What are the co-payments for Veterans (PART 2)?

If you don't fit into one of those catagories,as indicated in What ar the co-payments for Veterans (Part 1), the VA will ask you to provide your household income and net worth from the previous year. If your income is below certain thresholds, you will not have to make a copayment. Click here to view the thresholds for income. In addition, you must not have more than $80,000 in property. Those whose income exceeds the threshold or who refuse to submit to the means test may have to make a copayment.

Unlike Medicaid, there is no penalty for transferring assets before applying for veterans benefits, including long-term care. Remember, however, that if you do transfer assets it may affect your eligibility for Medicaid.

Even if your income is above the threshold, you do not have to make co-payments for the following services:

  • Special registry examinations offered by the VA to evaluate possible health risks associated with military service
  • Counseling and care for sexual trauma
  • Compensation and pension examination requested by the Veterans Benefit Administration
  • Care that is part of a VA-approved research project
  • Outpatient dental care
  • Readjustment counseling and related mental health services for Post Traumatic Stress Disorder
  • Emergency Treatment at other than VA facilities
  • Care for cancer of the head or neck caused from nose or throat radium treatments given while in the military
  • Publicly announced VA public health initiatives — i.e., health fairs
  • Care related to service for veterans who served in combat or against a hostile force during a period of hostilities after November 11, 1998
  • Laboratory services such as flat film radiology services and electrocardiograms

Outpatient co-payments. The following are the outpatient co-payments for non-service-related conditions:

  • Services provided by a primary care clinician are $15 (in 2010) for each visit
  • Services provided by a clinical specialist are $50 (in 2010) for each visit

Preventive care services (such as screenings and immunizations) are free.

Inpatient co-payments. The inpatient co-payment is calculated by adding:

  • $10 per day of hospitalization (in 2010), and
  • $1,068 for the first 90 days of hospitalization and $534 for each additional 90 days (in 2010).

There is a reduced co-payment rate (20 percent of the full inpatient rate) for certain individuals whose income is above the VA income thresholds, but below the Geographic Means Threshold (GMT). Click here to see if you are below the GMT.

Prescription co-payments. Prescription co-payments are charged only for outpatient treatment. The following veterans do not have to pay anything for medications:

  • A veteran who is 50 percent disabled or more with a service-connected disability
  • A veteran who has been determined by the VA as unemployable due to his service-connected conditions
  • A veteran who needs medication to treat a specific service-connected disability
  • Former POWs
  • A veteran whose income is below the maximum annual rate for a VA pension
  • A veteran who needs medication to treat conditions related to a veteran's exposure to herbicides during the Vietnam era ionizing radiation during atmospheric testing, or ionizing radiation during the occupation of Hiroshima and Nagasaki
  • A veteran who served in the Gulf War, in combat after the Gulf War, or during a period of hostility after Nov. 11, 1998, and who needs medication to treat a service-related condition
  • A veteran who needs medication to treat a military sexual trauma
  • A veteran with cancer of the head or neck caused by nose or throat radium treatments given while in the military
  • A veteran participating in a VA approved research project

If you don't fit into one of these categories, you must pay $8 (in 2010) for each 30-day or less supply of medication. If you are in one of the Priority Groups 2 through 6, there is an annual limit on the amount you have to pay for prescriptions. You will not be charged more than $960 during the calendar year. If you are in Priority Groups 7 and 8, you will have to pay the full co-payment amount, with no annual limit.

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