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Spickering Asked February 2015
Does a WW2 honorably discharged Vet qualify for prescription and in home care?
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My father is a US Marine Vet of WW2 with a service connected disability, awarded at 10%. He was honorably discharged after contracting malaria. The disease destroyed the electrical side of his heart and so now at the age of 90 he is 100% reliant on his pacemaker and heart drugs. He and my mom have been prudent savers throughout their life and they have $250,000 remaining in their savings account. They live in the home they own. Might he qualify for benefits to assist in caring for his wife at home? And benefits to pay for his medications?
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thezookeeper Feb 2015
Regarding Medicare coverage and Part D: Part D is one component of the Medicare program. It provides coverage for some medications. It is in addition to Part A, for hospitalization, and Part B, which covers doctors, medical providers, home health, some medical supplies, etc. Part A is provided to all persons over age 65 that paid into the SS system while working and there is no premium or fee, but there are co-insurance and deductibles. It is also provided to persons that qualify for Social Security Disability benefits, if they are under age 65. Part B has a monthly premium that is usually deducted from the covered person's monthly Social Security check and generally covers around 80% of the approved customary charges, leaving the remaining balance to be paid by the person or a secondary insurance plan. Part D has some tricky rules that govern what is covered, when things are covered, and the amounts that are covered, and there can be amounts that the covered person has to contribute toward that coverage, depending on their circumstances. My mom gets a credit from Social Security for her Part D benefits, and it is applied toward her better, more comprehensive prescription plan that her retiree secondary insurance plan provides.
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thezookeeper Feb 2015
PS - If you get confirmation from VA that services provided by non-VA providers are covered by VA, then the provider (doctor or pharmacy, etc) can bill VA directly, just like any other insurance plan or Medicare. I assume he has Medicare coverage, and unless he opted into a managed care plan at VA, VA is his secondary insurer, unless he never worked and paid into Social Security.
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thezookeeper Feb 2015
You should absolutely contact VA. The rules changed recently for people that live too far from VA facilities, and some of the services that are being provided by non-VA providers are now covered by VA. This was the result of the big investigation and shake-up that followed the fraudulent reporting of wait times at VA facilities last year. You may be paying for things the VA just started covering.
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Spickering Feb 2015
A few years back VA was covering his prescriptions 100% but the 160 mile round trip to see a VA doctor was deemed to far. So he visits a local doctor now and pays his own meds. He is not on Part D, but perhaps should be. Does Part D have a fixed annual cost?
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thezookeeper Feb 2015
Check with the VA to see what benefits he is qualified for. Because it sounds like they gave a "partial award", he may not be fully covered for all VA benefits, including medical care. If he's Medicare eligible, Part D covers some, but not all, medications. If he's 90, he's in no position to be caring for his wife alone. You need benefits to help pay for caregivers to assist him and would be more likely to get financial assistance with paying for hired outside help. He will most likely need to "spend down" the $250k in order to be eligible for state Medicaid assistance, if you decide to take that route for assistance.
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