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You are here: Home / Politics / Activist Judges! / VA eligibility info

VA eligibility info

by David Anderson|  February 18, 20158:23 am| 26 Comments

This post is in: Activist Judges!, Anderson On Health Insurance, All we want is life beyond the thunderdome

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Via valued commenter Ruckus on his experience of being a Vietnam era vet who did not serve in Southeast Asia regarding VA eligiblity for health coverage:

1)

A Vietnam era vet gets covered depending on income if they have no other qualifying events, like POW, serving in the combat zone and a few others.
There are 8 groups, someone who served during the Vietnam debacle and has income under a set amount based upon where they live and how many dependents would be in group 7 with no qualifying events. Over that limit they would be in group 8 and have to make copays or have too much income and not be covered. Generally I’ll speculate that someone who qualifies for subsidies probably would be VA eligible, at least to some degree. The qualifying amounts aren’t the same numbers but they seem to be close.

2)

I am covered by being a Vietnam era vet, I did not serve in a combat zone, or to use the vernacular, I never served in country.
My current qualifying group is #7 due to income. If my level was much more I’d fall into #8, if much less I be covered for more things, like dental or vision. I get everything else, primary care, necessary operations, hospital stays, etc. I didn’t qualify prior to about 9 yrs ago, income was too high. So the great recession did something for me. As well as to me and several million of my closest friends.

I just spent a couple of minutes playing around with the VA benefit window shopping service and entered as bland of a profile as I could (no injuries, no disabilities, not in SE Asia, not radiation exposed, honorable discharge etc) for my home zip code.  With a wage income of $39,500 (338% FPL) for a single adult, I would have qualified for a VA benefit structure that looks a lot like enhanced Medicare given the deductibles but better co-pays.  When I entered an income of $22,500 (192% FPL), it moved the benefits to 97% or 98% actuarial value.

So there is a narrow window where the King plaintiff might be above VA eligiblity but below the subsidy threshold of 400% FPL and where the non-subsidized cost of the cheapest Bronze plan is more than 8% of income.  But that is a very thin needle to thread and I don’t think the hacks and sociopaths at the Competive Enterprise Institute and Cato will have done the work right.

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Reader Interactions

26Comments

  1. 1.

    Matt McIrvin

    February 18, 2015 at 8:29 am

    In related news, this article claims that invalidating subsidies for the federal exchanges would also remove the employer mandate in the same states, since it’s triggered by the availability of subsidies:

    http://talkingpointsmemo.com/dc/king-burwell-obamacare-employer-mandate

    This might well be the money wing of the Republicans’ reason to buy in.

  2. 2.

    raven

    February 18, 2015 at 8:40 am

    I’m in group 6 and I am charged $50 for appointments other than with the primary care doc. My hearing aid and glasses ended up costing me about $300 total and that isn’t too bad.

  3. 3.

    Tenar Darell

    February 18, 2015 at 8:54 am

    @raven: Wow. That is amazing. I bought glasses a year ago, and it cost $300 with “plan approved” frames and certain extras (like graduated lenses, transitions, and anti-glare). I don’t remember how much my father pays for his hearing aids, but it’s a lot more than $300 for the pair.

  4. 4.

    rikyrah

    February 18, 2015 at 9:04 am

    you always provide good information.

  5. 5.

    Num Nut

    February 18, 2015 at 9:06 am

    I assume FPL is Federal Poverty Level because you never spelled out what the abbreviation or acronym means and it is not common knowledge. Do us all a favor and spell them out at least once. And since Healthcare can be full of acronyms and copy/paste is easy, it makes it clearer to your readers if you spell them out more than once.

  6. 6.

    raven

    February 18, 2015 at 9:16 am

    @Tenar Darell: The hearing aid (they would only approve one for my left ear) costs a couple of thousand dollars too!

  7. 7.

    Ruckus

    February 18, 2015 at 9:49 am

    Richard
    Thanks for re-posting this. I saw there was some confusion as to how VA eligibility is figured. And to show how difficult it can be to get info I know a gentleman who is a WWII vet (90 yrs old) whose wife needed to sign him up. She talked to several “vet resource” groups and what they really wanted was donations to help her. And then they just had her fill out the VA forms but wouldn’t actually send them in with out a donation. One wanted about $1000! Assholes. It took me about a month to persuade her to actually contact the VA. She was amazed that the people were nice and helpful. I did have to warn her that it takes time to get inserted into the system, it is not instantaneous. There are grifters everywhere.

