There have been a lot of questions lately on who qualifies for Veterans Administration healthcare.
Below should answer all your questions on eligibility.
http://www.va.gov/customer/MEDCARFS.asp
Veterans Health Administration
Department of Veterans Affairs
VA Medical Care Fact Sheet
U.S. DEPARTMENT OF VETERANS AFFAIRS
Veterans Health Administration
VA Medical Care Fact Sheet
Public Law 104-262 dated October 9, 1996, made significant changes in veterans' eligibility for VA medical care. A major feature of this new law makes eligibility rules the same for both inpatient and outpatient care. PL 104-262 eliminated many of the complicated eligibility rules governing outpatient care that previously existed. On November 30, 1999, the President signed Public Law 106-117, the Veterans Millennium Health Care and Benefits Act. This legislation authorizes VA to expand long term care services and to reimburse for the emergency treatment of certain enrolled veterans. The law also requires VA enroll veterans awarded the Purple Heart into Priority Group Three. VA is currently in the process of drafting regulations required to implement these new authorities. For specifics, contact the Health Benefits Service Center at 1-877-222-VETS (8387).
PL 104-262 establishes seven (7) enrollment priority groups and requires certain veterans to enroll in the VA health care system. Veterans enrolled in the VA healthcare system will be furnished needed hospital and outpatient care, and "may" be furnished nursing home care. However, hospital and outpatient care can only be provided to the extent and in the amount that Congress appropriates funds to provide such care. The first six (6) enrollment groups is composed of those veterans who were previously referred to as "Category A" veterans, but excludes 0 percent noncompensable service-connected (SC) veterans needing care for a nonservice-connected (NSC) disability. The enrollment groups are as follows:
Priority Group 1:
Veteran with service-connected conditions rated 50 percent or more disabling
Priority Group 2:
Veterans with service-connected conditions rated 30 to 40 percent or more disabling
Priority Group 3
Veterans who are former POWs
Veterans awarded the Purple Heart
Veterans with service-connected conditions rated 10 or 20 percent disabling
Veterans discharged from active duty for a disability incurred or aggravated in the line of duty
Veterans awarded special eligibility classification under 38 U.S.C., Section 1151
Priority Group 4
Veterans who are receiving aid and attendance or housebound benefits
Veterans who have been determined by VA to be catastrophically disabled
Priority Group 5
Nonservice-connected veterans, whose income and net worth are below the established dollar threshold
Zero percent service-connected veterans, whose income and net worth are below the established dollar threshold
Priority Group 6
Includes all other eligible veterans who are not required to make a co-payment for their medical care, including:
World War I and Mexican Border War veterans
Veterans solely seeking care for disorders associated with exposure to a toxic substance, radiation, or for disorders associated with service in the Gulf War, or;
For any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998
Compensable zero percent service-connected veterans
The seventh enrollment group is composed of veterans with 0% noncompensable disability ratings and veterans who were previously referred to as "Category C" veterans. VA "may" furnish needed hospital care, outpatient medical services, or nursing home care, but only to the extent resources and facilities are available. These veterans must agree to pay VA a copayment for their care.
Priority Group 7 includes:
Nonservice-connected veterans and zero percent non-compensable service-connected veterans with income and net worth above the established threshold and who agree to pay specified co-payments
Eligibility Assessment Procedures
Public Law 99-272, The Veterans Health Care Amendment of 1986, and Public Law 101-508, The Omnibus Budget Reconciliation Act of 1990, established eligibility assessment procedures, based on income levels, for determining whether or not certain veterans who have no other special eligibility, are eligible for cost-fee medical care. These income levels will be adjusted on January 1 of each year by the percentage that VA pension benefits are increased.
Veterans who are not subject to the eligibility income assessment (Means Test) are as follows:
Service-connected (compensable) veterans
Former prisoners of war
Veterans awarded the Purple Heart
Veterans discharged for a disability incurred or aggravated in line of duty.
