Health Care Benefits

Hospital and Nursing-Home Care Eligibility for VA hospital care and nursing-home care is divided into two categories: "mandatory" and "discretionary." Eligibility for outpatient medical care is listed separately under "Outpatient Medical Care." An income assessment is made to determine whether a nonservice-connected veteran is eligible for cost-free VA medical care. These income levels are adjusted on Jan. 1 of each year, based on the percentage of increase provided to VA improved pension benefits.

VA must provide hospital care and may provide nursing-home care to veterans in the mandatory category. VA may provide hospital and nursing-home care to veterans in the discretionary category if space and resources are available in VA facilities.

The law requires that VA must provide hospital care to veterans in the mandatory category at the nearest VA facility capable of furnishing the care in a timely fashion. If no VA facility is available, care must be furnished in a Defense Department facility or another facility with which VA has a sharing or contractual relationship. If space and resources at VA hospitals and nursing homes are available after caring for service-connected veterans, then VA may furnish care to those in the nonservice-connected category. Veterans in the discretionary category must agree to pay VA for their care.

MANDATORY CARE: Veterans who must be provided hospital care and may be provided nursing-home care and who are not subject to an income eligibility assessment are: veterans rated with service-connected disabilities, veterans who were exposed to herbicides while serving in Vietnam, veterans exposed to ionizing radiation during atmospheric testing or in the occupation of Hiroshima and Nagasaki, veterans for a condition related to service in the Persian Gulf, former prisoners of war, veterans on VA pension, veterans of the Mexican Border period or World War I, and veterans eligible for Medicaid.

The following income eligibility assessment applies to all other nonservice-connected veterans:

MANDATORY: Hospital care is mandatory if the patient is a nonservice-connected veteran with income of $19,408 or less if single with no dependents, or $23,290 or less if married or single with one dependent. The income maximum is raised $1,296 for each additional dependent. Hospital care in VA facilities must be provided to veterans in the mandatory category. Nursing-home care may be provided in VA facilities, if space and resources are available.

DISCRETIONARY: Hospital care is considered discretionary if the patient is a nonservice-connected veteran and income is above $19,408 if single with no dependents, or $23,290 if married or single with one dependent, plus $1,296 for each additional dependent. For VA care, the patient must agree to pay an amount equal to what would have been paid under Medicare. The Medicare deductible currently is $676 and is adjusted annually. VA may provide hospital, outpatient and nursing-home care in VA facilities to veterans in the discretionary category, if space and resources are available.

If the patient's medical care is considered discretionary, the VA holds the patient responsible for the cost of care or $676 for the first 90 days of care during any 365-day period. For each additional 90 days of hospital care, the patient is charged half the Medicare deductible. For each 90 days of nursing-home care, an amount equal to the Medicare deductible is charged. In addition to these charges, the patient will be charged $10 per day for hospital care and $5 a day for nursing-home

How Income Is Assessed

The patient's total income under the eligibility assessment 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. The income of spouse and dependents as well as the market value of stocks, bonds, notes, individual retirement accounts, bank deposits, savings accounts and cash also are used. Debts are subtracted from the patient's assets to determine net worth. The patient's primary residence and personal property are excluded. The patient must fill out VA Form 10-10f, Financial Worksheet, at the time care is requested. VA has the authority to compare information provided by the veteran with information obtained from the Department of Health and Human Services and the Internal Revenue Service.

Billing Insurance Companies

All veterans applying for medical care at a VA facility will be asked if they have medical insurance. VA is authorized by law to bill insurance companies for the cost of medical care furnished to veterans, including service-connected veterans, for nonservice-connected conditions covered by health insurance policies. A veteran may be covered by such a policy or be covered as an eligible dependent on a spouse's policy. Veterans are not responsible and will not be charged by VA for any charge required by their health-insurance policies. Veterans will not be responsible for uncovered charges from the insurance company, except for copayments required by federal law.

Nursing-Home Care Benefit

Skilled nursing care and related medical care in VA or private nursing homes is provided for convalescents or persons who are not acutely ill and not in need of hospital care.

