Friday, May 06, 2011 Veteran's Benefits - Prescription Drug Program
If you are a Veteran and are "in the VA system" you can obtain your prescriptions from the V for free or for a modest charge. The veteran can get a prescription filled by the VA clinic if the prescription is issued by either a VA physician or a private doctor. The co-payment ranges from $0.00 to $9.00 for a 30 day supply per prescription. The determing factor for the level of co-pay is the veteran's annual household income which is reviewed annually.
How do you get "in the system"?
To get into the VA health system you need to contact the loca VA Health Care Administration. You will need to provide them with your discharge papers/ Then fill out their application form. Part of the form asks for financial information. If you don't fill in the financial information you can still get prescription drug coverage but you will pay the maximum of $9 per monthly supply of each drug. To get enrolled in the system it is necessary to have a physical exam with a VA doctor. Start early, because it may be months before you can schedule an appointment.
Once you are enrolled in the prescription drug program you can have your prescriptions filled. The VA will mail the prescriptions to you.
Annually you will receive more paperwork to fill out. To stay enrolled you need to complete and mail in the forms, otherwise you will be dropped from the program.
The Prescription Drug Program is a benefit you earned as a Veteran.
Prepared by Susan M. Graham
Attorney Accreditied with the Veterans Administration
The Graham Law Office, P.A., 1009 W. Fort Street, Boise, Idaho 83702
208-344-0375 Friday, February 11, 2011 Are You a Veteran? Do you qualify for a ‘Presumptive Disability Benefit?”
The Department of Veterans Affairs has a list of “Presumptive” Disability Benefits for Certain Groups of Veterans. What does it mean to have a “presumptive” service connected disability? According to the VA they presume “that specific disabilities diagnosed in certain veterans were caused by their military service.”
This means if you are a veteran and have been diagnosed with one of the identified conditions you may be eligible to receive a military service connected disability.
I have attached the list prepared by the VA.
Monday, January 24, 2011 Is Elder Law Just Alzheimer's, Medicaid and Veterans Administration (VA) Benefit Planning? NO!
There is a difference between the solutions offered with traditional estate planning and the solutions available using Elder Law techniques.
Traditional Estate Planning clients are motivated to minimize or eliminate death taxes, a court probate of their affairs after death and decide who will receive their assets.
As an Elder Law attorney, I address the concerns of a client as they age as well as when they die. The people we help are also worried about what to do if they or their spouse has a long-term illness. Just this week I met with Betty who placed Frank, her husband, in a nursing home that is costing $10,000 per month. She was panicked about what to do because her husband has Alzheimer’s disease and will never be able to return home.
Betty did not want a traditional estate planning solution. She was desperate to know . . .
• How can she pay for her husband’s care and not end up in the poor house herself?
• Will she lose her home?
• How can she have enough income to live on?
• Where can she go for help?
The answer to the last question is easy. Betty came to see an elder law attorney who has the answers to these questions. Our goal is to help Betty and our other clients protect their income and assets, obtain quality care, and maintain their independence.
If a traditional estate plan only addresses a part of your concerns, please call my office so we can talk about how we may be able to help you.
P.S. If you have a gun, have you written down the serial number and other identifying information? My neighbors called me this week telling me my farmhouse was broken into and a shotgun was among the things stolen. The sheriff asked if I had the serial number because then it would be easy to trace if it was pawned. I had a written description, but no number in my records. Pooh! I want you to benefit from my mistake so if you have guns, make sure you have the serial numbers just in case.
Monday, November 22, 2010 Compare VA to Medicaid
If you need help paying for long-term care should you consider the Medicaid or the Veterans Administration programs? In earlier blogs the details of the programs were covered. Here is a chart to summarize the high points of the two programs.
COMPARE VA TO MEDICAID
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Basic Comparison Points for
Medicaid Institutional Benefit vs. Veterans Aid and Attendance Benefit
For the State of Idaho
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Issue
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Aid and Attendance (A&A)
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Medicaid Institutional
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Asset Test for a Single Person
The person can keep ….
Note: There are other assets allowed, the information presented here is general.
[Other assets include cash, CDs, investments, 2nd home, 2nd car, etc.]
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House unlimited value
Car unlimited value
Stuff
Prepaid irrevocable funeral
Other assets no fixed number, but anticipate below $40,000
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House with maximum value of $750,000
Car unlimited value
Stuff
Prepaid irrevocable funeral
Other assets $2,000
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Asset Test for a Couple
The healthy spouse can keep…
Note: There are other assets allowed, the information presented here is general.