  8. 8.

    raven

    February 18, 2015 at 9:55 am

    @Ruckus: The vets groups are the worst. From Wounded Warriors to the Purple Heart Vets, scumbags all. We’d cringe when we’d go see my father-in-law and he’d have some bullshit trinket they’d send him for a donation. He’d give them to me and I’d try to be gentle and tell them what a rip it was but it was useless. Our local VA health clinic has the state office of Vets Affairs in the back and they are very helpful. Depends on the state I guess.

  9. 9.

    Tenar Darell

    February 18, 2015 at 9:57 am

    @raven: I went with him the last time he got fitted. Since I spend a lot of time with him, it was best I was there for baseline calibration testing. As you know, they’re little microcomputers now, that can be programmed externally, can sync with certain kinds of phones etc. The actual price you mentioned seems about right. I remember being shocked by the check he wrote. I was admiring how clever they’ve gotten, but it costs.

    My father most definitely needs two aids. When I was speaking behind him, he could not hear me hardly at all. He’s been supplementing his hearing by lip reading, probably for years. He does the whole look at me when I’m talking to you bit because he needs the facial cues.

  10. 10.

    Occasional Reader

    February 18, 2015 at 9:58 am

    So getting cared for by the VA is a bit like filing taxes, where you have to tick a zillion boxes to figure out your situation? What a monumental waste of energy. Just cover everyone, FFS.

  11. 11.

    Ruckus

    February 18, 2015 at 9:58 am

    One of the things I didn’t state was that there is a geographical adjustment for the income limit with dependents accounted for as well. This could change the FPL comparison.

  12. 12.

    J R in WV

    February 18, 2015 at 10:00 am

    So if King’s access to VA care can be shown, how would lawyers go about that in an appeal court situation?

    What effect on his standing would access to VA care have??

    Don’t you expect the court (Supremes) would go ahead at this point and hear the case so that they can have their say right away, rather than waiting longer thereby having many more people come to lose their health coverage after getting treatment for their potentially fatal health problem???

    So many variables. I have good coverage as a retiree from state government, right now. I am also a Vietnam era vet, who never served “in country” or saw combat. Between my pension and my Social Security (which I have not yet applied for) I think my income is too high to access Va care.

    Of course Republicans have taken over the state government here. So my pension may be worth every bit as much as Mitt Romney’s pledge to care for the people working for the companies his investment fund bought and sold…

  13. 13.

    Ruckus

    February 18, 2015 at 10:09 am

    @raven:
    I have heard that most state vet orgs are pretty good. The private ones are not in my opinion.

    @Occasional Reader:
    No it’s not like doing taxes, although I find that process to also be pretty simple. But then I’m not in a bracket that has any advantage from most/all of the tax law. The explanation sounds far more convoluted than the reality. And your idea of just cover everyone, why that’s socialism!!!!. And if we just did that we wouldn’t need the VA in the first place nor would we need Medcaid nor Medicare. Or health insurance companies. But that’s way too simple for such a complex country and issue and would cut down on the amount of grifting/influence peddling that outside groups/lobbyists would be able to get away with. Can’t have any of that.

  14. 14.

    raven

    February 18, 2015 at 10:11 am

    @Tenar Darell: I have a Re-sound that is designed to work with my iPhone. The problem is that, when you use the bluetooth the default is for the goddamn thing to connect when you have an incoming call. The phone audio is not acceptable through the HA but there is no way to use the device without manually turning off the bluetooth AFTER the frickin call comes in. I use my iPhone as my work phone and that just doesn’t cut it. I’ve tried to address the issue with both Re-sound and Apple and they both blame the other. The only thing I can say is that I am glad I didn’t pay for it.

  15. 15.

    raven

    February 18, 2015 at 10:14 am

    @J R in WV: I don’t think it’s too high it’s that you will be charged for care. Like I said, I’m in 6 and I still have to pay co-pays. The glasses and hearing aids are free for in-country vets but I had to pay for everything else required to get them. I also payed extra for the special coating on the glasses.

  16. 16.

    raven

    February 18, 2015 at 10:17 am

    @Ruckus: Roger that.

    Navigating the VA was a pain in the ass but I got through it. I can’t imagine what it is like for some of the folks that are not at the top of their game. There is nowhere that I can find in writing that says a Nam Vet gets glasses and hearing aids based on needing them. A guy who said he was a VA audilolgist on hearing aids.com told me that was the case and it turned out to be true.

  17. 17.

    raven

    February 18, 2015 at 10:20 am

    Resound has a page for vets.

  18. 18.

    Scout211

    February 18, 2015 at 10:20 am

    I was helping my friend (in 2013) trying to convince her husband to sign up for Medicare for 2014 (his first year eligible). He had VA benefits and felt good about his care. His costs were close to zero because he was a combat veteran in Viet Nam and served near an Agent Orange exposed area.

