: Effective Jan. 17, 2003, VA no longer
enrolls new veterans in priority group 8).
are enrollment priorities only. VA services and treatment available
to enrolled veterans generally are not based on priority groups.
Enrollment will be reviewed each year and veterans will be notified
in writing of any change in their enrollment status. Call your
nearest VA health care facility or the Health Benefits Service
Center, 1-877-222-8387, to obtain the latest information.
Access to Care
Veterans with service-connected disabilities rated 50 percent
or greater based on one or more disabilities or unemployability
and veterans receiving care for a service-connected disability
receive priority in the scheduling of appointments for outpatient
medical services and admissions for inpatient hospital care.
want to enroll in priority group 5 based on their inability to
defray the cost of their care must provide information on their
annual income and net worth to determine whether they are below
the annually adjusted "means test" financial threshold.
assessment covers household income plus net worth and includes
Social Security, U.S. Civil Service retirement, U.S. Railroad
retirement, military retirement, unemployment insurance, any other
retirement income, total wages from all employers, interest and
dividends, workers' compensation, black lung benefits and any
other gross income for the calendar year prior to application
for care. Also considered are assets such as the market value
of stocks, bonds, notes, individual retirement accounts, bank
deposits, savings accounts and cash.
VA also is
also required to compare veterans' financial assessment information
with a geographically based income threshold. If the veteran's
income is below the threshold where the veteran lives, he or she
is eligible for an 80 percent reduction in the inpatient copayment
rates. VA may compare income information provided by the veteran
with information obtained from the Social Security Administration
and the Internal Revenue Service.
veterans and noncompensable zero percent service-connected veterans
whose income is above the national "means test" threshold must
agree to pay appropriate copayments for care. If they do not agree
to make copayments, the veteran will be ineligible for VA care.
Veterans whose income is determined to be above the means test
threshold and below VA's geographically based income threshold
are responsible for paying 20 percent of the Medicare deductible
for the first 90 days of inpatient hospital care during any 365-day
period. For each additional 90 days of hospital care, the patient
is charged 10 percent of the Medicare deductible. In addition
to these charges, the patient is charged $2 a day for hospital
care. Nonservice-connected veterans and noncompensable zero percent
service-connected veterans with incomes above the geographic income
threshold will be charged the full Medicare deductible for the
first 90 days of care during any 365-day period. For each additional
90 days of hospital care, the patient is charged one half of the
Medicare deductible and $10 per day.
exceptions, a veteran must agree to pay copayments for extended
care services. A veteran's application for extended
care services (VAF 10-10EC) requires financial information
used to determine the monthly copayment amount, based on each
veteran's financial situation. For outpatient medical care, a
three-tiered copayment system is effective for all outpatient
services. The copayment is $15 for a primary care visit and $50
for some specialized care. Certain services do not require a copayment.
Visits Not Requiring Copayments
visits for which no copayment will be assessed include: publicly
announced VA public health initiatives (e.g., health fairs) or
an outpatient visit solely consisting of preventive screening
and/or immunizations, such as influenza immunization, pneumonococcal
immunization, hypertension screening, hepatitis C screening, tobacco
screening, alcohol screening, hyperlipidemia screening, breast
cancer screening, cervical cancer screening, screening for colorectal
cancer by fecal occult blood testing, and education about the
risks and benefits of prostate cancer screening. Laboratory, flat
film radiology services, and electrocardiograms are also exempt
VA is authorized
to recover reasonable charges for medical care and services provided
to nonservice-connected veterans and to serviceconnected veterans
for nonservice-connected medical conditions. Money collected in
this way is used to maintain and improve VA's health care system
for veterans. Generally, VA cannot bill Medicare for medical services
provided to veterans; however, VA can bill Medicare supplemental
health insurance for medical care and services that are covered
by the supplemental insurance but not covered by Medicare. All
veterans applying for VA medical care will be asked to provide
information on their health insurance coverage, including coverage
provided under policies of their spouses. Although veterans are
not responsible for paying any remaining balance of VA's insurance
claim that is not paid or covered by their health insurance, veterans
whose income is above the applicable "means test" threshold are
responsible for the VA copayments required by federal law.
VA maintains databases called registries to help analyze health
conditions reported by veterans.
War and Depleted Uranium Registries: are for veterans
who served in the Gulf War (Aug. 2, 1990 to a date not yet established,
including Operation Iraqi Freedom).
Orange Registry: is for veterans possibly exposed to
dioxin or other toxic substances in herbicides used during the
Vietnam War (between 1962 and 1975), while serving in Korea between
1968 and 1969, or as a result of testing, transporting, or spraying
herbicides for military purposes.
Radiation Registry: is for veterans possibly exposed
to atomic radiation during the following activities: participation
in tests involving the atmospheric detonation of a nuclear device;
occupation of Hiroshima or Nagasaki from Aug. 6, 1945, through
July 1, 1946; internment as a prisoner of war in Japan during
World War II; serving in official military duties at the Department
of Energy gaseous diffusion plants at Paducah, Ky.; Portsmouth,
Ohio; or the K-25 area at Oak Ridge, Tenn., for at least 250 days
before Feb. 1, 1992, or in Longshot, Milrow or Cannikin underground
nuclear tests at Amchitka Island, Alaska, before Jan. 1, 1974;
or treatment with nasopharyngeal (NP) radium during active military
eligible for participation in any VA registry may receive free,
comprehensive registry medical examinations, including laboratory
and other diagnostic tests deemed necessary by an examining clinician.
