Veteran’s Administration Healthcare Benefits

The Veteran’s Administration pays for different types of care, and there are V.A. Clinics throughout the country that provide basic healthcare for veterans. According to the Department of Veterans Affairs, in order to qualify for medical assistance a veteran must have served 24 months of active duty in the Army, Navy, Air Force, Marines, Reserves or National Guard, or the full period they were ordered to active duty and have separated by Honorable Discharge. There are other criteria – so any veteran that served in active duty should apply for benefits.

The copayments for medical care provided are as follows:

Medications:               $8.00 per 30 day supply

Outpatient Clinics:      $15.00 for primary care & $50.00 for specialists

Inpatient Care:            Current year’s Medicare deductible plus $10.00 per day (this is the rate set by the VA; it doesn’t matter whether or not the veteran is eligible for Medicare).

Nursing Home:            Varies according to the veteran’s disability and ability to pay. The VA pays all charges if the veteran has a 70% service connected disability or greater.

Group Homes:             The VA has limited funds available to pay for group home placement for homeless veterans. Unless the veteran qualifies for a homeless veteran program, the VA doesn’t pay for group home placement and veterans need to pay for a group home or assisted living without assistance from the VA.

The VA limits payment for patients in a nursing home to those veterans who have a 70% or greater service-connected disability. This is a determination made only by the Veteran’s Administration.  The VA employs case managers and social workers who monitor their nursing home patients to ensure they receive the appropriate level of care – and the services are only provided in nursing homes that are contracted to provide care to Veterans.

If a patient is being discharged from a VA hospital, can’t return home and doesn’t require services covered by Medicare, the VA might possibly pay for the first few months of nursing home placement. The only reason that the VA would pay would be to give a nursing home enough time to secure a long-term payment source such as Medicaid. This doesn’t happen very often – and is only done on a case-by-case basis.

In addition to having contracts with private facilities, there are state-run Veteran’s homes in different areas of the country that accept veterans and charge a lesser amount out of pocket than if the patient had to pay privately – often around 30% of his income. Veteran’s homes aren’t always easy to find and there’s usually a long waiting list for the beds. Some families will pay the cost of moving a patient hundreds or thousands of miles away in order to secure a bed in a V.A. facility. By doing so, the patient won’t have to spend his entire life savings on nursing home placement (and the family members potentially save their inheritance).

Patients who have a VA pension will usually continue to receive the same income if they’re in a nursing home, as long as the amount they receive each month is enough to cover the nursing home room & board. If the patient’s ongoing income isn’t enough to pay the full cost of placement, it will be necessary to apply for Medicaid to pay for the cost of the care.

As mentioned previously, when Medicaid pays the patient’s room & board in a nursing home, his income (except $35.00) must be paid to the facility for his share of cost and Medicaid pays the rest – but this amount might be different if the veteran is married. If the patient has a VA annuity, it’s possible that income will continue, but will be counted toward his share of cost; a regular VA pension will be stopped and the patient’s case will be transferred to a program called Aid & Attendance (A&A). The amount the VA pays to the patient will be reduced to $90 per month; this might seem unfair, but the $90 doesn’t count toward his share of cost – so an A&A recipient keeps $90 more each month than the regular nursing home patient whose room & board is paid by the Medicaid program.

One doesn’t have to be receiving a full veteran’s pension prior to admission in order to be eligible to receive Aid & Attendance benefits. A&A is available to veterans who were honorably discharged after serving at least 90 days, one day of which must have been during active wartime, and who require assistance with their Activities of Daily Living. It is also available to the surviving spouses of deceased veterans. It’s important to note that most states require that the patient prove that an application has been submitted to the A&A program during the Medicaid application process.

Aid & Attendance is available to seniors who don’t qualify for Medicaid and are paying privately for room & board in a facility or who remain at home as long as they require assistance to remain independent. The A&A program offers up to $1632 per month to a veteran, $1,055 for the spouse of a deceased veteran, or $1,949 for a couple.

The Aid & Attendance application process isn’t difficult, although the application itself appears daunting. While it’s technically illegal to charge for assisting with Aid & Attendance benefits, companies circumvent this rule by charging for what they term “lifetime benefit assistance.” There are often brochures of these companies that assist with the process at the local senior center (and many websites offer assistance), but it doesn’t expedite the process. The VA certifies agencies to assist with A&A and investigates those who charge for assistance.  

It’s important to note that it can take several months to become approved and start receiving Aid & Attendance monies from the VA; this means that the first check received will include several months of retroactive payments. For Medicaid recipients, this amount will count toward the $2,000 allowable asset limit so it’s important to use the money to buy items (or to present receipts for items that have already been purchased) for the patient. Many people use this money to help pay for a burial plan.

For additional information about the VA healthcare or the A&A program, you can access the VA website at www.va.gov or speak with someone by calling (800) 827-1000.