    On the VA website at the time, it was clearly stated that VA services is not qualified as an ACA plan. I just checked this morning on the VA website and it says the exact opposite. VA services is qualified as an ACA plan.

    I have no idea when this policy changed, but this could be a factor in the confusion about standing in the lawsuit.

  19. 19.

    Richard Mayhew

    February 18, 2015 at 11:09 am

    @J R in WV: IF the plaintiff is VA eligible, he has access to an ACA qualified health plan at less than 8% of his income, therefore he is ineligible for subsidies on Healthcare.gov under the current IRS rule, therefore there is no case nor controversey, therefore he is shit out of luck.

  20. 20.

    Mnemosyne (iPad Mini)

    February 18, 2015 at 11:27 am

    Thanks, Richard and Ruckus! It sounded weird on the other thread when someone said Vietnam vet eligibility was based solely on level of disability, so it’s helpful to have the facts.

  21. 21.

    Mike R

    February 18, 2015 at 12:52 pm

    @Scout211: I received a letter from the VA just prior to the launch of the ACA that my VA coverage was considered acceptable under the law and complied with the requirements of the ACA.

  22. 22.

    VFX Lurker

    February 18, 2015 at 12:58 pm

    My 50-something co-worker and his wife have decided to not enroll in CoveredCA despite their chronic conditions. They decided it’s cheaper to pay the penalty at this time, continue to pay for misc. health costs out-of-pocket and pay down their dental/misc debt than to spend $12,000 this year on adequate coverage (they didn’t see any benefit to Bronze for their situation). They know it’s a real gamble, but they’re resigned about their situation. I don’t know if they saw a navigator to help them with this decision.

    I’m not sure what another co-worker has decided to do just yet. He griped that CoveredCA was too expensive for a family of four, and that the $16/year subsidy he could receive was inadequate.

    Yet another (younger) co-worker lives with an unemployed girlfriend and her 1-year-old kid. He started his CoveredCA application, but he had not finished it by the deadline. He was grateful to hear that the deadline was extended until this Friday, so he and his girlfriend will be signing up for it by this Friday.

  23. 23.

    cmorenc

    February 18, 2015 at 1:04 pm

    @Richard Mayhew:

    But that is a very thin needle to thread and I don’t think the hacks and sociopaths at the Competive Enterprise Institute and Cato will have done the work right.

    The King case would have been unlikely to ever be granted cert if there weren’t at least three full-time hacks/sociopaths on SCOTUS and two more part-time ones. OTOH one possibility counter to CW about the King case is that Roberts (and possibly Kennedy in his wake) may see this and the marriage equality case as sacrificial opportunities to shore up his (and the Court’s) long-term respectability and durable legacy in a conservative direction, rather than being seen as a strongly partisan-hack led aberration more vulnerable to relatively quick evaporation with a different court lineup. In voting to uphold the ACA back in summer 2012, implicit in Roberts’ vote is that he did not regard the ACA as a hill worth dying on to destroy or radically overturn existing precedent (as opposed to some incremental tinkering). Contrast e.g. the Voting Rights Act case where he did see it worthwhile to seize his initial opportunity to radically overturn existing precedent, and indeed blatantly ignore the language of the Fifteenth Amendment.

  24. 24.

    Eric U.

    February 18, 2015 at 1:13 pm

    I suppose I should apply for VA benefits now that these clowns have given me reason to find out I’m eligible. I served in SW Asia for GHWB’s stupid vanity war, so apparently I have higher priority, whatever that means. I have good insurance right now, not sure it will matter to me, but maybe it will in the future.

  25. 25.

    Miki

    February 18, 2015 at 1:23 pm

    I just enrolled in VA healthcare in January – it was a little bumpy getting enrolled but once I got the right people on the phone everything worked out well. I have the same coverage as raven (or so it seems). Have had one visit with my primary care physician and really like him – and the local clinic is less than 5 miles away. For specialized care and hospitalization I’ll need to go travel some but not that far and it’s doable by train. I declined enrollment for the work-provided health insurance and switched to the VA because the combined premiums/co-pays/deductibles became just too large for my income given my age and some health issues that have landed me in the hospital. Glad I have the option ….

  26. 26.

    Scout211

    February 18, 2015 at 1:30 pm

    @Mike R:

    That is good to know. It sure didn’t make sense to me at the time.

    My friend’s husband was afraid he’d lose his VA benefits if he had Medicare but the VA highly recommends that Medicare eligible veterans sign up for Medicare. You are allowed to have both but you have to decide which one you use when you seek medical services. They are separate and neither one acts as a supplement to the other. At least that is what we learned when he signed up.

    VA services is a qualified Medicare part D drug plan, too. Which is quite a savings for Medicare eligible veterans.

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