Eligibility

Admission or transfer to VA nursing-home care is the same as for hospitalization. Veterans who have a service-connected disability are given first priority. Direct admission to private nursing homes at VA expense is limited to: (1) a veteran who requires nursing care for a service-connected disability after medical determination by VA, (2) any person in an Armed Forces hospital who requires a protracted period of nursing care and who will become a veteran upon discharge from the Armed Forces, or (3) a veteran who had been discharged from a VA medical center and is receiving home health services from a VA medical center. VA may transfer veterans who need nursing-home care to private nursing homes at VA expense from VA medical centers, nursing homes, or domiciliaries. VA-authorized care normally may not be provided in excess of six months except for veterans whose need for nursing-home care is for a service-connected disability or for veterans who were hospitalized primarily for treatment of a service-connected disability. Nursing-home care for nonservice-connected veterans whose income exceeds the income limit for hospital care may be authorized only if the veteran agrees to pay the applicable copayment.

Domiciliary Care

Domiciliary care provides rehabilitative and long-term, health-maintenance care for veterans who require minimal medical care but who do not need the skilled nursing services provided in nursing homes. VA provides domiciliary care to veterans whose annual income does not exceed the maximum annual rate of VA pension, and to veterans the Secretary of Veterans Affairs determines have no adequate means of support.

Outpatient Medical Treatment Benefit

Outpatient medical treatment includes medical examinations and related medical services, drugs and medicines, rehabilitation services, and mental health services. As part of outpatient medical treatment, veterans may be eligible for home health services for the treatment of disabilities. Veterans may be eligible for such Home Improvements and Structural Alterations (HISA) determined necessary for treatment or to provide access to the home or to essential sanitary facilities. Eligibility

1. VA must furnish outpatient care without limitation: To veterans for service-connected disabilities. To veterans with a 50 percent or more service-connected disability, for any disability. To veterans who have suffered an injury as a result of VA hospitalization, for that condition only.
2. VA must furnish outpatient care for any condition to prevent the need for hospitalization, to prepare for hospitalization or to complete treatment after hospital care, nursing-home care or domiciliary care to:

   Any 30-40 percent service-connected disabled veteran.

   Any veteran whose annual income is not greater than the maximum annual pension rate of a veteran in need of regular aid and attendance.

    

3. VA may furnish outpatient care without limitation to:

   Veterans in a VA-approved vocational rehabilitation program.

   Former prisoners of war.

   World War I or Mexican Border Period veterans.

   Veterans who receive increased pension or compensation based on the need for regular aid and attendance of another person, or who are permanently housebound.

4. VA may furnish outpatient care to prevent the need for hospitalization, to prepare for hospitalization, or for a condition for which the veteran was hospitalized to:

   Any 0-20 percent service-connected disabled veteran.
   Veterans exposed to a toxic substance during service in Vietnam, or exposed to ionizing radiation following the detonation of a nuclear device.
   Any mandatory category veteran whose income is more than the pension rate of a veteran in need of regular aid and attendance.

   Discretionary category veterans, subject to a copayment of $33 per outpatient visit. Allied beneficiaries, beneficiaries of other federal agencies and certain other nonveterans.

Veterans receiving medication for treatment of service-connected conditions and veterans rated with 50 percent or more service-connected disability are not charged for pharmacy services. Veterans whose annual income does not exceed the maximum VA pension are not charged. Veterans receiving medication on an outpatient basis from VA facilities for the treatment of nonservice-connected disabilities or ailments are charged $2 for each 30-day supply or less.

Outpatient Dental Treatment

Outpatient dental treatment may include examinations and the full spectrum of diagnostic, surgical, restorative and preventive techniques. The following are eligible for dental treatment:
(a) Dental conditions or disabilities that are service connected and compensable in degree will be treated.
(b) Service-connected dental conditions or disabilities that are not compensable in degree may receive one-time treatment if the conditions can be shown to have existed at discharge or within 180 days of release from active service. Veterans must apply to VA for care for the service-connected dental condition within 90 days following separation. Veterans will not be considered eligible if their separation document indicates that necessary treatment was completed by military dentists during the 90 days prior to separation. Veterans who served on active duty for 90 days or more during the Persian Gulf War are included in this category.
(c) Service-connected, noncompensable, dental conditions resulting from combat wounds or service injuries, and service-connected, noncompensable, dental conditions of former prisoners of war who were incarcerated less than 90 days may be treated.
(d) Veterans who were prisoners of war for more than 90 days will receive complete dental care.
(e) Veterans will receive complete dental care if they are receiving disability compensation at the 100-percent rate for service-connected conditions or are eligible to receive it by reason of unemployability.
(f) Nonservice-connected, dental conditions that are determined by VA to be associated with and aggravated by service-connected, medical problems will be treated.
(g) Disabled veterans participating in a vocational rehabilitation program will be treated.
(h) Veterans will be treated for nonservice-connected, dental conditions or disabilities when treatment was begun while in a VA medical center, when it is professionally determined to be reasonably necessary to complete such dental treatment on an outpatient basis.
(i) Veterans scheduled for admission to inpatient services or who are receiving medical services will be provided outpatient dental care if the dental condition is professionally determined to be complicating a medical condition currently under treatment by VA.