Veterans who were exposed to herbicides while serving in Vietnam, to ionizing radiation during atmospheric testing and in the occupation of Hiroshima and Nagasaki, or exposed to an environmental hazard while serving in the Gulf War and need treatment for a condition that might be related to such exposures.
Veterans receiving a VA pension.
Veterans of the Mexican border period or World War I.
Veterans eligible for Medicaid.
The eligibility income assessment, which follows, applies to all other veterans without special eligibility regardless of age:
Your hospital care, medical services and nursing home care (when provided) are cost-free if:
You are not subject to the eligibility income assessment (as listed above):
or,
You are a nonservice-connected veteran or 0% non compensable service-connected veteran seeking care for a non service-connected disability and your combined household income is $22,887 or less and your income plus net worth is less than $50,000, if single with no dependents: or your combined household income is $27,468 or less and your income plus net worth is less than $50,000 if married, or single with one dependent (add $1,532) to the income level for each additional dependent).
Your hospital care, medical service and nursing home care (when provided) will require your agreement to pay VA a deductible (also referred to as co-payment) amount for that care equal to what you would have to pay under Medicare, as adjusted annually, if,
Your combined household income is $22,888 or above if single with no dependents or $27,469 or above if married or single with one dependent, plus $1,532 for each additional dependent.
If you are required to pay a deductible for your medical care, you will be charged a copayment, for which you will be personally responsible, as follows:
A co-payment equal to the Medicare deductible, currently $776 for the first 90 days of hospital care during any 365-day period. (In addition to this co-payment, you will be charged a fee of $10 per day for inpatient hospital care.)
For each additional 90 days of hospital care, you will pay half the Medicare deductible plus the additional charge of $10 per day.
For each 90 days of nursing home care, you will pay the full Medicare deductible. (In addition to this co-payment, you will be charged a fee of $5 per day for nursing home care.)
A co-payment of $50.80 will be charged for each outpatient visit.
NOTE: The income assessment level and co-payments rates are adjusted annually.
How Income is assessed
Your total income and net worth under the eligibility assessment, include social security: U.S. Civil Service retirement; U.S. Railroad retirement: military retirement; unemployment insurance; any other retirement; total wages from all employers; interest and dividends; workers' compensation; black lung benefits; and any other gross income for the calendar year prior to your application for care.
The income of your spouse and dependents as well as the market value of your stocks, bonds, notes, individual retirement accounts, bank deposits, savings accounts, cash, etc. are also used.
Your debts are subtracted from your assets to determine your net worth. However, your primary residence and personal property are excluded from this assessment.
VA has the authority to compare information you provide with information from the Department of Health and Human Services and the Internal Revenue Service.
NOTE: The Department of Veterans Affairs is authorized to bill insurance carriers for the cost of Medical Care furnished to all veterans covered by health insurance policies for treatment of nonservice-connected conditions.
The Omnibus Budget Reconciliation Act of 1990 provides that veterans receiving medications on an outpatient basis from VA facilities, for the treatment of a nonservice-connected disability or condition, are required to make a co-payment of $2.00 for each 30-day or less supply for medication provided. Veterans receiving medications for treatment of a service-connected condition, veterans rated 50 percent or more service-connected, and veterans receiving VA pension or whose income is at or below the maximum VA pension rate are exempt from the co-payment requirement for medications.
Enrollment Requirements
Public Law 104-262, established enrollment requirements for certain veterans. All veterans are required to enroll in the VA health care system except:
Veterans rated by VA as being service-connected 50% or greater
Veterans seeking care for an adjudicated service-connected disability, or;
Veterans recently discharged from the military (within the past 12 months) for a disability that the military determined was incurred or aggravated in the line of duty.
Veterans applying for hospital care or outpatient medical services will be required to complete VA Form 10-10EZ, Application for Health Benefits. Your application for health care will be processed and you will be assigned into an enrollment priority group.
Prepared by Health Administration Service
January 1, 1999 (January 1, 2000)
The page was last updated on 23 June 2000 . Please send your comments on this page to the The VA Consumer Affairs Office. Before you email VA, please read the VA Privacy Policy on Information Collected from E-mails and Web Forms.
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