Healthcare/Medical Benefits Package

General Information About the Medical Benefits Package

This is a standard health benefits plan that is available to all enrolled veterans. It includes preventive and primary care, as well as prescription drugs. As of January 17, 2003, enrollment was limited by the Secretary of Veterans Affairs to allow the VA hospitals to catch up on their patient workload. Priority Group 8 veterans are not being accepted for enrollment. Currently enrollment is based on service-connection and/or household income. This program offers full spectrum healthcare and prescriptions for veterans at their local VA Medical Centers and Clinics. There is a limited co-pay, and for many veterans with reduced income, there is no co-pay. This program does not provide healthcare for veteran’s dependents or survivors.

Do I have to enroll to receive health care?
Normally, yes. You are NOT required to apply for enrollment if you fall into one of the following categories:

• VA has rated you as 50% or more service-connected;
• Less than one year has passed since you were discharged from military service for a disability that the military determined was incurred or aggravated in the line of duty, but VA has not yet rated; OR
• You are seeking care from VA for a service-connected disability only (even if the rating is only 0%).

How do I apply?
You can apply for VA health care by completing VA Form 10-10EZ, Application for Health Benefits. The 10-10EZ may be obtained by visiting, calling, or writing any VA health care facility or veterans service office. You can also call toll-free 1-877-222-VETS (1-877-222-8387).

Enrollment is an ongoing process. You can apply for enrollment at any VA health care facility. An important aspect of enrollment is for you to identify which VA health care facility you choose as your preferred facility.

The preferred facility is where you receive your primary care. If for any reason a selected facility is unable to provide the health care needed by an enrolled veteran, then that facility will make arrangements for referral to another VA health care facility or to one of VA’s private sector affiliates to provide the required care.

How long will I remain enrolled?
Once enrolled, most veterans will remain enrolled from year to year without further action on their part. You may choose not to be re-enrolled, or changes in VA available resources may reduce the number of priority groups VA can enroll in a given fiscal year. VA will announce any enrollment changes and then assure that they are widely publicized.

Will I have to pay a co-pay?
Most nonservice-connected veterans and noncompensable 0% service-connected veterans are required to complete an annual means test or to agree to pay VA the applicable co-payment. The means test is based on their family’s income and net worth. Some veterans are required to make co-payments for their care and medications. There are four basic types of charges:

• Medication – Prescription co-payment charges were established by Congress. The charge is $8 for each 30 day or less supply of medications provided on an outpatient basis for nonservice-connected conditions.
• Outpatient – The co-payments will be based on primary care visits ($15) and specialty care visits ($50).
• Inpatient – Congress determined the appropriate inpatient co-payment should be the current inpatient Medicare Deductible Rate for the first 90 days that you remain in the hospital plus a per diem charge.
• Long Term Care – VA charges for Long Term Care Services vary by type of service provided and the individual veterans ability to pay.

For more information on the current co-payment rates, visit the VA website.

What are the priority groups?
Once you apply for enrollment, your eligibility will be verified. Based on your specific eligibility status, you will be assigned a priority group. The priority groups are as follows, ranging from 1-8 with 1 being the highest priority for enrollment. Under the Medical Benefits Package, the same services are generally available to all enrolled veterans. As of January 17, 2003, VA is not accepting new Priority Group 8 veterans for enrollment (veterans falling into Priority Groups 8e and 8g.)

• Priority Group 1
  • Veterans with service-connected disabilities rated 50% or more disabling
• Priority Group 2
  • Veterans with service-connected disabilities rated 30% or 40% disabling
• Priority Group 3
  • Veterans who are former POWs
  • Veterans awarded the Purple Heart
  • Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty
  • Veterans with service-connected disabilities rated 10% or 20% disabling
  • Veterans awarded special eligibility classification under Title 38, U.S.C., Section 1151, "benefits for individuals disabled by treatment or vocational rehabilitation"
• Priority Group 4
  • Veterans who are receiving aid and attendance or housebound benefits
  • Veterans who have been determined by VA to be catastrophically disabled
• Priority Group 5
  • Nonservice-connected veterans and noncompensable service-connected veterans rated 0% disabled whose annual income and net worth are below the established VA Means Test thresholds
  • Veterans receiving VA pension benefits
  • Veterans eligible for Medicaid benefits
• Priority Group 6
  • Compensable 0% service-connected veterans
  • World War I veterans
  • Mexican Border War veterans
  • Veterans solely seeking care for disorders associated with:
    1. exposure to herbicides while serving in Vietnam; or
    2. exposure to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki; or
    3. for disorders associated with service in the Gulf War; or
    4. for any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998.
• Priority Group 7
  Veterans who agree to pay specified co-payments with income and/or net worth above the VA Means Test threshold and income below the HUD geographic index
  • Subpriority a: Noncompensable 0% service-connected veterans who were enrolled in the VA Health Care System on a specified date and who have remained enrolled since that date
  • Subpriority c: Nonservice-connected veterans who were enrolled in the VA Health Care System on a specified date and who have remained enrolled since that date
  • Subpriority e: Noncompensable 0% service-connected veterans not included in Subpriority a above
  • Subpriority g: Nonservice-connected veterans not included in Subpriority c above
• Priority Group 8
  Veterans who agree to pay specified co-payments with income and/or net worth above the VA Means Test threshold and the HUD geographic index
  • Subpriority a: Noncompensable 0% service-connected veterans enrolled as of January 16, 2003 and who have remained enrolled since that date
  • Subpriority c: Nonservice-connected veterans enrolled as of January 16, 2003 and who have remained enrolled since that date
  • Subpriority e: Noncompensable 0% service-connected veterans applying for enrollment after January 16, 2003
  • Subpriority g: Nonservice-connected veterans applying for enrollment after January 16, 2003

Where can I get more information?
You can visit the VA website or call toll-free 1-877-222-VETS (1-877-222-8387).

Your CVSO can assist you in obtaining relevant documents and submitting your claim to the appropriate VA regional office. Please contact us so that we may offer our assistance and guidance.