Federal Benefits for Veterans and Dependents

Health Care Benefits (continued) >>

Health Care Benefits

Health Care Enrollment | Priority Groups | Special Access to Care | Financial Assessment | Services Requiring Copayments | Outpatient Visits Not Requiring Copayments | Billing Insurance Companies
Registry Programs | Readjustment Counseling Services | Prosthetic and Sensory Aid Services
Services and Aids for the Blind | Home Improvements and Structural Alterations
Alcohol and Drug-Dependence Treatment | Compensated Work Therapy | Outpatient Dental Treatment

Health Care Enrollment

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.

To apply, 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/).

Priority Groups

Veterans will be enrolled to the extent Congressional appropriations allow. If appropriations are limited, enrollment will occur based on the following priorities:

Priority Group 1: Veterans with service-connected disabilities who are rated 50 percent or more.

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

Priority 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 in treatment.

Priority 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 for copayments.

Priority Group 5: Veterans who are determined to be unable to defray the expenses of needed care.

Priority 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 tuberculosis.

Priority 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 pay copayments.

Priority 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).

These groups 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.

Special 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.

Financial Information

Financial Assessment

Veterans who 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.

The financial 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.

Services Requiring Copayments

Nonservice-connected 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.

With certain 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.

Outpatient Visits Not Requiring Copayments

Outpatient 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 from copayments.

Billing Insurance Companies

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.

Health Care Programs

Registry Programs
VA maintains databases called registries to help analyze health conditions reported by veterans.

Gulf 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).

Agent 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.

Ionizing 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 service.

Veterans 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 Internet (http://www.va.gov/environagents/).

Readjustment Counseling Service
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.

Eligible 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.

Readjustment 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).

Prosthetic 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.

Services 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, including:

1. A total health and benefits review by a VA Visual Impairment Services team.
2. Adjustment to blindness training.
3. Home improvements and structural alterations to homes.
4. Specially adapted housing and adaptations.
5. Automobile grant.
6. Low-vision aids and training in their use.
7. Electronic and mechanical aids for the blind, including adaptive computers and computer-assisted devices such as reading machines and electronic travel aids.
8. Guide dogs, including the expense of training the veteran to use the dog.
9. Talking books, tapes and Braille literature.

Home 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.

Alcohol and Drug-Dependence Treatment
Veterans eligible for VA medical care may apply for substance abuse treatment. Contact the nearest VA medical facility to apply.

Compensated Work Therapy
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 services.

The CWT/Transitional 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.

Outpatient Dental Treatment

Outpatient 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 following:

(1) veterans having service-connected and compensable dental disabilities or conditions;
(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 unemployability;
(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 treatment..

Veterans may 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.

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