Not eligible for VA health care?

To get a sense of which “high income” non-service connected vets might be denied VA health care now, we need to get acquainted with Priority 8 GMT income limits for Fiscal Year 2012, (see health benefit chart) and a desired state and county.   For example, comparing these cities using figures for 1 veteran and 1 dependent yields:  Miami =$46,200;  Phoenix =$46,750; Houston =$47,080.


VA gogglygookers

One should also use the VA’s Financial Calculator online tool where zip codes count.  I’ve plugged in a few numbers based on the above.  It appears as if income and assets are treated differently (from free care) to determine eligibility for care with co-pays (I admit that the VA’s gobbledygook copy has me confused.)  I’ve used the VA Health Benefits tool with caution but one must start somewhere.

I’ve imagined a self-employed veteran (F–59 years) and spouse.  The veteran has been in good health until Sept. 2013.  However she’s just learned she has Multiple Sclerosis (MS).  They dropped their health insurance in 2011 because premium increases took too big a bite out of their modest “Mom and Pop” business–a decision she now regrets.  She wants to enroll in VA health care now. Medicare is six years away; ACA has greater out-of-pocket costs.)

I used these parameters: Active Service before 1980? Yes;  VA pension? NO; Purple Heart? NO;  POW? NO;  VA rated Service Connection condition? NO; Military discharge due to disability?  NO;  Eligible for state Medicaid, NO; Within 5 years of discharge?  NO; Vietnam combat vet, SW Asia, WWII radiation exposure, Project 112/SHAD? NO. Allowable deductible Expenses:  Education and Burial, NO.

Now the numbers.  Pretend this couple reported $48,000 income for their 2012 taxes. Their 2012 health expenses were moderate ($1,197.00) giving them a countable net income of $46,803. Pretend they have $50,000 in savings.

I’m using three VA locations with VA Multiple Sclerosis (MS) Specialty Clinics:  Miami VAMC (33125); Houston VAMC (77030); and Phoenix VAMC (85012).

If this vet lived in Miami or Phoenix, the app would report:

Based on the financial information you provided, it appears that VA cannot accept you for enrollment at this time.

If the vet lived in Houston, it would read:

Based on the information you provided, it appears you would be eligible for enrollment in Priority Group 8b or 8d if you agree to make copays for your care…(blah blah).

If this vet had reported just $1,000 less in 2012  income ($47,000 – 1,197.00 allowed medical expenses = $45,803) and even if they had greater savings ($80,000), they could enroll as Group8 b or 8d even if they lived in Miami or Phoenix.

Possible strategies to get into Priority 8b or 8d


VA to vets; Not to worry.
We’ll let you know.

To reduce income by $1,000 + they (or you) should hunt for more medical expenses (travel to dentists, OTC receipts etc..).  Ask your caring RO for a waiver/financial hardship determination (LOL)? Apply now even if one’s income is higher than published limits.  The VA promises to contact you a letter if you qualify later.  There may be rules against changing residences to qualify but it might be an option in dire circumstances.  Use the calculator to get an estimate. Still apply if marginally over “income and asset” If over assets, pay down your home mortgage, car loan. Take that postponed dream vacation.


VA is so so sad for vets
too rich for care or vets denied SC.
All these difficult decisions. Booohoo….

Here’s the VA’s crocodile tear explanation for enrollment restrictions (the VA):

Enrollment Restriction:
In order to ensure the availability of quality and timely health care to Veterans with service connected conditions, special authority based on military service, low income, and those with special health care needs, in January 2003 VA made the difficult decision to stop enrolling new Priority Group 8 (high income) Veterans whose income exceeded VA Income Thresholds….[new rules]enable the…VA to relax income restrictions on enrollment for health benefits. While this new provision does not remove consideration of income, it does increase income thresholds.

Income is verified (IRS and SSA).  Some fine print:


VA scolding vets

If the IV process confirms the Veteran’s household income exceeds the established VA national income (means test) thresholds, the Veteran may be determined responsible for copays for health care provided since the date of completion of the initial financial assessment. In addition, if the Veteran enrolled on or after January 17, 2003, the Veteran’s enrollment could become denied. As a result, the Veteran would no longer be eligible for VA health care for treatment of their non service-connected conditions.

So there…they’ve read us the riot act in advance of our failure to figure this all out.

This is bad for veterans who are

Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds* or VA National Geographic Income Thresholds by 10% or less are not

–eligible for enrollment 

Subpriority e: Noncompensable 0% service-connected
Subpriority g: Nonservice-connected

10%? So is 9.99% the leeway that the VA can add to The Thresholds?  And those 8 b, d, e, g have me officially bleary-eyed and done for now.

About Laura

NW Vermont.
This entry was posted in Guest authors, Medical News, VA Medical Mysteries Explained, vA news and tagged , , , , , , , , , . Bookmark the permalink.

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