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House unlimited value
Car unlimited value
Stuff
Prepaid irrevocable funeral
Other assets no fixed number, but anticipate below $40,000
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House unlimited value
Car unlimited value
Stuff
Prepaid irrevocable funeral for both
One-half of the Other assets
But no less than $23,912 and no more than $111,560.
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Penalty for transfer of assets?
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No
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Yes – 5 Year look back
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Joint accounts/asset attributed all to Applicant.
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No. Split among joint account/title holders not in household.
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Yes.
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Cash benefit?
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Yes 2010 levels are
Single Vet $1644
Married Vet $1949
Widow of Vet $1056
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No. Pays for medical services, doe not give cash to recipient.
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Pays NH costs in full?
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No. VA A&A is a fixed payment amount. This is cash to the recipient, If A&A recipient goes on Medicaid the VA benefit reduced to $90.
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Yes. Minus cost share. Cost of share is usually the social security and pension income of the Medicaid recipient.
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Attorney Fees
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Cannot charge to do application, other limitations, read the rules.
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Can charge for all services.
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Certifications required to represent as attorney?
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Yes.
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No.
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P.S. Barbara and I were gone last week to a conference for law offices who use Apple computers. We were amazed how many attorneys think outside the box and have come up with creative ways to use computers in their office and the courtroom. We plan to use some of the ideas to enhance the services we offer out clients.
Happy Thanksgiving to you and yours. I'll enjoy cooking for friends and making pumpkin and apple pie for desserts.
Friday, July 23, 2010 HOW TO PAY FOR LONG-TERM CARE? - VETERANS BENEFITS CONTINUED: THE ASSET TEST
Last week, July 16, 2010, I wrote about some of the tests that must be met to qualify for a Veterans Administration “non-service connected pension” benefit that can help provide added funds to pay for care in your home or in a facility. These tests included 90 days of military service, one day of service during war time, having the right discharge papers, and having reoccurring monthly medical expenses that were more or somewhat less than your monthly income.
An important additional test to qualify for the VA benefit is the asset test. The Veteran (and their spouse) is allowed a number of assets that are not counted by the Veterans Administration. These include:
One house
One car
“Stuff” in the house.
The instructions for VA Form 21-526 define net worth as follows:
Net worth is the market value of all interest and rights in any kind of property, after
subtracting any mortgages and other claims against the property. List all assets
except the house in which you live, any reasonable area of land on which it sits,
and those items you use everyday, such as your vehicle, clothing and furniture.
Clearly indicate if you and your spouse jointly share assets (such as money in a
joint checking account). Report the value of farms or buildings that you or a
dependent owns as “real property.”
You must disclose all financial transactions that involve a transfer of assets, even
if the transaction occurred prior to the date of your application for VA pension. A
gift of property or a sale below the property’s value to a relative residing in the
same household does not reduce net worth. Likewise, a gift of property to someone
other than a relative residing in your household does not reduce any net worth
unless it is clear that you have relinquished all rights of ownership, including the
right to control the property
The “other assets” become the area of focus. Other assets include a second home, rental, cabin, bare lot, other cars, bank accounts, certificates of deposit, stocks, bonds brokerage accounts, Individual Retirement Account (IRAs), 401(k), other retirement accounts, cash value of life insurance, annuities, partnerships, and the list goes on.
The old rule used to be if the “other assets” were less than $80,000 they would be ignored, and the claimant (and their spouse, if any) could keep up to $80,000. That rule has changed. Now the total amount of the “other assets” that you can keep is dependent on the claimant’s life expectancy. If the “other assets” are over $50,000, it may be best to consult with a VA Accredited Attorney, VA Accredited Agent or the Idaho Veterans Service Office.
The value of the other assets is based on the current fair market value of the assets owned by the claimant (and their spouse). If an asset is owned by someone in addition to the claimant (and their spouse), then the value of the asset is considered proportional to the number of owners. For example if you have a single claimant, and a few years ago he put his three children’s names on his Certificate of Deposit valued at $100,000, the VA would treat his interest in the Certificate of Deposit as $25,000.
