The information that follows is for general planning purposes; it is not exhaustive. A veteran’s health, income and the availability of care are the primary factors determining what care is provided and at what cost. Veterans should speak with the VA directly to determine final eligibility.
Definitions
VA Health Care – VA Health Care is a medical benefits program offered to all veterans who served in active duty military service and received a discharge status other than Bad Conduct or Dishonorable. One must have 24 consecutive months of service or served their full active duty period if enlisted after September 7, 1980, or became active duty after October 16, 1981. An exception is if one was discharged early due to a disability.
Priority Groups – During enrollment, each veteran is placed in a Priority Group of 1 – 8. Placement into Priority Groups is dependent on a large number of factors including: length & dates of service, discharge status, service-connected disabilities, financial assets, income and other factors. A veteran’s Priority Group determines the level of priority and care offered. For instance, veterans in Priority Group 1 are given the highest priority for enrollment. However, the availability of VA resources also plays a role in determining what care is offered.
Due to the complexity of the Priority Groups and the ever-changing availability of VA resources, it is nearly impossible for veterans to determine the long-term care services for which they qualify and the fees for those services without speaking directly with the VA on a case-by-case basis.
Qualifications
Veterans must go through a complex eligibility evaluation to receive benefits, and the eligibility rules can change based on the availability of resources. Therefore, it is important to check with the VA or a veterans’ benefits consultant about one’s eligibility.
Disabilities / Health
During enrollment in VA Health Care, veterans are assigned into different Priority Groups. A veteran’s disabilities, especially those connected to their military service, are one of the primary factors that impact into which Priority Group one is assigned. As an example, veterans assigned to Priority Group 1 must have a minimum of 50% disabling due to a service-connected disability. However, veterans are not required to have a disability to be eligible, but having a disability plays a very large role in determining which benefits a veteran receives and how much those benefits cost them.
Financial
As of March 2015 the VA no longer takes into consideration the net worth (financial assets combined with income) of veterans when considering eligibility. Now only the veteran’s household income is considered and that information is taken directly from the IRS. The income limits change annually and change based on the number of dependents and geographic location of the veteran. One can estimate their specific income threshold here. Please note, for extended care services, one’s net worth is still considered.
Veteran Service & Discharge Status
Veterans are required to have 24 months of continuous active duty military service and a discharge status other than Bad Conduct or Dishonorable to be eligible for VA Health Care. There are exceptions to the 24-month rule for:
- Reservists or National Guard members that were called to Active Duty and completed their terms.
- Veterans requiring treatment for a service-connected condition or disability
- Veterans discharged or released from active duty for a hardship or an “early out”
- Veterans that were discharged from active duty prior to September 7, 1980.
Geographic
The veteran’s geographic location does not affect eligibility directly but the maximum allowable amount of income changes depending on the county in which the veteran resides.
Personal Factors Not Affecting Eligibility
Age and marital status do not impact eligibility for VA Health Care directly, but the number of dependents one has does impact their income threshold.
General Benefit Information
VA Health Care benefits are made in the form of medical care, personal care and payments to medical providers. VA Health Care does not provide cash to veteran seniors. Benefits limits range dramatically depending on the veteran’s Priority Group. For long term care, co-pays can range from $0 – $100 / day. Veterans with a compensable service-connected disability are exempt from long-term care co-pays. Although the VA has made significant improvements in their claims processing backlog, application decisions can still take many months.
Long Term Care Benefits
Assisted Living
The VA offers assisted living care through the Community Residential Care (CRC) Program and at VA Domiciliaries. However, for the majority of veterans, the VA only pays for this program’s administration and clinical services. Care is provided at both VA facilities and at approved outside facilities. There is also specialized dementia and Alzheimer’s care programs available. Veterans should also be aware of the VA Aid and Attendance Program, which provides financial assistance to help pay for assisted living.
Skilled Nursing
VA offers skilled nursing care at VA nursing homes, State Veterans Homes and outside nursing homes when VA or State homes are not available in a location that would allow the veteran to remain close to their family. Skilled nursing home care is available under two programs. If the care is considered temporary, it is referred to as Community Living Center Care; if care is for the long term, it is called Community Nursing Home Care. Prospects must be assessed by a medical provider and determined to require inpatient nursing care and be medically stable. Payment for care varies dramatically depending on the veteran’s Priority Group.
In-Home Care
Some veterans that have been approved to receive skilled nursing care can receive that care at home through the VA’s Homemaker and Home Health Aide program. This is an attractive option for many families should they have someone at home who can provide the necessary supervisor in the absence of the VA interdisciplinary treatment team. As with all VA health care services, cost varies dramatically depending on the veteran’s priority group.
Adult Day Care
Adult day health care programs offer supervision during daytime hours when the family of the veteran is at work. This is also an attractive option as it allows the senior to remain living at home. Costs vary dramatically depending on the veteran’s priority group.
Other Options
Veterans should be aware of an alternative program that enables them to direct their own health and personal care instead of receiving care services from the VA. This program is known as the Veteran-Directed Care Program (VDC). The VA also provides the following types of care: telehealth, hospice, respite, and palliative.
Costs
There are no costs to enroll or monthly premiums. However, some veterans are responsible for co-pays.
How to Apply
Applying
Veterans can apply for VA long term senior care by completing VA Form 10-10EZ. Veterans without service-connected disabilities or with 0% service-connected disabilities will also need to complete VA Form 10-10EC. This is used to measure the veteran’s and family’s current income to determine if they will be charged co-pays for long term care. One can also apply online here.
Getting Assistance with the Application Process
The VA has a “duty to assist” applicants in the collection of supporting documents. However, veterans can greatly accelerate the process by providing these documents themselves or by working with a private veterans benefits planner. Veterans can also call the VA’s Health Benefits Service Center toll free at 877-222-VETS (8387).
