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Veterans Affairs (VA) Benefits - Means Test Thresholds

Veterans enrolling in priority group 5 based on their inability to defray the cost of care must provide information on their annual household income and net worth to determine whether they are below the annually adjusted "means test" financial threshold.

Veterans completing a financial assessment must report their annual gross household income plus net worth, which includes Social Security, U.S. Civil Service retirement, U.S. Railroad retirement, military retirement, unemployment insurance, any other retirement income, total wages from all employers, interest and dividends, workers' compensation, black lung benefits and any other gross income for the calendar year prior to application for care. Also considered are assets such as the market value of property that is not the primary residence, stocks, bonds, notes, individual retirement accounts, bank deposits, savings accounts and cash.

VA also is required to compare veterans' financial assessment information with a geographically based income threshold. If the veteran's income is below the threshold where the veteran lives, he or she is eligible for an 80-percent reduction in the inpatient copayment rates.

Your previous calendar year income must fall at or below these amounts for classification into "Category 1 - Category A" medical treatment category. Veterans whose income alone falls below these levels may need further assessment to determine category placement if their income and/or assets are greater than $80,000. These thresholds are in effect for calendar year 2012, and normally change each January.

Add $2,093 for each additional dependent.

Definitions

(1) "Below the means test threshold." "Below the means test threshold" is defined as those veterans whose attributable income and net worth are such that they are unable to defray the expenses of care; therefore, they are not subject to co-payment charges for hospital and outpatient medical services. Within the Veterans Health Information Systems and Technology Architecture (VistA) system such veterans are designated as "Means Test Copay Exempt."

(2) "Above the means test and GMT threshold." "Above the means test and GMT threshold" is defined as those veterans whose attributable income and net worth are such that they are able to defray the expenses of care; therefore they must agree to pay a co-payment for hospital care and outpatient medical services. Within the VistA system these veterans are designated as "Means Test Copay Required."

(3) "Above the means test and below the GMT threshold." "Above the means test and below the GMT threshold," is defined as those veterans whose attributable income and net worth are such that they are able to defray the expense of care, but whose inpatient medical care co-payments are reduced 80 percent. Within the VistA system these veterans are identified as "GMT Copay Required."

Additional Information

An internal PDF document (requires Adobe Acrobat Reader) showing current and historical financial income thresholds for VA health care benefits is available in this version of WorkWORLD.

NOTE: Click here to view the Financial Income Thresholds tables.
Use the Help window's Back button to return here when finished.

Source

http://www.va.gov/healtheligibility/Library/pubs/VAIncomeThresholds/

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