Every VA medical center has a team ready to welcome OEF/OIF/OND Servicemembers and to help coordinate their care.
Special Eligibility and Coordination of Care for Combat Veterans
Serving in Combat Theater After 11/11/1998–
Returning Servicemembers (OEF/OIF/OND)
VA is ready to provide health care and other medical services to our nation’s returning OEF/OIF/OND Servicemembers. Every VA medical center has a team ready to welcome OEF/OIF/OND Servicemembers and to help coordinate their care. For more information about the various programs available for recent returning service members, log on to the Returning Servicemembers web site at http://www.oefoif.va.gov/VA_Help.asp.
Veterans who served in a theater of combat operations also have special eligibility for VA health care. Under the “Combat Veteran” authority VA provides cost-free health care services and nursing home care for conditions possibly related to military service and enrollment in Priority Group 6 or higher for 5 years from the date of discharge or release from active duty, unless eligible for enrollment in a higher priority group to:
Combat Veterans who enroll with VA under this enhanced Combat Veteran authority will continue to be enrolled even after their enhanced eligibility period ends, although they may be shifted to Priority Group 7 or 8, depending on their income level, and required to make applicable copays. Additionally, for care not related to combat service, copays may be required depending on their financial assessment and other special eligibility factors.
NOTE: The 5-year enrollment period applicable to these Veterans begins on the discharge or separation date of the service member from active duty military service, or in the case of multiple call-ups, the most recent discharge date.
Financial Assessment (Means Testing) and Income Thresholds
While many Veterans qualify for enrollment and cost-free health care services based on a compensable service- connected condition or other qualifying factors, certain Veterans will be asked to complete a financial assessment, or means test as part of their initial enrollment application process to determine their eligibility for cost-free medications and travel benefits. Otherwise known as the Means Test, this financial information may be used to determine the applicant’s enrollment priority group (see Enrollment Priority Groups section on page 19) and whether he/she is eligible for cost-free VA health care. Higher-income Veterans may be required to share in the expense of their care by paying copays (Refer to the Copay section of this booklet on page 21).
Veterans who are already enrolled may submit their subsequent annual means test or at anytime their income or demographic information changes using the automated Online 10-10EZR, Health Benefits Renewal Form, (see information on page 10).
Income threshold information can be found online at: http://www.va.gov/healthbenefits/cost/income_thresholds.asp or you may contact the Enrollment Coordinator at your local medical facility.
Due to VA’s restricting enrollment of Priority Groups 8e and 8g, Veterans applying for enrollment who do not have any other special eligibility qualifying factors and decline to provide financial information, may not be accepted for enrollment.
Geographically-Based Copays
Recognizing the cost of living can vary significantly from one geographic area to another, Congress added income thresholds based on geographic locations to the existing VA national income thresholds (www.va.gov/ healthbenefits/cost/income_thresholds.asp) for financial assessment purposes. This assists lower-income Veterans who live in high-cost areas by providing an enhanced enrollment priority and reducing the amount of their required inpatient copay.
Geographically-based copay reductions apply ONLY to INPATIENT SERVICES. Outpatient services, long-term care, as well as medication copays are NOT affected by this provision.
Congress added income thresholds based on geographic locations to the existing VA national income thresholds for financial assessment purposes.
Catastrophically Disabled
To be considered catastrophically disabled, Veterans must have a severely disabling injury, disorder or disease that permanently compromises their ability to carry out the activities of daily living. The disability must be of such a degree that Veterans require personal or mechanical assistance to leave home or bed, or require constant supervision to avoid physical harm to themselves or others. Veterans may request a catastrophic disability evaluation by contacting the Enrollment Coordinator at their local VA health care facility. VA will make every effort to schedule an evaluation within 30 days of the request and there is no charge for the Catastrophic Disability evaluation. Veterans determined by a VA provider to be catastrophically disabled will be upgraded to Priority Group 4 i