Eligible veterans do not have to be enrolled in VA health care
to participate in registry examinations. Veterans wishing to participate
should contact the nearest VA health care facility or visit the
Readjustment counseling is provided at 206 community-based Vet
Centers located in all 50 states, the District of Columbia, Guam,
Puerto Rico, and the U.S. Virgin Islands, and is designed to help
combat veterans in their readjustment to civilian life. Vet Center
staff provide group, individual and family counseling plus a wide
range of other services to include medical referral, homeless
veteran services, employment services, VA benefit referral, and
the brokering of non-VA services.
veterans include those who served on active duty in a combat theater
during World War II, the Korean War, the Vietnam War, the Gulf
War, or the campaigns in Lebanon, Grenada, Panama, Somalia, Bosnia,
Kosovo, Afghanistan, Iraq and the global War on Terror. Veterans
who served in the active military during the Vietnam Era, but
not in the Republic of Vietnam, are also eligible, provided they
requested services at a Vet Center before Jan. 1, 2004. Vet Centers
also provide bereavement counseling to the families of military
personnel killed in action and sexual trauma counseling to veterans
who suffered sexual trauma while on active duty.
difficulties can include post-traumatic stress disorder (PTSD)
or any other problems that affect functioning within the family,
work, school or other areas of everyday life. For additional information,
contact the nearest Vet Center, listed in the federal government
section of telephone directories, or visit the Internet at (http://www.va.gov/rcs).
and Sensory Aid Services
VA will furnish needed prosthetic appliances, equipment and devices,
such as artificial limbs, orthopedic braces and shoes, wheelchairs,
crutches and canes, to veterans receiving VA care for any condition.
VA will provide hearing aids and eyeglasses to veterans who receive
increased pension based on the need for regular aid and attendance
or being permanently housebound, receive compensation for a service-connected
disability or are former prisoners of war. Otherwise, hearing
aids and eyeglasses will be provided only in special circumstances,
and not for normally occurring hearing or vision loss. For additional
information, contact the prosthetic representative at your local
VA health care facility.
and Aids for Blind Veterans
Blind veterans may be eligible for services at a VA medical center
or for admission to a VA blind rehabilitation center. Services
are available at all VA medical facilities through the Visual
Impairment Services coordinator. In addition, blind veterans enrolled
in the VA health care system may receive VA aids for the blind,
- A total
health and benefits review by a VA Visual Impairment Services
to blindness training.
- Home improvements
and structural alterations to homes.
adapted housing and adaptations.
aids and training in their use.
and mechanical aids for the blind, including adaptive computers
and computer-assisted devices such as reading machines and electronic
dogs, including the expense of training the veteran to use the
books, tapes and Braille literature.
Improvements and Structural Alterations
The Home Improvements and Structural Alterations program provides
funding for eligible veterans to make home improvements necessary
for the continuation of treatment or for disability access to
the home and essential lavatory and sanitary facilities. Home
improvement benefits up to $4,100 for service-connected veterans
and up to $1,200 for nonservice-connected veterans may be provided.
For application information, contact the prosthetic representative
at the nearest VA medical center or outpatient clinic.
and Drug-Dependence Treatment
Veterans eligible for VA medical care may apply for substance
abuse treatment. Contact the nearest VA medical facility to apply.
VA's Mental Health Psychosocial Rehabilitation Programs provide
therapeutic work opportunities for eligible veterans through Incentive
Therapy, Vocational Assistance, Transitional Residence, and Compensated
Work Therapy programs. Each program offers rehabilitative treatment
to help veterans live and work in their communities. Incentive
Therapy is a token base payment program frequently used as a precursor
to Compensated Work Therapy (CWT) or as a mainstay for veterans
with serious mental illness. Veterans referred to CWT receive
an individualized vocational assessment, rehabilitation planning
and work experience. Vocational assistance services are designed
to help veterans achieve a maximum degree of selfsufficiency based
on their needs, preferences and abilities. The CWT program works
closely with community-based organizations, employers and state
and federal agencies for direct job placement and supportive follow-up
Residence program provides work-based, residential treatment in
a stable living environment. This program differs from other VA
residential bed programs in that participants contribute (using
their CWT earnings) to the cost of operating and maintaining their
residences and are responsible for planning, purchasing and preparing
their own meals. The program offers a comprehensive array of rehabilitation
services including home, financial and life skills management
in a therapeutic community model.
dental treatment provided by VA includes examinations and the
full spectrum of diagnostic, surgical, restorative and preventive
procedures. Veterans eligible to receive dental care include the
(1) veterans having service-connected and compensable dental disabilities
(2) former prisoners of war;
(3) veterans with service-connected, noncompensable dental conditions
as a result of combat wounds or service injuries;
(4) veterans with nonservice-connected dental conditions determined
by VA to be aggravating a medical problem;
(5) veterans having service-connected conditions rated as permanently
and totally disabling or rated 100 percent by reason of individual
(6) veterans participating in a vocational rehabilitation program
under chapter 31 of title 38;
(7) certain enrolled homeless veterans participating in specific
health care programs;
(8) veterans with nonservice-connected dental conditions for which
treatment was begun while the veteran was an inpatient in a VA
facility when it is necessary to complete such treatment on an
outpatient basis; and
(9) veterans requiring treatment for dental conditions clinically
determined to be complicating a medical condition currently under
receive one-time dental treatment for service-connected and noncompensable
dental disabilities or conditions if the following conditions
are met: the dental condition can be shown to have existed at
time of discharge; the veteran served on active military duty
for at least 180 days, (or 90 days during Gulf War Era); the veteran
applied to VA for dental care within 90 days of discharge or release
from active duty, and the certificate of discharge does not include
certification that all appropriate dental treatment had been rendered
prior to discharge.
Health Care Benefits (continued) >>