VETERANS BENEFITS – Part I
The Veterans Administration (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.
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% 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. As of Jan. 17, 2003, veterans assigned to priority 8 are not eligible for enrollment or care for non-service connected conditions.
What is Covered
The standard benefits package includes: Preventative care services, out-patient diagnostic and treatment services (including mental health and substance abuse treatment), in-patient 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:
-Geriatric evaluation – provides either an in-patient or out-patient evaluation of a veteran’s ability to care for him or herself
-Adult day health care – a therapeutic day care program that provides medical and rehabilitation services to veterans
-Respite care – provides either in-patient or out-patient supportive care for veterans to allow caregivers to get a break
-Home care – nursing, physical therapy and other services provided in the veteran’s home
-Hospice/palliative care – provides services for terminally ill veterans and their families
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:
-Veterans who are seeking nursing home care for a service-related condition
-Veterans with a service-connected disability rating of 70% or more
-Veterans who have a service-connected disability of 60% and are unemployable
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.
Careful planning by a knowledgeable elder law firm is crucial in applying and becoming eligible.
Part 2 will discuss Co-Payments.