Should a veteran choose Medicare or veterans medical benefits?
If you're caring for a veteran, it's well worth looking into veterans medical benefits. While Medicare is a tremendously effective program, it still leaves up to half of an older adult's healthcare costs unpaid. It doesn't cover some services and supplies, and its deductibles and co-payments are hefty. For eligible veterans, however, veterans medical benefits can be one way to cover these unpaid expenses.
A veteran eligible for care can receive it from any V.A. doctor or facility, but not all V.A. healthcare benefits are available to all veterans. The V.A. maintains a priority system, with the most benefits going to those with the greatest health or financial need.
Why a veteran might opt for V.A. healthcare over Medicare coverage
With V.A. healthcare, your friend or relative might receive a number of healthcare-related services that Medicare doesn't cover, including:
- Physical exams and other preventive care.
- Dental care.
- Long-term in-home care.
- Long-term nursing home residential care.
Another reason to choose V.A. care over Medicare-covered care can be cost. V.A. co-payments and deductibles are generally lower than Medicare's, including for prescription drugs.
Some veterans qualify for both
Even if he's also enrolled in Medicare, your family member may qualify for the wide range of free or low-cost healthcare benefits provided by the Department of Veterans Affairs (V.A.). The V.A. provides healthcare through its own hospitals, clinics, nursing homes, pharmacies, and doctors nationwide.
Who qualifies for veterans medical benefits, and how do you apply?
Who qualifies for veterans medical benefits can be complex, so the older adult you're caring for may need your help and encouragement throughout the application process.
Veterans medical benefits are determined by a priority system.
Anyone who served on active duty in the military may be eligible for at least some V.A. healthcare benefits. Someone who was in the reserves or National Guard may also qualify if he was called up for active duty.
But the V.A. health system can't provide full care for all veterans. So the V.A. has set up a complicated priority system to determine veterans' benefits and out-of-pocket costs. The system divides veterans into eight groups, with the highest-priority groups eligible for the most services at the lowest costs.
The priority groups are based on service-connected disability, other disability, and income. Veterans with severe service-connected disabilities get the broadest coverage; veterans with less severe service-connected disabilities, or other disabilities combined with low income, are given midlevel priority; veterans without disability or low income get the least V.A. care.
How to apply for veterans medical benefits
Before you can find out what veterans medical benefits an older adult might be eligible for, he has to formally enroll with the V.A. The V.A. will then decide what priority group the veteran will be placed in and therefore which healthcare services he can obtain. Enrollment is free.
You can help your veteran apply by obtaining an Application for Health Benefits form (V.A. Form 10-10EZ), available online. Or you can call the V.A. toll-free at 877-222-8387 and ask for a form to be mailed. To learn more about eligibility for veterans medical benefits, visit the healthcare pages on the V.A. website.
My dad has both Medicare and VA benefits,as well as a Medicare supplement through his state retirement. He does have a VA clinic right up from his house where he sees the doctor as his primary for his preventative care;however, when he fell back in the spring and needed to see one on an emergency, that wasn't so easy; if not for a cancellation, I was told at the time he would not be able to see his VA doctor - and further was told he needed to still have an outside primary doctor - he had not seen one of those for 5 years from before they built the VA clinic close to him. However, I was also told later that rule has been changed, or at least was in process being phased in clinic by clinc, so that might be something you'd want to check into. In our case, his regular appointment was in just in a few days, but he was supposed to follow up with his dr. the next day after going to the ER the next day after his fall, which he didn't understand but he woke up that morning with severe pain in his neck and not being able to turn it; his solution was to go to the chiropractor who then wouldn't see him without a medical clearance so that's why we were trying to get him in to see his VA dr. However, he still wouldn't give him one without the X-ray results from the local ER, which is understandable. But that's where things get sticky. They were supposed to request them, which either wasn't done or it wasn't received or they weren't sent; either way by the time I got there to take him back for his scheduled appt. they still didn't have them and didn't even realize it or that this appt. was even connected to his previous visit and involved this neck pain until I pointed all this out and that the doctor was going to want to see those results when he saw him, or at least was