Finding more benefits

Most Veterans do not realize they qualify for a substantial amount of aid for their rising health care costs

 1.Veterans Benefits.  Important!  See an update here!  Most veterans and the widows or widowers (but not divorced spouses) of veterans (if the veteran served at least 90 days, at least one day of which was during a time period that is officially considered “war time”) are eligible for “aid and attendance” benefits once they have significant expenses for nursing home, assisted living, or home care.  The “war time” periods are as follows:

  • World War II                               12/07/1941 – 12/31/1946
  • Korean Conflict                           06/27/1950 – 01/31/1955
  • Viet Nam Conflict                        08/05/1964 – 05/07/1975
  • Gulf War                                         08/02/1990 – Present[1]

Resources or assets other than the home must generally be less than $80,000.  Because the asset limit is not stated in the law, VA is allowed to consider many factors in determining whether the veteran actually “needs” the aids and attendance benefit.  For example, cases are becoming all too common in which a veteran with barely more than $30,000 is denied benefits based on a VA determination that he or she has a very short life expectancy and should therefore not run out of money!

If the veteran passes this vague assets test, the benefit payments are generally computed by subtracting what is left of the income of the client and his or her spouse after the payment of medical expenses (including long-term care) from the following maximum monthly benefit rates (2015 figures):

Single veteran – $1788;  Married veteran – $2120;  Widow of veteran – $1149

These amounts are higher by $332 for each additional dependent if the veteran has more than one dependent.  If the client is not married and has no dependents and also qualifies for nursing home Medicaid, then the VA “aid and attendance” benefit will be reduced to $90 per month.  The benefit is NOT reduced if the veteran has a spouse or other dependent.

If the spouse of a living veteran needs long-term care, but the veteran does not, then no VA “aid and attendance” benefits are provided.  If you think that the client may be eligible for VA “aid and attendance” benefits, insist that contact be made with the local Department of Veterans Affairs, whose staff will assist with applications for federal VA benefits.

Another option to consider is long-term care through the Veterans Administration federal and state programs.  Public Law 106-117, The Veterans’ Millennium Health Care and Benefits Act, codified at 38 U.S.C. 1710(A), mandates that the VA provide nursing home care for  veterans in federal VA nursing facilities who need nursing home care for a service connected disability, have a 60% service-connected disability and are unemployable, have a 60% service-connected disability and are permanently and totally disabled, or need nursing home care for any condition (whether service-connected or not) if the veteran has a combined service-connected disability of 70% or more.  When no room is available in a federal VA facility, the VA must contract with private entities to provide the care needed by the eligible veteran.

To qualify for admission, the veteran must have been honorably discharged from at least 90 days of military service, at least one day of which was during a time of war, must need the level of care as defined by the VA, and must have been a resident of the state in which the VA home admission is sought during the immediately preceding 12 months.  If the veteran does not have war-time service, he or she may still be admitted on a space available basis.  This is a highly affordable option for long-term care.

OTHER MILITARY BENEFITS

Retirement benefits

TriCare for Life

VA as pharmacy

Service connection

[1]   Even though troops have left Iraq, there are still hostilities in Afghanistan.  Nevertheless, the author was unable to locate definitive guidance on the end of hostilities for this purpose.

2. Medicare Savings Plans (MSP): For beneficiaries with low income, there are a number of “Medicare Savings Programs” (not to be confused with Medicare Advantage Programs), that will pay for up to 100% of the shortfall or “gaps” in Medicare, depending upon income.  Those qualifying for one of these programs or for full Medicaid benefits are often referred to as “Dual Eligibles.”  Medicare Savings Plans are administerered through Social Security and the local Medicaid agency and generally offer 3 programs, although other state specific programs may be available as well. They are:

A. QMB: Qualified Medicare Beneficiary program. This is a great program that gives a person who is making below 100% of the Federal Poverty Limit (FPL) several important benefits.  First, the program pays the Medicare premium, so this year, the annual savings of having QMB, just for that portion, is over $ 1,200.00.  Next, the program gives Medicaid health coverage as a supplement to the Medicare, meaning that the low income beneficiary does not have to participate in cost-sharing and will only have to contribute very nominal amounts for services or drugs.  Third, the prescription drug card is free, so long as it is one of the cards that is at or below the average cost of $ 30.00 per month.  There are no premiums, copays, coinsurance, deductibles and prescriptions will be $ 2.55 to $ 6.35.    To qualify, the beneficiary must have income of less than $ 1001.00 if single and $ 1,348.00 if married, and some states also limit the assets of the recipient.  Those limits are $ 7,160.00 if single, $ 10,750.00 if married. Alabama does not limit resources. When calculating income for these programs, be sure to disregard the first twenty dollars of income for everyone and the first $ 65.00 and half of all remaining earned income.

B. SLMB:  Special Medicare Low Income Beneficiary program.  Qualification for those who make a bit to much to qualify for QMB but still make less than 120% of the FPL.  The main benefits of this program are the payment of the Medicare premium and the free drug card, both the same terms as described above for QMB.  What SLMB does not provide is additional help with health care costs.  Those users need either a Medigap policy or a Medicare Advantage plan under Part C to assist with the costs of healthcare.  For 2014, the monthly income limits are $ 1,197.00 for an individual and $ 1,613.00 for a married couple.  As with QMB, the resource limits may apply, as well as the income disregards.  (See above).

C. QI-1 is the Qualified Individual Program. This program is similar to the benefits of SLMB, but permit income up to 135% of FPL.  The QMB and SLMB programs are available anytime, but the QI-1 program may not be available.   Income limits for 2015 are $ 1,345.00 for an individual and $ 1,813.00 for a married couple.