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Veterans Benefits image Elder Law Associates, PLLC - Design Artwork AREAS OF CONCENTRATION - Veteran's Benefits

Topics Covered - Click on any topic to begin:





Veterans of the United States armed forces may be eligible for a broad range of programs and services provided by the U.S. Department of Veterans Affairs (VA). In addition, their dependents and survivors may also be eligible for benefits. For more information about all the benefits available from the VA, see the VA booklet Federal Benefits for Veterans, Dependents and Survivors.


Topics Covered - Click on any topic to begin:

Medical Care   |   Who is Eligible   |   What Is Covered   |   Co-payments   |   How to Enroll for Health Benefits

Disability Benefits   |   Disability Compensation   |   Disability Pension Benefit   |   How To Apply


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Medical Care


The VA provides health care benefits to veterans. The plan covers a number of health care services, including preventative services, diagnostic and treatment services, and hospitalization. It may also cover nursing home and other long-term care options.


Topics Covered - Click on any topic to begin:

Medical Care   |   Who is Eligible   |   What Is Covered   |   Co-payments   |   How to Enroll for Health Benefits

Disability Benefits   |   Disability Compensation   |   Disability Pension Benefit   |   How To Apply


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Who Is Eligible


To receive care, most veterans must be enrolled in the VA health system. Eligibility for the health system depends on a number of factors, including the nature of your discharge from military service, your length of service, whether you have service-connected disabilities, your income level, and available VA resources, among others.


To be eligible, you must not have been dishonorably discharged from the military. Your length of service may also be important. Former enlisted persons who started active duty before September 8, 1980, and former officers who first entered active duty before October 17, 1981, do not have a length-of-service requirement. Otherwise you must have 24 months of continuous active duty military service, though there are several exceptions for reservists, national guard members, service-connected disabilities, and hardship discharges, among others.


Certain veterans do not need to be enrolled in the VA health system to receive benefits if: you are 50 percent or more disabled from a service-connected disability, you are seeking care for a VA rated service-connected disability, or it has been less than one year since you were discharged for a disability that the military determined was caused or aggravated by your service, but the VA has not yet rated the disability.


The VA has limited resources, so if you are eligible for services, you will be assigned to a priority group. The priority groups range from 1-8 with 1 being the highest priority for enrollment. To see the priority list, click here. Previously, veterans assigned to priority 8 were not eligible for enrollment or care for non-service connected conditions. New regulations went into effect on June 15, 2009 that enable the VA to relax income restrictions on enrollment for health benefits. For more information, click here.


Topics Covered - Click on any topic to begin:

Medical Care   |   Who is Eligible   |   What Is Covered   |   Co-payments   |   How to Enroll for Health Benefits

Disability Benefits   |   Disability Compensation   |   Disability Pension Benefit   |   How To Apply


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What Is Covered


The standard benefits package includes: Preventative care services, outpatient diagnostic and treatment services (including mental health and substance abuse treatment), inpatient diagnostic and treatment services, prescriptions, and long-term care (including nursing home care for some veterans).


Long-term care


The VA offers a number of long-term care options through its health plan. All enrolled veterans are eligible for the following services:



Some services are limited to certain veterans: nursing home care and domiciliary care are not automatically available to all veterans enrolled in the VA health plan. The following veterans automatically qualify for unlimited nursing home care:



A service-connected disability is a disability that the VA has officially ruled was incurred or aggravated while on active duty in the military and in the line of duty. The VA must rule that your illness/condition is directly related to your active military service, and it assigns each disability a rating. The ratings are established by VA regional offices around the country.


The VA may provide nursing home care to other veterans if space permits. Veterans with service-connected disabilities receive priority.

There are also state-run veteran's nursing homes. The VA provides funds to states to help them build the homes and pays a portion of the costs for veterans eligible for VA health care. The states, however, set eligibility criteria for admission.


A Domiciliary is a VA facility that provides care on an ambulatory self-care basis for veterans disabled by age or disease who are not in need of acute hospitalization and who do not need the skilled nursing services provided in a nursing home. Domiciliary care is available to low-income veterans with a disability.


Topics Covered - Click on any topic to begin:

Medical Care   |   Who is Eligible   |   What Is Covered   |   Co-payments   |   How to Enroll for Health Benefits

Disability Benefits   |   Disability Compensation   |   Disability Pension Benefit   |   How To Apply


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Co-Payments


There are no costs for certain veterans and low-income veterans. The following veterans are eligible to receive cost-free health care benefits automatically:



If you don't fit into one of those categories, the VA will ask you to provide your household income and net worth from the previous year. If your income is below certain thresholds, you will not have to make a co-payment. Click here to view the thresholds for income. In addition, you must not have more than $80,000 in property. Those whose income exceeds the threshold or who refuse to submit to the means test may have to make a co-payment.


