TRICARE / VA BENEFITS

For those of you who are active or retired military you have access to certain types of medical coverage that the general civilian world does not. The bad news is you’re not covered any better for the problem of long-term care. These pages will help lay out accurate information regarding both TriCare for life and the VA so you can better understand what you have and more importantly…what you may need.

TRICARE For Life (TFL)
Introduced in October 2001 was designed for Medicare-eligible military retirees allowing them to save the money that would otherwise have been spent on a Medicare Supplement program.

TFL’s most significant feature is as a second payer to Medicare taking the place of traditional Medicare supplements by paying any Medicare deductibles or co-payments. While this site will not provide a primer on all aspects of TFL, it will focus on long-term care issues and the services or lack thereof provided by TFL. Click for complete information on TFL.

As mentioned in the Medicare section, a retired person with Medicare can expect up to 100 days of covered skilled nursing care, 20 days paid in full and the remaining 80 days in which you will pay the first $101.50/day and Medicare will pay whatever’s over. TFL will pay the $101.50 thus potentially giving a person 100 days of skilled nursing care following a three-day hospital stay. If you remember from our Medicare discussion, after 100 days Medicare pays nothing, but TFL may pay 75% if you meet certain criteria.

TRICARE and long-term care
Probably the most important thing to remember about TRICARE is what it does not do. According to TFL’s publication “TRICARE for Life, The Road To Honoring Healthcare Commitments”, put out by The Retired Officer Magazine, under Services covered by Neither Medicare nor TFL: “You remain responsible for the cost of non-covered services, e.g., routine dental care, hearing aids, eye glasses, and long-term care.”

Certainly TFL puts military retires in a much better situation than there were in, but still leaves a gap in coverage for long-term custodial care (the kind most people need). Many military retirees take advantage of the money saved by TFL and purchase a long-term care insurance policy.

Currently many military organizations and groups including The Retired Officer’s Association endorse General Electric’s long-term care plan as the best available. If you would like information on this particular plan contact us or email and we will forward you the appropriate information.

VA Benefits

Again this will not be a primer on VA benefits, but will stay focused on the issue of long-term care. To learn all about VA benefits visit: www.va.gov

While many veterans were promised a lifetime of care after service it appears that the government can’t afford, or won’t provide needed long-term care services for veterans. According to a recent VA benefits pamphlet here is how the VA decides who gets health care services according to a priority rating system:

1. Veterans with service connected disabilities 50% or more.
   

2. Veterans with service connected disabilities 30-40%.
   

3. Former POW’s, or Purple Heart and 10-20% disabilities.
   

4. Veterans who have been determined to be “catastrophically disabled”.
   

5. Non-serviced connected veterans and services connected veterans rated 0%.
   

6. All other veterans.
   

Note: For veterans meeting numbers 1 and 2 the US is already over capacity with waiting lists for those.

Financial Assessment
Any veterans who want to enroll in priority group 5 based on their inability to otherwise defray the costs of long-term care must provide the VA with information on their annual income and net worth to determine whether they are below the “means test” threshold. This threshold is adjusted annually and includes all sources of household income.

Nursing Home Care
Nursing Care in VA facilities or private nursing homes may be provided for veterans…for a service connected disability rated at 70% or more. Non-service connected disabilities must complete financial section VA Form 10-10EZ to determine if they will be billed for nursing home care.

Armed Forces Retirement Homes
The following veterans may be eligible to live in two retirement homes based on some criteria:

1. 20 years or more of active service.
   

2. Incapable of earning a livelihood because of a service-connected disability.
   

3. Other veterans incapable of earning a livelihood because of injuries, disease, or disability who served in the war theater during a time of war declared by Congress.
   

Note: New residents must be capable of living independently in dormitory type facilities.

The VA is not capable of providing long-term care services to most of its veterans. Of the very narrow range of people who would qualify, there just aren’t enough facilities available. As for the US Soldier’s and Airman’s Home, and the US Naval Home, you must be able to take care of yourself, and thus long-term care is not provided.

Options
The government is encouraging people to take care of themselves by purchasing private long-term care insurance by making certain tax provisions available. Benefits from a tax-qualified long-term care plan will not result in income taxes, and the premiums you pay for the insurance may be a tax-deductible medical expense. If you would like details on a tax-qualified plan please contact us or email for information.