By Larry Dandridge
This is the final article in a series on VA Health Care eligibility, priority groups, copay rates, and how veterans’ income levels and other special eligibility factors affect VA healthcare. These five articles and the VA websites referenced within should encourage veterans to stop procrastinating and:
- Make an appointment with their local VA-accredited Veterans Service Officer (VSO). There is a county veterans service office in every county of South Caroline, Georgia and North Carolina (and in most other states). Find S.C., Ga., and N.C. County VSOs at https://bit.ly/4uqu6OJ; https://bit.ly/42zq62N; and https://bit.ly/4tpY052. Veterans can search for VA-accredited representatives (VSOs, Attorneys, and Claims Agents) nationwide at the VA’s “Accreditation Search” webpage at https://bit.ly/4tSOMze. Veterans can also search for VSOs co-located with Veterans Benefits Administration Regional Offices at https://bit.ly/48FjL9g. Veterans Service Organizations, such as the VFW, VVA, AL, FRA, AMVETS, DAV, PAV, and others, list their VA-accredited VSOs on their websites.
- Ask their VA-accredited VSO to explain their federal and state veterans’ benefits and help them apply. Ask the VSO to help you enroll in VA healthcare and apply for service-connected disability compensation for any wounds, injuries, illnesses, scars, events, traumas, HAZMAT contaminations, which have caused a disabling condition. VSOs can also help them request copies of their official military personnel files (Military Medical, Dental, Personnel records from the National Archives (National Personnel Records Center-NPRC). Learn more at https://bit.ly/3OWsUUn. This may include requesting Military Medical Records from VA, Army, Navy, Air Force, Marine Corps, and Coast Guard storage locations. The VSO can also help veterans order VA and civilian medical records.
- Check their eligibility for VA health care. Learn more about VA health care eligibility by asking your VSO and reading the VA webpage “Eligibility for VA Health Care” at https://bit.ly/4urGttZ.
- Enroll in VA healthcare. Ask your VSO to help you enroll in VA health care. Learn more about how to apply by phone, by mail, in person, online, or with the help of a VSO for VA health care benefits at “How to apply for VA Health Care” at https://bit.ly/42zqfDn. Find a VA Medical Center or Community-based Outpatient Clinic (CBOC) near you at https://www.va.gov/find-locations/.
- If you live outside of the USA or travel outside of the USA, learn about the Foreign Medical Program (FMP). If you are a veteran who gets medical care outside the U.S. for a service-connected condition, the VA may cover the cost of your care. Learn more at https://bit.ly/3P5a4dI; https://bit.ly/4tRlBMT; and https://bit.ly/4wbHcB2.
- Ask your VSO and or the VA to explain the factors used by VA to assign veterans to a priority group. The VA bases a veteran’s priority group on: 1) the veteran’s military service history; 2) the veteran’s disability rating; 3) the veteran’s income level; 4) whether or not the veteran qualifies for Medicaid; and 5) other benefits the veteran may be receiving (like VA pension benefits). VSOs, VA Medical Center Eligibility and Enrollment Office employees, and VA Social Workers can explain VA priority groups.
- Learn about VA priority groups and VA copay rates. According to the webpages “VA priority groups” at https://bit.ly/3QGDpvB and “Current VA health care copay rates” at https://bit.ly/4eWG91O, after the VA processes a veteran’s application for VA health care, the VA will assign the veteran to one of eight priority groups. Ask your VSO or your local VA Medical Center (Eligibility and Enrollment Office), or CBOC, or if you are already enrolled in VA Health Care, ask your Primary Care Patient Aligned Care Team Social Worker to explain VA Priority Groups and what group you are in. Learn more at the VA webpage “VA priority groups” at https://bit.ly/4dn43Cq.
- Learn all about Your VA health care costs. Ask your VSO or your local VA Medical Center Eligibility and Enrollment Office or CBOC about whether or not you will have to pay copays for VA health care. Learn about veterans’ health care costs at the VA webpage “Your health care costs” at https://bit.ly/4f3cWlL. Learn about current/past health care copay rates at the webpage “Current VA health care copay rates” at https://bit.ly/4n7gSEa. The copay rates for Urgent-Outpatient-Inpatient Care, Medication, and Geriatric/Extended Care are listed. Services that do not require a copay (no matter what the veteran’s disability rating is) include:
- Readjustment counseling and related mental health services.
- Counseling and care for issues related to military sexual trauma.
- Exams to determine your risk of health problems linked to your military service.
- Care that may be related to combat service for veterans who served in a theater of combat operations after November 11, 1998.
- VA claim exams (also called compensation and pension, or C&P, exams).
- Care related to a VA-rated service-connected disability.
- Care for cancer of the head or neck caused by nose or throat radium treatments received while in the military.
- Individual or group programs to help you quit smoking or lose weight (These aren’t considered whole health programs.)
- Care that’s part of a VA research project (like the Million Veteran Program)
- Laboratory (lab) tests.
- Electrocardiograms (EKGs or ECGs) to check for heart disease or other heart problems.
- VA health initiatives that are open to the public (like health fairs).
- Learn about VA health care benefits. Ask your VSO, your VA Medical Center Eligibility/Enrollment Office, or your VA Social Worker, and read the information at https://bit.ly/4daMrsl about VA health benefits. Each veteran’s medical benefits package is unique. Yours will include care and services to help: 1) Treat illnesses and injuries; 2) Prevent future health problems; 3) Improve your ability to function; and 4) Enhance your quality of life. All veterans receive coverage for most care and services, but only some will qualify for additional benefits, such as dental care. The full list of a veteran’s covered benefits depends on: 1) The veteran’s priority group; 2) The advice of the veteran’s VA primary care provider (the veteran’s main doctor, nurse practitioner, or physician’s assistant); and 3) The medical standards for treating any health conditions the veteran may have.
The bottom line
Applying for VA and state veterans’ benefits is complicated. Use a VA-accredited VSO for filing benefits and appealing VA decisions. The more you know about VA benefits and services and how to apply for those benefits, the more likely the VA will approve your claims and appeals
Larry Dandridge is a Vietnam War wounded warrior, a combat and 100% service-connected disabled veteran, an ex-Enlisted Infantryman, an ex-Warrant Officer Pilot, and a retired Lt. Colonel. He is a former Veterans Service Officer, a Patient Adviser at the RHJ VA and Durham VA Medical Centers, a Fisher House Charleston Goodwill Ambassador, and the Veteran Benefits Advisor for the AUSA Coastal Carolina Chapter, MOPH Chapter, MOAA Triangle Chapter, and VFW Post 7383. Larry is also the author of the award-winning Blades of Thunder (Book One) and a contributing freelance writer with the Island News. Contact him at LDandridge@earthlink.net or 843-276-7164.