Unlike the Medicaid rule, the VA rules do not penalize a claimant if they have given assets away in the years before applying for the VA benefits. So, if a grandparent has helped a grandson by paying $10,000 for his school expenses and then the Veteran grandparent goes into an assisted living facility, there is no penalty for the gift. Under the new VA Form 21-526, it is necessary to disclose each gift, but there is no penalty imposed.
Watch out for irrevocable trusts. If the creator of the trust retains any “strings” of control, it is likely the VA will pull the asset back and treat it as if it belongs to the Veteran or the Veteran’s spouse.
What is a “string” of control? Examples include: Substitute assets, change trustees, change trust protector, change beneficiary, or income from the trust is distributed to the creator of the trust and a 1099 is issued in that person’s name.
Being able to receive the Veterans non-service connected pension is a great help to many so they can stay in their home or afford to pay for an assisted living facility.
One last great feature of the VA pension - there is no “Estate Recovery.” The VA is not a “loan” program. The VA does not want to be paid back after the death of the claimant. Friday, July 16, 2010 HOW TO PAY FOR LONG-TERM CARE? - VETERANS BENEFITS
In the last Blog we discussed Medicare as a first government program that can help with the costs of long-term care. Now we will discuss a second program, available through the Veterans Administration that can help certain Veterans with the costs of paying for care in their home, assisted living or skilled nursing homes,
VETERANS ADMINISTRATION (VA) BENEFITS
The Veterans rules are complex and do not always follow common sense guidelines. The information about the Veterans programs presented here are general in nature. If you are interested in pursuing Veterans benefits, you are encouraged to contact the Idaho State Division of Veterans Services to find the contact information for your local Veterans Service Office, 208-577-2300, or contact an Attorney or Agent Accredited with the Veterans Administration.
When to use this program?
It may be possible to use the VA “non-service connected disability income” (called “pension” by the VA) to help pay for care in the home, assisted living or skilled nursing home facilities. The VA benefit is sometimes referred to as “Aid and Attendance.”
The VA has a number of programs available to Veterans, but the only one addressed here will be the “non-service connected pension.” Veterans who are disabled as a result of their military service have other benefits available.
What does it take to qualify for the Veterans “pension” benefits? There are a series of tests to qualify for this benefit.
The simple tests are listed below:
• Are you a Veteran, Veteran's spouse, widow or widower of Veteran
• Was the Veteran in the military for 90 days
• Was one day of the military service during a defined Wartime. The war periods recognized by the VA1 are:
WWII December 7, 1941 through December 31, 1946;
Korean: June 27, 1950 through January 31, 1953;
Vietnam: February 28, 1961 through May 7, 1975 for Veterans who served in Vietnam during that period and August 5, 1964 through May 7, 1975 inclusive for all others;
Persian Gulf: August 2, 1990 through (no one knows since the war on Terror continues and is part of the Persian Gulf War)
• Other than dishonorably discharged
• Is the Veteran age 65 or older? There is no age limit for the Veteran's spouse.
The tests that can be more difficult to measure are concerned with the applicant’s income and assets.
Income Test
The income test compares the gross income of the veteran and the veteran's spouse to their repeating monthly medical expenses. Gross income is defined as the income from social security, pensions, dividends and interest and other sources of regular income, before any deductions are taken out for taxes, Medicare Part B premiums, other health insurance premiums, etc. Repeating monthly medical expenses include, but are not limited to Medicare Part B premiums, health insurance premiums, Medicare Part D premiums paid for prescription drug coverage, prescription drugs, the cost of care givers coming into the home, if the physician declares him or her housebound and in need of assistance from another individual, which may also include services offered in assisted living. If the physician states the applicant needs to live in a “protective environment” then 100% of the assisted living expenses may be deemed a reoccurring medical expense for VA purposes.
What does it really mean to be in “need of assistance from another?” These are some of the categories.
Blind
Living in a nursing home
Unable to
Dress/ undress or keep oneself clean and presentable
Attend the wants of nature without assistance
Have a physical or mental incapacity that requires assistance on a regular basis to protect the claimant from daily environmental hazards.
What is the maximum the VA pays in 2010 for Aid and Attendance Pension on a monthly basis?
For a single Veteran, $1,644
For a married Veteran $1,949
For a widowed spouse of a Veteran $1,056
For a Veteran married to a Veteran $2,540
Calculating the amount of the VA benefit.
Start with the gross Income before any deductions of a single person or both spouses.
