VA Health Care System for veterans

Silver Tips is written by the Senior Citizens’ Law Office in Albuquerque.

All veterans are now entitled to obtain services from the US Department of Veterans Affairs' health care program, the VA Health Care System. A broad range of services is

available, and co-payments for some types of services-in particular for prescription drugs-are quite low. In addition, many veterans can be exempt from co-payments.

The VA Health Care System serves military veterans who were honorably discharged.

Except in extremely limited situations, services are available only to the veteran. In order to obtain services from the system, and to seek exemption from co-payments, the veteran must fill out an application form and enroll.

The VA Health Care System provides a uniform, comprehensive range of inpatient and outpatient services, including prescription drugs. In New Mexico, the largest provider of care is the VA Medical Center in Albuquerque. However, services can also be obtained at VA health care clinics in 14 other New Mexico cities, as well as from branches of the Health Centers of Northern New Mexico.

Different, uniform co-payments for each of three types of services are: inpatient services (e.g., hospitalizations), outpatient services (e.g., doctor and clinic visits), and prescription drugs. The veteran must pay these co-payments, unless the veteran is exempt from co-payments, the veteran has insurance, which covers them, or the veteran qualifies for a special, individualized waiver based upon severe financial hardship.

Co-payments for inpatient services are similar in amount to those under Medicare. The outpatient services co-payment is currently just under $51. In the case of prescription drugs, co-payments are only $2 for a 30-day (or less) supply! At a time when more and more people are finding it hard to meet the costs of prescription drugs, that coverage is extremely valuable, whether or not the veteran is exempt from the co-payment.

Several groups of veterans are exempted from some or all co-payments. Numerous groups are exempt from the inpatient and outpatient services co-payments. These include: veterans with service-connected disability ratings of 10% or greater, former POWs, Purple Heart recipients, and veterans with family incomes and assets below specified levels (mentioned below). A more limited number of groups-including veterans with service connected disability ratings of 50% or greater, and veterans with family incomes below those levels-also are exempt from the prescription drug co-payment.

If a veteran is not already a patient in the VA Health Care System, he or she must enroll to obtain services. This is done by submitting a completed Application for Health Benefits, called the VA10-10EZ. The application is also used as an application for exemption from co-payments. If the exemption application is based on family income and assets, the veteran's prior year family income and assets are used. Certain non-reimbursed medical expenses, burial and funeral expenses for immediate family members, and the veteran's own payments for college or vocational education, are deducted from income in determining eligibility.

Financial eligibility limits are substantially higher than those of other benefit programs. In 2001, the limit is $23,688 for a veteran with no dependents, and $28,429 for veterans with two dependents. The levels increase for each additional dependent, and eligibility limits increase each year.

Applications for enrollment in the VA Health Care System can be made at the VA Medical Center in Albuquerque and at VA clinics in different parts of the state.

For more information, including questions about qualifications, call the VA and ask for the Eligibility and Benefits Office (505) 256-2741, (505) 265-1711, or (800) 465-8262. Additional information can also be obtained from the New Mexico Aging and Long-Term Services Department's Health Insurance and Benefits Assistance Corps, toll-free statewide at 1800-432-2080.