Applying for Medical Benefits
One of the most important things to do before leaving the military is to apply for your veteran’s medical benefits. This is to ensure that there is no lapse in your medical coverage when you transition from active duty to civilian life. Once you enroll in VA healthcare, your benefits are accssible anywhere within the Va health system.
Determining Your Eligibility and Benefit Level
Two things will determine your initial eligibility for medical benefits:
1. You were active duty in a Military, Air, or Naval service, and you were honorably discharged.
2. You were in the Reserves or National Guard, and were called to active duty by Executive order. This excludes regular Reserve or Guard training, and you must have fulfilled your full call-up term.
The level of eligibility and coverage also depends on the circumstances of your military separation.
Regular Active Duty Military Discharge
Before You Leave the Military
Here are a few things you should do before you leave the military. They will help make the transition process easier.
1. Gather your financial records so you can take advantage of any special programs you are eligible to enroll in.
2. Get copies of all of your medical records. This will save the hassle of having to fill out request for information forms when you move to your new location.
3. Apply for your Tricare package and any VA health benefits you qualify for to avoid lapses in coverage.
Most veterans fall into two designations:
Priority level 5: Veterans or retirees who have 0% service-related injuries, and either qualify for medicaid, or who’s income is below the VA means threshold.
*Priority level 5 veterans must verify their income annually to qualify for free care or to qualify for lower deductibles and co-pays.
Priority level 7- Veterans who have 0% service-related injuries, and who’s income is above the means test, but below the VA national or regional threshold, and who agree to pay co-pays. The income threshold varies by state, county, and family size. The table for your state and county is available online.
All other priority levels are automatically enrolled, except for level 8, which must gain a waiver to apply.
Applying for Benefits- Your Options
The VA has streamlined the process for VA health benefits for those leaving active duty. Active duty military who are separating from the military no longer have to apply in person or supply documentation to verify their status. the form is available online, and after filling it out and sending, all information is verified by the VA. You will receive a notice of coverage by mail.
Former active duty veterans are also eligible to enroll in Tricare under various plans, according to their situation.
Members of the military who have reached retirement age qualify for Tricare as military retirees. They may also be eligible for some VA health benefits dependent on financial status. The cap for VA retirement eligibility is $80,000 per year after deductions and exemptions.
Returning Service Members
Combat veterans who are designated OEF/OIF/OND are eligible for free health benefits related to combat in Iraq or Afghanistan for 5 years after their discharge from the service. OEF/OIF/OND veterans must enroll in VA health care to receive this benefit.
Service members who are medically retired due to a service-related injury may apply for VA health benefits, dependent on the military and medical rating. They must submit a health care benefits application to the VA, and will receive treatment for their condition at the VA.
In order for the injury or disability to be considered service-related it must meet the following criteria:
1. The injury or disability must affect the veteran’s ability to function in everyday life.
2. It must have been the result of, or was worsened by, an injury or disease which developed while the veteran was on active duty, in training while on active duty, or on inactive duty for the purpose of training.
Some specific service or combat-related injuries are:
- POWs who develop any symptoms of anxiety or nervousness, heart disease, osteoarthritis, or stroke, regardless of the length of time they were held.
- The development of ALS at anytime during or after active duty service.
- exposure to Agent Orange or other harmful chemical agents.
- Gulf War veterans with chronic conditions which developed after their service there.
Your financial situation may affect your eligibility. In order to determine your level of coverage, you must fill out a financial disclosure form. This form asks for basic financial information, including number of dependents; your income, both earned and unearned; medical and education expenses; and savings.
Common Errors to Avoid
The VA has done their best to make the process of enrollment as easy as possible, but there are still some things that you can do to avoid unnecessary delays.
- Don’t wait until the last minute to enroll.
- Have all necessary documentation, such as finan.cial records, on hand
- Fill out all forms completely and accurately, and double check them before turning them in.
- If you have any questions, don’t guess. Ask your VA representative about anything you are unclear of..
- If there is a procedural problem, take the necessary steps to remedy it as soon as possible.
- It is important to note that VA health does not cover everything. If you have Tricare, or other private insurance coverage, keep it to supplement your VA health care coverage.
A Final Note to Veterans
Beginning in February, 2012, the VA sent out detailed personal VA medical benefits handbooks to all eligible veterans. These handbooks are case-specific, and are sent based on priority groupings, beginning with Priority Group 1. There are 8 priority groups in all.
There is an online version available where veterans can access their most current benefit information from anywhere, 24/7.
If you have any questions about your priority group designation and other VA health questions, or you have not received your handbook as scheduled, please contact the VA at 1 877-222-VETS.