Medical Care Fact Sheet
Recent Laws passed by Congress made several changes in veterans' eligibility for VA medical care to ensure care is provided to service-connected veterans and to lower income veterans. Those nonservice-connected veterans with higher income will be provided VA medical care on a space and resource available basis and will be charged a co-payment for their care.
There are now seven Priority Groups for VA health care. Priority Groups eligible for cost-free VA medical care are as follows:
Group 1 - Veterans with service-connected conditions rated 50% or more disabling.
Group 2 - Veterans with service-connected conditions rated 30% or 40% disabling.
Group 3 - Veterans who are former POWs, Veterans with service-connected conditions rated 10% or 20% disabling, Veterans discharged from active duty for compensable conditions, and Veterans awarded special eligibility classification (3 8 USC,Sct 115 1).
Group 4 - Veterans who are receiving aid and attendance or housebound benefits and Veterans who have been determined by VA to be catastrophically disabled.
Group 5 - Nonservice-connected veterans and service-connected veterans rated 0% disabled, whose income and net worth are below the established dollar thresholds which is an income of $22,887 or less if single with -no dependents or $27,468 if married with one dependent, plus $1,532 for each additional dependent. Total net worth (prior year's income plus assets) cannot exceed $50,000.
Group 6 - All other eligible veterans who are not required to make co-payments for their care including: World War I and Mexican Border War Veterans, Veterans receiving care for exposure to toxic substance or environment hazards while in the service, and Compensable zero percent service-connected veterans.
There is a $2.00 Prescription co-payment for a 30-day supply of prescription and over- the-counter medication. You are not charged a medication co-payment for medical supplies such as syringes.
The following Priority Group requires a co-payment for VA medical care:
Group 7 - Nonservice-connected veterans and noncompensable 0% service-connected veterans with income and net worth above the statutory threshold and who agree to pay specified co-payments. Prior year income is above $22,887 if single with no dependents or $27,468 or single with one dependent, plus $1,532 for each additional dependent. Out of pocket medical expenses including medical insurance premiums (prior year) can be deducted.
The co-payment for outpatient treatment is $50.80 for each outpatient visit. In addition there is a $2.00 prescription co-payment for a 30-day supply of prescription and over-the- counter medication, You are not charged a medication co-payment for medical supplies such as syringes.
Service-connected veterans rated 50% or more and veterans in receipt of a VA pension are exempt from the $2.00 medication co-payment for each 30-day supply of medication provided on an outpatient basis.
Legislation is in process for Persian Gulf veterans to be exempt from means testing if their treatment is for a condition which may be related to oily contaminants. Until this legislation is passed, these types of veterans will be means tested but no co-payment will be charged.
If inpatient hospital care or nursing home care is necessary, you must agree to pay a deductible amount for your care equal to what you would have to pay under Medicare.
The Medicare deductible currently is $776 and is adjusted annually. You will be charged a co-payment equal to the Medicare deductible, currently $776 for the first 90 days of care during any 365 - day period. For each additional 90 days of hospital care, you will pay half the Medicare deductible. For each 90'days of nursing home care, you will pay the Medicare deductible. You will be personally responsible for these charges.
In addition to the above co-payment, you will be charged a fee of $10 per day for inpatient hospital care, and $5 per day for nursing home care.
The term service-connected refers to a VA decision that your illness or injury was incurred in or aggravated by military service.
HOW INCOME IS ASSESSED
Your total income and net worth under the means testing, included Social Security; US Civil Service retirement; US Railroad retirement; military retirement; unemployment insurance; any other retirement; total wages from all employers; interest, dividends and annuities; 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, IRA's, cash, etc. is also used. Your primary residence and personal property, however, are excluded. You will
not be required to provide proof of income or net worth beyond filling out form VA Form 10- 1 OF (Financial Worksheet) at the time you apply for care; however, VA has the authority to verify the veteran's self-reported income against records maintained by the Social Security Administration and the Internal Revenue Service.