Veterans' Benefits

Federal Benefits for Veterans and Dependents

There are a variety of federal benefits available to veterans and their dependents. Eligibility depends upon individual circumstances. Contact the nearest Regional Veterans Affairs Benefits Office at 800-827-1000 for information. Counselors can answer questions about benefits, eligibility and application procedures. They may also make referrals to other VA Offices and facilities, such as medical centers and national cemeteries. You may also find telephone numbers of VA Offices and facilities in the Federal Government section of your local telephone directory under “Department of Veterans Affairs.”

Veterans’ Health Care Benefits

For most veterans, entry into the VA healthcare system starts with enrollment at a local VA Medical Center. The Veteran should contact their local VA Medical Center, make an appointment to register and bring with them their discharge papers. Veterans in Delaware County are recommended to enroll at Coatesville VA Medical Center (800 290-6172 or 610 384-7711) or Philadelphia VA Medical Center (800 949-1002 or 215 823-5800). Veterans with Internet access may apply for enrollment on-line at www.VA.Gov/1010ez.htm by completing VA Form 10-10EZ, Application for Health Benefits, which can also be obtained by calling the toll-free Veterans Affairs telephone number. You must attach a copy of your discharge paperwork with VA Form 10-10EZ. A veteran must have been honorably discharged and participated in active duty (although there are no minimums required) to qualify.

Once enrolled, a veteran is eligible to receive services at VA facilities anywhere in the country. VA medical centers provide a full range of medical care including inpatient and outpatient services such as typical primary care, i.e. management of medical conditions; transitional care, i.e. nursing home placement or adult day care centers; and mental health care. Eligibility is determined by whether the veteran has been given a disability rating by the VA which is a percentage rating of “service connected”. “Service connected” means the veteran has been given a disability rating that his/her illness or condition is directly related to his/her military service. In lieu of a service connected disability rating, eligibility is determined on a case-by-case basis dependent on the veteran’s “priority group” and income. Since January 16, 2003, absent a catastrophic disability, i.e. blindness, loss of limb, quadriplegia or paraplegia, for an individual veteran to be eligible for any services his/her income can not exceed $38,200 after medical expenses. For a couple it can not exceed $43,650 after medical expenses.

A Means Test is imposed as a measure of the veteran’s family’s annual income and assets and used to determine if non-service connected and zero percent connected veterans need to make co-payments for medical care. Co-payments are charged by the VA for inpatient and outpatient medical treatment, daily charges for inpatient treatment and for medication. In some instances, some co-payments may be as low as two dollars or may be waived for certain classes of veterans.

A veteran’s supplemental health insurance policy may pay up to twenty percent (20%) of the charges. If the supplemental does not cover the VA co-payment, the veteran is responsible for the remaining amount dependent on his/her “priority group” and income. The VA is not presently authorized to bill Medicare or HMO’s. However, the VA can file claims with any other health insurance companies under which a veteran is covered. In all cases, veterans should apply for benefits under the Uniform Benefits Package because the VA’s Uniform Benefits Package emphasizes preventative and primary care.

Veterans’ Nursing Home Benefits

The VA must provide, at no cost, nursing home care at federal VA nursing homes to certain veterans with service connected injury or illness dependent on their disability rating (i.e. 70% or higher service connected disability) or if they are in need of care because of their service connected disability. The veteran keeps all income and assets and there is no estate recovery.

All other eligible veterans and their spouses may receive care, at their own cost, from a state VA nursing home. A level of service related injury or illness is not necessary, rather, a medical opinion that there is need for skilled level care is required. You must be a resident of Pennsylvania. Admission is on a first come, first served basis. There are waiting lists. Additionally, monthly payments against the maintenance fee will be required based on ability to pay. The estate of the eligible veteran is liable for the cost of care expended. Generally, this is the maintenance fee minus payments made by the veteran and the state.