Subtract from the gross income all repeating monthly medical expenses, such as insurance, prescriptions, attends, caregivers or assisted living or nursing home costs to come up with “net income”
If the difference is
Zero, the VA will pay the maximum benefit.
Less than zero, the VA will pay the maximum benefit.
More than zero, the VA will only pay the difference between the maximum benefit and the net income.
Here is an example of the calculation for a single vet:
Gross income from Social Security and Pension 3,150
Repeating monthly expenses for Medicare Part B, Medicare Part D premiums
health insurance premiums and the cost of caregivers coming into the home 2,150
Difference 1,000
VA maximum benefit 1,644
Subtract Difference 1,000
VA will pay 644
Next time we will discuss the other criteria needed to qualify for the VA non-service connected pension benefits.
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1Check the VA regulations for additional war time dates. Friday, June 25, 2010 The Conveyor Belt of Aging - As People Age They Usually Fall Apart
We all want to just die some day in the distant future. No one wants to be dependent and require caregivers for any extended period before we die. The reality is obvious - as we age we probably fall apart. Just like an older car, the tires get flat or bald, the fender rusts and falls off, the battery dies. What is the progression for people?
Hopefully you started on the conveyor belt of life for seniors as a healthy retired person. As the belt moves along have you found yourself;
• Taking medications
• Having health issues
• In the hospital for a crisis (pneumonia or a fall)
• Experiencing memory loss
• Less mobile
• Signing up for Medicare and supplemental insurance to help pay for all of this.
At this point care becomes an issue, care in the home is needed and a new concern becomes how to pay for that care. Is the care paid for “out of pocket," with long-term care insurance, Veterans Administration benefits, or Medicare? As the conveyor belt keeps moving, staying in the home may no longer be possible, so you move to an assisted living facility (where you can do a few things for yourself) or you become a fragile senior and need to be in a skilled nursing home. Again, the concern is what funds you will use to pay for that care – your own money, VA non-service connected pension benefits, Medicare, Medicaid or long-term care insurance.
What is the average length of care in facilities?
Assisted Living stays range from 2.5-3 years.1 To qualify to stay in an assisted living facility, the residents need some help with what are called “activities of daily living.” These six activities include: medications, bathing, dressing, toileting, transferring and eating.
Skilled Nursing Care (nursing home) stays average 2.4 years. Of course, the average is based on residents who stay for only a few days, and others who stay for a decade or more.
What does it cost for care in southwestern Idaho?
Assisted Living $2,000 to 5,000/month
Nursing Home $6,000 to $8,000/month
At Home $20/hr for a bath aide in the home to
$15,000/month for 24-hour care.
Once the conveyor belt has stopped, after death, are there care needs for the surviving spouse or dependent disabled children?
The issues become frightening when considering this progression. Start planning NOW.
1 Public Policy Institute, Assisted Living in the United States Fact Sheet, AARP, FS62R Friday, April 16, 2010 "Tough Luck" If You Miss A VA Deadline
Susan M. Graham, Accredited VA Attorney and Certified Elder Law Attorney, Boise, Idaho
David L. Henderson was discharged from the military in 1952, after serving on the front lines in the Korean War and was diagnosed of paranoid schizophrenia. He petitioned the VA for help with his service-connected condition in 2001. He represented himself, and his request was denied because he had 120 days to appeal, and he took 135 days. His request for reconsideration, or waiver of the 120-day deadline was denied by the United States Court of Appeals for the Federal Circuit in Washington. Why? Because the US Supreme Court ruled three years ago in Bowles V. Russell, [an appeal about filing deadlines related to a murder case], that filing deadlines are rigid and there are no excuses.
Even though it may take years for the VA to process a service connected claim, the VA is taking the position that there is no give in the filing deadlines no matter that Mr. Henderson’s psychiatrist said that he was “incapable of rational thought or deliberate decision- making and ...[is] incapable of understanding and meeting deadlines.”
This matter has been appealed to the US Supreme Court and hopefully before the Court leaves for the summer break, they will decide to hear this appeal.
Of course the legal system is not always fair, but this inflexible approach is more than disappointing as a way for dealing with Veterans with a disability that was caused by their military service and that disability makes it difficult to obtain the benefits to which they are entitled.
Source: “Strict Deadlines, Disabled Veterans and Dismissed Cases, by Adam Liptax, published April 5, 2010, The New York Times. |