Nonservice-connected veterans who are authorized outpatient dental care may be billed the applicable copayment if their income exceeds the maximum threshold.

Persian Gulf, Agent Orange and Ionizing Radiation

Registry Examination Programs

Under the auspices of VA's Persian Gulf, Agent Orange and Ionizing Radiation Registries, veterans who served in the Persian Gulf War or who claim exposure to Agent Orange or atomic radiation are provided with free, comprehensive medical examinations, including base-line laboratory tests and other tests determined necessary by an examining physician to determine current health status. Results of the examinations, which include completion of a questionnaire about the veteran's military service and exposure history, are entered into special, computerized programs maintained by VA. These databases assist VA in analyzing the types of health conditions being reported by veterans. Registry participants are advised of the results of their examinations by personal consultation. Each registry serves as an outreach mechanism which assists VA in providing participants with significant information of concern to them. Veterans wishing to participate should contact the nearest VA health-care facility to request an examination. Appointments generally can be arranged within two to three weeks.

Agent Orange, Nuclear Radiation and Environmental Contamination Treatment

VA provides priority treatment to any Vietnam-Era veteran who, while serving in Vietnam, may have been exposed to dioxin or to a toxic substance in a herbicide or defoliant used for military purposes. Priority health-care services are available for any veteran exposed to ionizing radiation from the detonation of a nuclear device in connection with nuclear tests or with the American occupation of Hiroshima and Nagasaki, Japan, during the period beginning on Sept. 11, 1945, and ending on July 1, 1946. Treatment currently is authorized through Dec. 31, 1993, for veterans exposed to Agent Orange or nuclear radiation. VA also provides priority treatment to any Persian Gulf veteran who requires treatment for a condition medically determined to be possibly related to service in the Persian Gulf area.

Beneficiary Travel

Payment or reimbursement for travel costs to receive VA medical care, called beneficiary travel payment, may be made to the following:
(a) Veterans whose service-connected disabilities are rated at 30 percent or more.
(b) Veterans who are traveling in connection with treatment Of a service-connect ed condition.
(c) Veterans who are in receipt of VA pension.
(d) Veterans traveling in connection with a compensation and pension examination.
(e) Veterans whose income is less than or equal to the maximum, base VA pension rate.
(f) Veterans whose medical condition requires use of a special mode of transportation, if the veteran is unable to defray the costs and travel is pre-authorized -- unless the medical condition is a medical emergency.

Travel is subject to a deductible of $3 for each one-way trip -- with an $18 per month cap. Two exceptions to this rule are travel for a compensation and pension examination and travel by special modes of transportation.

Counseling for Persian Gulf Veterans

Marital and family counseling is provided to veterans of the Persian Gulf War and their spouses and children. The counseling is provided at VA medical centers and vet centers.

Alcohol and Drug Dependence Treatment

Veterans without service-connected disabilities whose incomes exceed the threshold for free medical care may be authorized treatment for alcohol and drug dependence only if the veteran agrees to pay the applicable copayment. After hospitalization for alcohol or drug treatment, veterans may be eligible for outpatient care, or may be authorized to continue treatment or rehabilitation in private facilities such as halfway houses at VA expense.

Prosthetic Services

Veterans may apply for prosthetic services to treat any condition when receiving hospital, domiciliary, or nursing-home care in a VA facility. Veterans who meet the basic requirements for outpatient medical treatment may be provided needed prosthetic services if:

(1) For a service-connected disability or adjunct condition.

(2) For any medical condition for a veteran with a service-connected disability rated at 50 percent or more or for a veteran receiving compensation as a result of treatment in a VA facility.

(3) For a disability for which a veteran was discharged or released from active service.

(4) For a veteran participating in a rehabilitation program under 38 USC Chapter 31.

(5) As part of outpatient care to complete treatment of a disability for which hospital, nursing home or domiciliary care was provided.

