Reviewing VA's Medical Benefits Package
Public Law calls for VA to provide you hospital care and outpatient care services that are defined as “needed.” VA defines “needed” as care or service that will promote, preserve, and restore health. This includes treatment, procedures, supplies, or services. This decision of need will be based on the judgment of your health care provider and in accordance with generally accepted standards of clinical practice.
The following three categories contain a list of health care services that are provided under the Medical Benefits Package, a list of some that are not covered by VA, and a list of other services that are provided under special authority.
• Outpatient medical, surgical, and mental health care, including care for substance abuse.
• Inpatient hospital, medical, surgical, and mental health care, including care for substance abuse.
• Prescription drugs, including over-the-counter drugs and medical and surgical supplies available under the VA national formulary system.
• Emergency care in VA facilities.
• Emergency care in non-VA facilities in certain conditions: This benefit is a safety net for veterans requiring emergency care for a service-connected disability or enrolled veterans who have no other means of paying a private facility emergency bill. If another health insurance provider pays all or part of a bill, VA cannot provide any reimbursement. To qualify for payment or reimbursement for non-VA emergency care service for a service-connected disability, you must meet all of the following criteria:
- You were provided care in a hospital emergency department or similar emergency care facility
- You are enrolled in the VA health care system
- You have been provided care by a VA health care provider within the last 24 months.
- You are financially liable to the provider of the emergency treatment for that treatment.
- You have no other form of health care insurance.
- You do not have coverage under Medicare, Medicaid, or a state program.
- You do not have coverage under any other VA programs.
You have no other contractual or legal recourse against a third party that will pay all or part of the bill.
- Department of Veterans Affairs or other federal facilities were not feasibly available at the time of the emergency.
The care must have been rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health.
• Bereavement counseling.
• Comprehensive rehabilitative services other than vocational services.
• Consultation, professional counseling, training, and mental health services for the members of the immediate family or legal guardian of the veteran.
• Durable medical equipment and prosthetic and orthotic devices, including eyeglasses and hearing aids.
• Reconstructive (plastic) surgery required as a result of a disease or trauma but not including cosmetic surgery that is not medically necessary.
• Respite, hospice, and palliative care.
• Payment of travel and travel expenses for eligible veterans.
• Pregnancy and delivery service, to the extent authorized by law.
• Completion of forms.
Aid and Attendance and Housebound
Veterans and survivors who are eligible for a VA pension and require the aid and attendance of another person, or are housebound, may be eligible for additional monetary payment. These benefits are paid in addition to monthly pension, and they are not paid without eligibility to pension.
Since Aid and Attendance and Housebound allowances increase the pension amount, people who are not eligible for a basic pension due to excessive income may be eligible for a pension at these increased rates. A veteran or surviving spouse may not receive Aid and Attendance benefits and Housebound benefits at the same time.
Aid & Attendance (A&A). The Aid & Attendance increased monthly pension amount may be added to your monthly pension amount if you meet one of the following conditions:
• You require the aid of another person in order to perform personal functions required in everyday living, such as bathing, feeding, dressing, attending to the wants of nature, adjusting prosthetic devices, or protecting yourself from the hazards of your daily environment
• You are bedridden, in that your disability or disabilities requires that you remain in bed apart from any prescribed course of convalescence or treatment
• You are a patient in a nursing home due to mental or physical incapacity
• Your eyesight is limited to a corrected 5/200 visual acuity or less in both eyes; or concentric contraction of the visual field to 5 degrees or less
Housebound. This increased monthly pension amount may be added to your monthly pension amount when you are substantially confined to your immediate premises because of permanent disability.
How to apply. You may apply for Aid and Attendance or Housebound benefits by writing to the Pension Management Center (PMC) that serves your state, which is listed at http://www.benefits.va.gov/PENSION/resources-contact.asp
You may also visit your regional benefit office to file your request. You can locate your regional benefit office using the VA Facility Locator at http://www.va.gov/directory/guide/state.asp?state=AK&dnum=3. Sources for this article come from Military.com and from the VA website.
Mike Dryden is a retired Army Major and current Older Persons Action Group, Inc. board member.