QUESTIONS AND ANSWERS

Q. I previously lived in another Ohio county and that Veterans' Service Office did more than your office does for veterans, how come?

A.  Each of Ohio's 88 (eighty-eight) counties operates on a different budget, also the Ohio Revised Code (Title 5900) gives the Veterans' Commission enough room to apply their office guidelines in accordance with how they can best distribute the available funds that an office has to work with.

Simply stated, our offices work off of a .5 mil tax base (one mil is 1/10th of one cent).  It stands to reason that richer (usually more populated) counties have more money to spend because more people are paying into this tax base.  In turn they normally have more veterans than a more rural county like Clinton County.  Some Counties that have a higher population work off a budget of over a million dollars a year, where Clinton County is only a fraction of that amount.

As this tax base changes our operational guidelines change to best spend the money intended to assist veterans and their families. 

Q. My dad was in the Army during WWII but he never left Fort Dix, New Jersey, is he a veteran?

A. Most likely yes he is, if he served honorably for 90 days of active duty or one day in a combat zone prior to 1980.

Q. Can I get medical treatment at the Veterans Hospital even if I wasn't in the war?

A.  Maybe, see our page on Eligibility for DVA Health Care.

Q. My buddy at the Legion Hall told me that I cannot go to the VA unless I have an ID card, is that true?

A. No that is not true, you can go to the Veterans Hospitals if you are enrolled, you can enroll if you meet the eligibility for VA health care, once you are enrolled you are issued an ID card, and it is a VA ID card not one like you had while on active duty in the military.

Q. Are veterans required to sign up for Medicare's Prescription drug plan?

A. No, Medicare's prescription drug coverage is completely voluntary.

Q. Does enrollment in VA provide "creditable coverage" for Medicare purposes?

A. Yes.

Q. I am an enrolled veteran. Can my spouse elect to be covered under my VA benefits instead of a Medicare prescription drug plan?

A. A spouse of an enrolled veteran can obtain VA benefits only if the spouse is a qualified veteran herself or himself. A spouse must determine whether enrollment in a Medicare prescription drug plan is a good idea without regard to the enrolled veteran's status.  Spouses covered by CHAMPVA should contact CHAMPVA for information at 1-800-733-8387 or visit http://www.va.gov/hac/forbeneficiaries/forbeneficiaries.asp.

Q. I am a veteran in a state veterans home. Do I have creditable coverage through VA?

A. A veteran who is or who becomes a patient or inmate in an institution of another government agency (for example, a state veterans home, a state mental institution, a jail, or a corrections facility), may not have creditable coverage from VA while in that institution. Veterans who are unsure whether this may apply to them should contact the institution where they reside, the VA Health Benefits Service Center at 1-877-222-VETS (8387), or their local VA medical facility.

Q. How much does VA charge for a medication copayment?

A. Certain veterans are required to pay copayments for medications.  There are exceptions to the requirement that VA charge copayments for medications.  The three main exceptions to the copayment requirement include medications for the treatment of a service-connected disability; medications to treat any disability of a veteran with a service-connected disability rated 50% or greater; and medications for any disability of a veteran with annual income below a limit set by statute.  Currently, the copayment amount is set at $7, with an annual cap of $840.  In calendar year 2006, the copayment amount will increase to $8, with an annual cap of $960.

Q. How much does a Medicare prescription drug plan charge for a medication copayment?

A. The Medicare copayment may vary. If the beneficiary has low income and has the FULL Medicare low income subsidy, the Medicare copayment will be $1 or $2 for generics and preferred prescription drugs, and $3 or $5 for preferred brand name drugs. Other low-income subsidy eligible individuals not eligible for the full subsidy may receive a partial cost sharing subsidy resulting in a $50 deductible and 15% coinsurance.  The Medicare copayment will be for each prescription, whether it is for a 30, 60 or 90 day supply of medication. If the beneficiary does not have Medicare's extra help for low-income individuals, the cost sharing for a prescription will vary according to the selected drug plan.  For the standard benefit, here is how the coverage works:

After you pay the $250 yearly deductible, you pay 25% of your yearly drug costs after the $250 deductible until you reach $2,250 in drug costs, and your plan pays the other 75% of these costs.  Then you pay 100% of your next $2,850 in drug costs (known as the coverage gap), and then 5% of your drug costs (or a small copayment) for the rest of the calendar year after you have spent $3,600 out-of-pocket.  Your plan pays the rest.  In other plans, you may have tiered cost sharing, either flat copayment or coinsurance, by type of drug (ie. generic or brand) after the deductible and until you reach $2,250 in total drug costs.  Because of this flexibility in benefit design, it is important to compare benefits across plans.

The national average monthly premium is $32.20 for 2006--this will vary by plan.  This premium may be deducted from your Social Security check or paid to the plan itself. 

Q. Am I eligible for the extra help?

A. Medicare provides extra help to cover your prescription drug plan expenses if your annual household income is below $14,355 (or 19,245 if you are married and living with your spouse), and your resources are less than $11,500 if single and $23,000 if married.  To apply for extra help, contact Social Security at 1-800-772-1213 or apply on line at www.socialsecurity.gov.

Q. If a veteran signs up for Medicare prescription drug coverage, will the premium and copays be a deductible medical expense for VA's health care means test purposes?

A. Yes, all annual medical out of pocket expenses are deductible for purposes of VA means test (subject to those aggregate expenses that exceed 5% of VA's applicable maximum pension rate).

Q. Will VA bill Medicare prescription drug plans for a veteran's prescription written by VA?

A. No, by law VA does not bill Medicare.

Q. If the veteran joins a Medicare prescription drug plan and also uses VA health care prescription benefits, will a veteran's payment of a VA medication copayment count towards Medicare prescription drug true out-of-pocket (TrOOP) toward his/her catastrophic limits?

A. No, VA health care and prescriptions benefits are separate and distinct from Medicare prescription drug plan requirements.

Q. How will the Center for Medicare & Medicaid Service (CMS) know if a veteran is enrolled with VA?

A. VA is currently discussing strategies to provide proof of VA enrollment to CMS.

Q. What happens if a veteran is disenrolled and no longer has access to the VA medical benefits package, which includes prescription drugs?

A. Although VA is not enrolling any new veterans in priority category 8, VA has never used the enrollment process to cut-off or disenroll current enrollees.  Depending on available funds, the cut-off point for enrollment may change in the future.  If such an enrollment decision is made in the future, the veteran would be able to join a Medicare plan without penalty if he or she signs up within 62 days of losing enrollment.

Q. What are the implications of Medicare's prescription drug plan for survivors and dependents of veterans who may be eligible for CHAMPVA?

A. For this information, please call 1-800-733-8387 or visit http://www.va.gov/hac/forbeneficiairies/forbeneficiaries.asp.

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