(6) For a veteran in receipt of increased pension or allowance based on needing aid and attendance or being permanently housebound.

(7) For a veteran of World War I or the Mexican Border period.

(8) For a former prisoner of war.

Blind Aids and Services

Veterans are eligible to receive VA aids for the blind if their blindness is a service-connected disability, if they are entitled to compensation from VA for any service-connected disability, or if they are eligible for VA medical services. Veterans with best-corrected vision of 20/200 or less in the better eye or field defect of 20 degrees or less are considered to be blind. Blind veterans need not be receiving compensation or pension to be eligible for admission to a VA blind rehabilitation center or clinic, or to receive services at a VA medical center. Benefits include:
(a) A total health and benefits review by a VA Annual Visual Impairment Services Team (VIST)
(b) Adjustment to blindness training.
(c) Home improvements and structural alterations to homes (HISA Program).
(d) Specially adapted housing and adaptations.
(e) Low-vision aids and training in their use.
(f) Approved electronic and mechanical aids for the blind, and their necessary repair and replacement.
(g) Guide dogs, including the expense of training the veteran to use the dog and the cost of the dog's medical care.
(h) Talking books, tapes and Braille literature, provided from the Library of Congress. Readjustment Counseling (Vet Centers)

Veterans who served on active duty during the Vietnam Era or served in the war or conflict zones of Lebanon, Grenada, Panama and the Persian Gulf theaters during periods of hostilities or war are entitled to counseling to assist in readjusting to civilian life.

Counseling is provided by VA's Readjustment Counseling Service to help veterans resolve war-related psychological difficulties and to help them achieve a successful post-war readjustment to civilian life. Assistance includes group, individual and family counseling, community outreach and education. Vet center staff help veterans find services from VA and non-VA sources if needed. One common readjustment problem is post-traumatic stress disorder, or PTSD. This refers to such symptoms as nightmares, intrusive recollections or memories, flashbacks, anxiety or sudden reactions after exposure to traumatic conditions. Other readjustment difficulties may affect functioning in school, family or work. Counseling also is provided veterans for difficulties due to sexual assault or harassment while on active duty.

The location of the nearest vet center usually can be found in the U.S. Government section of the phone book under Department of Veterans Affairs. All vet centers are listed in the back of this booklet. In areas which are distant from vet centers or VA medical facilities, veterans may obtain readjustment counseling from private sector counselors, psychologists, social workers, or other professionals who are on contract with VA. To locate a contract provider, contact the nearest vet center.

Medical Care for Merchant Seamen

Those Merchant Marine seamen whose World War II service qualifies them for veterans' benefits must present their DD-214 discharge certificate when applying for medical care benefits at VA medical centers. VA regional offices can provide information on obtaining a certificate.

Medical Care for Allied Veterans

VA is authorized to provide reciprocal medical care to veterans of nations allied or associated with the United States during World War I or World War II. Such treatment is available at any VA medical facility but must be authorized and reimbursed by the foreign government. The VA also is authorized to provide hospitalization, outpatient and domiciliary care to former members of the armed forces of the governments of Czechoslovakia or Poland who participated during World Wars I and II in armed conflict against an enemy of the United States, if they have been citizens of the United States for at least 10 years. Benefits are the same as those provided to U.S. veterans. Medical Care for Dependents and Survivors (CHAMPVA)

The Civilian Health and Medical Program of the Department of Veterans Affairs, known as CHAMPVA, helps pay for medical services and supplies obtained from civilian sources by eligible dependents and survivors of certain veterans. The following are eligible for CHAMPVA benefits, provided they are not eligible for medical care under CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) or Medicare:

(a) The spouse or child of a veteran who has a permanent and total service-connected disability.
(b) The surviving spouse or child of a veteran who died as a result of a service-connected condition; or who at the time of death was permanently and totally disabled from a service-connected condition.
(c) The surviving spouse or child of a person who died while on active military service in the line of duty.
(d) A surviving spouse who remarries may qualify for care after the subsequent marriage is terminated.
Care under the CHAMPVA program is not normally provided in VA facilities. In December 1991, however, VA began offering CHAMPVA beneficiaries treatment in a number of VA health-care facilities. VA facilities that elect to participate may provide treatment when (1) they are equipped to provide the care and (2) use of these facilities does not interfere with care and treatment of veterans. Apply to the CHAMPVA Center, 4500 Cherry Creek Drive South, Denver, CO 80222, or call 1800-733-8387.