Monthly payment amounts are determined by completing a VA Form 10-10EC. The VA assesses the veteran’s total income, deducts either the statutory amount of $100 or $150 for personal allowances, health insurance premiums, personal obligations and a flat fee of $540. Eighty percent of remaining income is allocated to the facility. However, a community spouse is allowed $865 per month in income. If their income is less than that, the veteran’s income is combined with it and the community spouse allotted $865. Although disclosure of all assets and transfers within the previous 2 years is required, only the veteran’s income, and not assets, is used to pay for care. There is no penalty for transfers made before admission. (A change in this rule is currently being considered.) However, a veteran may NOT transfer assets after admission, even to a spouse.

Non-Service Connected, Needs-Based Aid and Attendance Benefits

Aid and Attendance is available to a veteran (widow(er) and dependents) who is not only disabled, but also needs the aid and attendance of another person to perform acts of daily living. A veteran can receive a maximum of $1,675 per month in benefits. A widower can also receive benefits of up to $980 per month. A veteran is defined as a person who served in the active military, naval or air services and who was discharged under conditions other than dishonorable. The veteran must have ninety (90) days or more of active duty, one (1) day of which was during wartime. The applicant must be found to be “permanently and totally disabled.” The VA will generally accept a letter from the applicant’s personal doctor as to the disability. The applicant needs only to show that he or she is in need of aid and attendance on a regular basis. A patient in an assisted living facility is presumed to be in need of aid and attendance. The VA will generally deny an application if the net worth of the individual is $80,000 or more. This is not a hard and fast rule. The home is not counted. There is no penalty period for transfers of assets prior to admission. The VA simply asks for the net worth of the applicant on the date of the application and does not inquire about previous transfers. The applicant must also have countable income below the maximum annual pension rate, currently, $1,675 per month. Countable income is all income of any kind attributable to the veteran. In computing the income, certain items can be deducted. These include unreimbursed medical expenses, such as doctor and dentist fees, glasses, Medicare deductibles and co-payments, prescriptions, transportation to doctors, therapy, health insurance and funeral expenses. The costs of an assisted living facility or in-home aid are also deductible.

In determining income for Medicaid eligibility, aid and attendance benefits are specifically excluded. After Medicaid eligibility, if the veteran resides in a nursing home, the aid and attendance benefit is reduced to $90 payable directly to the veteran.

Aid and attendance benefits are an excellent source of income for those who are in financial need and have disabilities making living outside of a nursing home more and more difficult.

Additional Prescription Benefits for Members of the Uniformed Services

There are additional pharmacy programs providing pharmacy benefits available in the United States to older Americans who are registered in the Defense Enrollment Eligibility Reporting System, were in the Uniformed Services and are age 65 and over. Eligible beneficiaries must be enrolled in Medicare Part B in order to use mail-order and retail pharmacy benefits which may be available to them. Beneficiaries may also continue to use military hospitals and clinical pharmacies, but additionally, may be eligible for benefits to obtain low cost prescription medications. The providers of low cost prescriptions are the National Mail Order Pharmacy (NMOP) and Tricare Network and non-network civilian pharmacies. Initial registration forms can be obtained by calling NMOP toll-free at 800-903-4680. In addition, you must ensure that the Defense Enrollment Eligibility Reporting System has your current address by contacting them at 800-538-9552. For more information, the toll-free Tricare Information Service at 877-DOD-MEDS (1-877-363-6337) can be contacted.

Additional Information

For additional information, one may call for local information at the Delaware County Veterans Affairs Department at 610-891-4646. There may be a number of available benefits including money, medical treatment and burial to service persons and their families depending on the specifics of the service person’s background.

In addition, there are a variety of guidebooks available that provide complete, user-friendly information and are available for purchase on Amazon.com. Veterans’ Benefits, The Complete Guide, by Keith Snyder is a good resource although its last edition was printed in 1994. Veterans’ Benefits: A Guide to State Programs, received a five-star customer rating.