Unlike the Medicaid program, there is no penalty for transferring assets before applying for veterans benefits, including long-term care. Remember, however, that if you do transfer assets it may affect your eligibility for Medicaid.


Even if your income is above the threshold, you do not have to make co-payments for the following services:



Outpatient co-payments


The following are the outpatient co-payments for non-service-related conditions:



Preventive care services (such as screenings and immunizations) are free.


Inpatient co-payments


The inpatient co-payment is calculated by adding:



There is a reduced co-payment rate (20 percent of the full inpatient rate) for certain individuals whose income is above the VA income thresholds, but below the Geographic Means Threshold (GMT). Click here to see if you are below the GMT.


Prescription co-payments


Prescription co-payments are charged only for outpatient treatment. The following veterans do not have to pay anything for medications:



If you don't fit into one of these categories, you must pay $9 (in 2012) for each 30-day or less supply of medication. If you are in one of the Priority Groups 2 through 6, there is an annual limit on the amount you have to pay for prescriptions. You will not be charged more than $960 during the calendar year. If you are in Priority Groups 7 and 8, you will have to pay the full co-payment amount, with no annual limit.


The Medicare prescription drug benefit


As part of the new Medicare law enacted in December 2003, Congress added a modest prescription drug benefit, which took effect January 1, 2006. The benefit is available to anyone who is eligible for Medicare Part A or B coverage. The benefit is completely voluntary, so you must decide whether you want to participate in a plan or not based on your own situation. If you decide to participate in the Medicare plan, your VA prescription drug coverage will not be affected.


Most Medicare beneficiaries must choose a plan or be subject to significant financial penalties for late enrollment. However, because the VA prescription drug coverage is considered "creditable coverage," you will not face a penalty if you do not sign up for the Medicare plan. If you discontinue your enrollment or lose your VA prescription drug coverage, you will have 62 days to sign up for a Medicare plan without being subject to a penalty.

For more information on the Medicare Prescription Drug Benefit, click here.


Long-term care co-payments


The first 21 days of long-term care are free. Co-payments start on the 22nd day. Long-term care co-payments are calculated differently from other co-payments they are set based on the individual veteran's financial status. Veterans must fill out a financial assessment to determine their co-payments. This is a separate form from the form veterans had to fill out to determine if they were eligible for free health care. This form assesses your current income as opposed to the previous year's income. The co-payments will be adjusted for each individual veteran based on his or her ability to pay. Once you have submitted a form, a social worker will contact you to let you know how much your co-payments will be.


What to do if you can't afford co-payments


There are several options if you cannot afford your co-payments. One option is to request a waiver. You will have to submit proof that you can't financially afford to make payments to the VA.


If your income changed since you applied for free health care, you can request a hardship determination. This will change your priority group assignment. To do this, you will need to provide current financial information to the VA.


Another option is to request a compromise and make a partial payment. Most compromise offers that are accepted must be for a lump sum payment payable in full 30 days from the date of acceptance of the offer.


Topics Covered - Click on any topic to begin:

Medical Care   |   Who is Eligible   |   What Is Covered   |   Co-payments   |   How to Enroll for Health Benefits

Disability Benefits   |   Disability Compensation   |   Disability Pension Benefit   |   How To Apply


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How to Enroll for Health Benefits


You can fill out the form to enroll for health benefits online at https://www.1010ez.med.va.gov/sec/vha/1010ez/ or you can receive the form by calling 1-877-222-VETS (8387). Once you complete and sign the form, mail it to your local VA health care facility. * Click here to find the facility nearest you.


(* The previous link takes you to a page that uses Adobe Flash, a utility that is NOT compatible with iPhone/iPad devices. If you are interested in utilizing the previous link, please do so via a desktop computer or a smartphone/tablet device that is windows-based or android-based.)


Topics Covered - Click on any topic to begin:

Medical Care   |   Who is Eligible   |   What Is Covered   |   Co-payments   |   How to Enroll for Health Benefits

Disability Benefits   |   Disability Compensation   |   Disability Pension Benefit   |   How To Apply


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Disability Benefits


The VA offers two disability programs. Disability compensation is available only for veterans with service-connected disabilities, while the disability pension benefit is available to anyone who served during wartime and has a disability. The disability does not have to be related to military service.