going to need to, which even though they didn't agree, was right, but I at least was able to get them - finally when I got a nurse involved and not just the front office - faxed over and put in his chart for when he saw the doctor. But what really helped all this along was the fact that his head wound he received from the fall abscessed and ruptured while we were dealing with all of this; that got them going! It also enabled the doctor to order him for wound care treatment at the wound center at the local hospital. I know this is long but part of why I'm saying all this is that had that not happened he would not have been able to get that care locally; they would have required him to go to the VA Wound Care Center, which in his case is 2 hrs. away, at least for them to pay for it. Now, in his case, of course he has Medicare, but as has been pointed out that in itself would not have paid for all of it; as I said also in his he does have a supplement, but as has also been said and I didn't realize, there are a number of people who do not, since they have to pay for it. In his case, that is one of the responsible things my dad did; he went to work for the state mainly for these types of benefits, which are paying off now. Anyway, point being, as has been said VA Healthcare is not insurance; you have to do it the way they say; he had to go to Wound Care starting out 3x/wk.; that would have been a pain to travel 2 hours to do that, even if, as in his case, they would pay and they do also provide transportation, but he was in no shape to do that, but no he wasn't bedridden, at least not after he started getting the care, which they told me was the criteria otherwise to not have to make the trip and get the care locally, if that rupture hadn't happened in the clinic, enabling him to get it that way on an emergency basis. There is more but this has gotten long; I may do it later; overall VA has been good but we'd never had an emergency before, so this was somewhat of an experience. Just something to think about
spell out the priority system in more detail, who gets graded how?
Can a wife file for benefits on line? My husband is a WWII vet housed in a center in Norman Oklahoma. I am in Italy on a Mission, I would like to have base access to medicine.
I was in an accident with the recruiter,when i was going to spend the night at the hotel and be sword in the next day. After that the army didn't want me, but I was hurt with the recuiter,I have suffer 5-bulging disc in my back I'm in pain all day long. I recently had surgery on my back to relieve some of the pain. I haven't been compensated by no one. What can I do ?
we would have never known about VA benefits for my inlaws (ages late 80's) if not for an assisted living coordinator inquiring if my father in law had served in the military - he served overseas in WWII. However, my father in law would have never ever been able to fill out, let alone, comprehend how to handle ALL the intricate paperwork required by the government for such benefits. If not for my husband's diligence in pursuing the massive paperwork and phone calls, it is easy to see how the "red tape" of working through anything government related, would make one throw up their hands and say "it's not worth the hassle". I know that if left on his own, my 87 year old father in law would have never been able to do any of this on his own.
dUE CARE MUST BE EXERCISED IN MAKING STATEMENTS. dENTAL CARE FOR s/c DENTAL INJURYS OR 100% DISABLED s/c (S/C SERVICE CONNECTED) MEDICAL CARE CAN BE SOME DISTANCE FROM THE VETERAN AND BE ADVISED YOU NEED TO USE THEIR FACILITIES - mEDICARE IS A INSURANCE PLAN / v.a. IS A HEALTHCARE PROGRAM -NOT INSURANCE.
Hi r=rock, Thank you very much for your comment. Here are a few Ask & Answer pages that you may find helpful: ( http://www.caring.com/questions/va-and-medicare ) and ( http://www.caring.com/questions/va-coverage-with-medicare ). In additon, if you would like to post your own Ask & Answer page, you can do so here: ( http://www.caring.com/ask ). Take care -- Emily | Community Manager
I have the same question as Harristv. I know my husband is eligible for both and Im tryng to find out if Va would be better alone. thanks
examples of eligibility and non-eligibility
Hi harristv. Thanks for your question. We have a couple Ask & Answer conversations on this topic. They are ( http://www.caring.com/questions/va-and-medicare ) and ( http://www.caring.com/questions/va-coverage-with-medicare ). I hope they help! Take care, Jeff | Caring.com Community Team
Is a veteran eligible for VA benefits and medicare? How does one find out if they are eligible for both.
Hi dolo, Thank you for your question. You can find an online version on the VA Form-10-10EZ, here: ( https://www.1010ez.med.va.gov/sec/vha/1010ez/ ). I hope that helps! Take care -- Emily | Community Manager
Where online can I get VAForm-10-10EZ??
Can a veteran who now has Cancer be elgible for V A medical benefits.
I was married for 17 years before my divorced. My ex remarried.I would like to know if I'm eligible for any medical coverage(EYE DOCTOR&DENTIST) benefits.I never remarried.
Thank you for this link! It is getting me going on inquiries.