so
welcome to another edition of cck live my name is emma peterson and today i'm joined by nick
briggs and frank padula and we're going to be discussing va healthcare eligibility
this should be a really interesting topic not one that we typically
represent our clients on but really important nonetheless so let's dive right in
so frank can you give us a brief overview of va healthcare definitely so the veterans healthcare
administration or vha for short is actually the largest integrated healthcare system in
the united states it provides care at over 1 200 facilities and helps over 9
million veterans across the country and each va vha facility is staffed with patient advocates
who can answer any questions veterans may have about the healthcare system and this healthcare
system may include services related to vision and hearing dental care health exams and education
inpatient services for example maybe surgeries mental health services and even more than that
great uh nick can you tell us some of the requirements for va healthcare sure emma so first
to qualify for va healthcare veterans need to have served an active military naval or air service
they need to have received an other than honorable discharge or other than dishonorable discharge and
be service connected for a qualifying condition importantly for the baseline eligibility they the
rating doesn't matter as long as there's a service connected condition they can qualify for benefits
in terms of other requirements a veteran if they enlisted after september 1980
or entered active duty after october 1981 they must have served either 24 continuous months
or the full period for which they were called to active duty in order to be eligible however
there are some exceptions to this minimum duty requirement rule these exceptions include if
a veteran was discharged due to a disability that was caused or made worse by their service
or if they were discharged for a hardship reason or finally if they served prior to september 1980
finally if they're a current or former member of the reserves or national guard
in order to be eligible to va healthcare they need to have been called to active duty by a
federal order and completed the full period for which they were called to that active duty
if for some reason they were only active duty status or training purposes
uh then they don't qualify for va healthcare great so for folks out there who are watching
who are enrolled in va healthcare they're probably familiar with different priority groups
they've probably been assigned a priority group so when veterans apply for enrollment
with va healthcare they will determine whether they're one eligible in general and two what
priority group they're going to fall into and via uses these priority groups to categorize veterans
and the different kinds of health care benefits they receive different levels and breadth of care
in making a determination about who's going to fall into what priority group
va kind of backtracks to look at their budget for the entire year
and then they'll make the determination of how many veterans can fit into each priority group
so the requirements can change from year to year um each priority group has a different copay
and i think that's probably the key takeaway for many people is that it's going to be a different
amount of money honestly out of pocket depending what priority group you're in um so if you are
moved you know from year in and year out from different priority groups just know that that
copay can't change um we're not going to get into the actual copays um in in this discussion that
really gets into the nitty gritty but just know that they can change depending on priority group
so frank can you tell us about the different kind of different tiers of priorities definitely um so
we'll start with priority group one and priority group one is actually the highest priority group
and in order to be placed in this group the veteran would need to be service connected at a
50 level or higher or that veteran would need to be receiving what's called the total
disability rating based on individual unemployability or just tdiu for short
and additionally veterans who receive the medal of honor also qualify for priority group one
and prior to group number two um so veterans and priority group number two
need to be service connected at a 30 level or a 40 level that's great
nick can you walk us through priority groups three and four absolutely so for priority group three
the veterans need to meet one of three criteria um either be service connected between 10 and 20
be a former prisoner of war or be a purple heart recipient however additional members of this group
may also be eligible if they were discharged from service due to a disability that was
caused or worsened by service or they were awarded special eligibility classification under
chapter 1151 and then for priority group 4 we're talking about veterans who receive
benefits for either housebound status or aid in attendance benefits and then finally
veterans who va has determined to suffer from a catastrophic disability are also eligible
um for priority group five and as you can see there are a lot of priority groups so stick with
us there's a couple more to go uh priority group thrive are veterans who are receiving
pension benefits so non-service-connected pension um or are also eligible to apply
for medicare qualify for priority group six veterans who are not service connected
or our service connected at a non-compensable level so they have a bunch of zero percent ratings
are also eligible under this category um but it's based on va's geographical um adjusted income
limits so that can fluctuate depending on where you are in the country and then priority group 6
is comprised comprised of veterans that meet one of the following requirements service in vietnam
between january 1962 and may 1975 um persian gulf war veterans who served on active duty active
duty military service between august 2nd 1990 and november 11th 1998 so pg-1 um there also includes
veterans who are veterans of world war one or the mexican border period i don't know how many
we have out there um watching this particular broadcast but if you know a member of that group
um there are many priority group six um for folks who've been awarded a zero percent compensable
rating um which also seems to overlap with group five so again the ins and outs of that um is a
little beyond this discussion um but for folks who are zero percent related to active duty service
um if you were exposed to an herbicide to agent orange you qualify under group six
um you are currently your previously part of project one one two or a shad participant
if you were exposed to ionizing radiation if you completed at least 30 days of active duty military
service at camp lejeune between 1953 and 1987 if you are a veteran or a military service member
who served or is serving after november 11 1998 um and those who are actively discharged after
january 28th 2003 are going to receive enhanced post-discharge benefits for five years um so
again these are all sort of minimums not maximum so you're gonna at a minimum meet priority group
six but you might be bumped up depending on what else you have um so frank can you take us through
the last two priority groups yes so there's priority group seven and those who qualify
for priority group seven will need to have a household income that is below va's income limit
based on geographical location and there are actually two subgroups within prior to group seven
there is sub priority a and sub priority b so sub priority a includes veterans who registered as of
january 16 2003 and who have remained continuously enrolled or had a change in eligibility status
and sub-priority b includes veterans who are registered as of june
15 2009 and whose annual income is 10 or less above va's geographically adjusted income limits
and after prior to group seven comes priority group eight
and priority group eight requirements are also based on va's geographically adjusted income
limits but to qualify the veteran will need to have an income that a but that is above
this threshold and similar to priority group seven there are sub-priority categories
first there are sub-priority group c and sub-priority group d sub priority group c
includes veterans who registered as of january 16 2003 and who have remained continuously enrolled
or had a change in eligibility status sub priority d includes veterans who are registered as of june
15 2009 and whose annual income is 10 or less above va's geographically adjusted income limits
but there is more there is also sub-priority e and sub-priority g
these groups actually do not provide for va healthcare services but there is an exception
veterans rated at a non-compensable or zero percent level for their service related disability
may receive medical benefits that cover only their service related injury or disability within these
groups great thanks frank all right nick i think probably most important part of the broadcast
today how does one enroll in va healthcare so pretty straightforward here va has one a specific
form for it you know how va loves their forms so in this particular case it's va form 10-1-0 easy
fill out the form to the best of your ability and then file it either by mail in person or online
if you do choose to submit it by mail you should send it to the health eligibility center addressed
to the enrollment eligibility center specifically at 2957 claremont road suite 200 in atlanta
georgia zip code 303 29-1647 great thanks nick um so where this really comes into play for us
in our practice is that you know as your journey through getting service connected disability
benefits changes you know your healthcare priority group might change so an increase in benefits or
a decrease in benefits if you move locations um that might have an effect on your health care so
just keep that in mind and keep an eye out for any changes because health care coverage is obviously
super important nick any final thoughts for those watching out there today
like you mentioned this is a bit different than a lot of the compensation claims that we usually
handle and oftentimes the best place to get answers to your health care related questions
is to just go see your patient advocate at your local va hospital or clinic they'll have more
answers for you than we might absolutely frank what about you any final i just agree with nick
you know the va patient advocates that's their job to help you with these
sort of questions and also va's website might have some really good information about this as well
thanks frank and also our website so please be sure to check out our blog we'll have more about
this as always you can leave questions or thoughts in the comments and we'll do our very best to get
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you