Topics Covered - Click on any topic to begin:

Medical Care   |   Who is Eligible   |   What Is Covered   |   Co-payments   |   How to Enroll for Health Benefits

Disability Benefits   |   Disability Compensation   |   Disability Pension Benefit   |   How To Apply


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Disability Compensation


If you have an injury or disease that happened while on active duty or if active duty made an existing injury or disease worse, you may be eligible for disability compensation. The amount of compensation you get depends on how disabled you are and whether you have children or other dependents. Click here to see the current compensation rates. Additional funds may be available if you have severe disabilities, such as loss of limbs, or a seriously disabled spouse.


Topics Covered - Click on any topic to begin:

Medical Care   |   Who is Eligible   |   What Is Covered   |   Co-payments   |   How to Enroll for Health Benefits

Disability Benefits   |   Disability Compensation   |   Disability Pension Benefit   |   How To Apply


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Disability Pension Benefit


The VA pays a pension to disabled veterans who are not able to work. The pension is also available for surviving spouses and children. This pension is available whether or not your disability is service-connected, but to be eligible you must meet the following requirements:



In addition, your income must be below the yearly limit set by law; called the Maximum Annual Pension Rate (MAPR). The MAPR for 2012 are below:



Your pension depends on your income, but there are certain costs that can be deducted from income for VA qualification purposes.  The VA pays the difference between your adjusted income and the MAPR.  The pension is usually paid in 12 equal payments.


Example: John is a single veteran and has a yearly income of $6,736. His pension benefit would be $5,520 (12,256 - 6,736). Therefore, he would get $460 a month.


Your income does not include welfare benefits or Supplemental Security Income. It also does not include unreimbursed medical expenses actually paid by the veteran or a member of his or her family. This can include Medicare, Medigap, and long-term care insurance premiums; over-the-counter medications taken at a doctor's recommendation; long-term care costs, such as nursing home fees; the cost of an in-home attendant that provides some medical or nursing services; and the cost of an assisted living facility. These expenses must be unreimbursed. This means that insurance must not pay the expenses. The expenses should also be recurring this means they should recur every month.


Aid and Attendance.


A veteran who needs the help of an attendant may qualify for additional help on top of the disability pension benefit. The veteran needs to show that he or she needs the help of an attendant on a regular basis. A veteran who lives in an assisted living facility is presumed to need aid and attendance. A veteran who meets these requirements will get the difference between his or her income and the MAPR below (2013 figures):




Topics Covered - Click on any topic to begin:

Medical Care   |   Who is Eligible   |   What Is Covered   |   Co-payments   |   How to Enroll for Health Benefits

Disability Benefits   |   Disability Compensation   |   Disability Pension Benefit   |   How To Apply


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How To Apply


You can apply for both disability benefits by filling out VA Form 21-526, Veteran's Application for Compensation Or Pension. If available, you should attach copies of dependency records (marriage & children's birth certificates) and current medical evidence (doctor & hospital reports). You can apply online at http://vabenefits.vba.va.gov/vonapp.


Since a large percentage of applications (~75%)  submitted by individuals are initially denied, we suggest using an accredited attorney, accredited claims agent or a Veterans Service Organization (VSO) like American Legion, Veterans of Foreign Wars (VFW), etc.  In the mid-south region, we recommend Veterans Support Center in Memphis, TN  (901) 795-5688.   By law, no person or entity is allowed to charge for assisting in the application of veterans benefits.


Topics Covered - Click on any topic to begin:

Medical Care   |   Who is Eligible   |   What Is Covered   |   Co-payments   |   How to Enroll for Health Benefits

Disability Benefits   |   Disability Compensation   |   Disability Pension Benefit   |   How To Apply


TOP OF PAGE   |   BOTTOM OF PAGE



DISCLAIMER:  This information was originally obtained from www.elderlawanswers.com and has been updated. The updated information is based on new and/or revised federal, state, or local laws, with some of the updated information applicable to citizens with residence in the state of Tennessee. The effective date of all changes and/or revisions to the information contained on this site: TUESDAY, JANUARY 1, 2013.


The information on this web site is a public resource of general information, which is intended, but not promised or guaranteed, to be correct, complete and up-to-date. The information on this web site is not intended to be, and is not, a source of advertising, solicitation or legal advice. No person who visits this web site should consider the information on this web site to be an invitation for an attorney-client relationship or rely on the information provided herein. Every person who visits this web site and needs legal advice or an attorney should seek the advice of competent counsel in his or her State.