Most Veterans who do not receive a VA disability or pension payment or have a VA special eligibility, such as a recently discharged Combat Veteran or a Purple Heart recipient, must complete a financial assessment when applying for enrollment to determine their eligibility for enrollment and copay responsibility for VA health care and/or prescription medication. These Veterans must provide their gross household income (which includes spouse and dependent children) for the prior calendar year. This income information will be used to determine the Veteran’s enrollment status and copay responsibility for VA health care and/or prescription medication.
As of March 24, 2014, most Veterans are no longer required to complete the annual financial assessment known as a Means Test. Instead, VA will receive income information from the Internal Revenue Service (IRS) and Social Security Administration (SSA), and will contact the Veterans only if the information received indicates a change in their VA health benefits may be appropriate. The elimination of the annual means test frees enrolled Veterans to enjoy their VA health care benefits without worrying about completing annual income assessment forms. Under the new process, Veterans will be required to have one financial assessment on file – their current file if they’re already enrolled, or the assessment they provide when they apply. That assessment will be maintained and monitored by VA and updated only as substantial income changes occur.
- Veterans who do not receive a VA disability or pension payment or who have a VA special eligibility such as a Purple Heart must report their total gross household income (includes spouse and dependents, if applicable) information when applying for VA health care enrollment.
- Veterans who are eligible for enrollment only because their income is below VA income limits will:
- Be still required to complete a means test when applying for VA health care enrollment
- Not be required to complete annual means test updates
- Be required to complete a means test at their next health care visit if their means test status is "Required"
- Veterans who complete a financial assessment to determine their eligibility for cost-free medications or Beneficiary Travel only will still be required to submit their income on an annual basis.
VA will receive income information from the IRS and SSA, and will contact the Veteran only when the information received indicates a change in VA health benefits may be appropriate. Consistent with VA’s current income verification processes, Veterans will still have access to care during the period of review should they dispute what IRS or SSA says about their income.
There is no change in VA's long-standing policy to provide no-cost care to indigent Veterans, Veterans with catastrophic medical conditions, Veterans with a disability rating of 50 percent or higher or for conditions that are officially rated as "service-connected."
VA encourages Veterans to continue to report changes in their income information, as well as their personal information, such as address, phone numbers, dependents, next of kin and health insurance, using VA Form 1010EZR available online or at their local medical center.
In order to ensure the availability of quality and timely health care to Veterans with service connected conditions, special authority based on military service, low income, and those with special health care needs, in January 2003 VA made the difficult decision to stop enrolling new Priority Group 8 (high income) Veterans whose income exceeded VA Income Thresholds.
The new regulations went into effect on June 15, 2009 and enable the Department of Veterans Affairs (VA) to relax income restrictions on enrollment for health benefits. While this new provision does not remove consideration of income, it does increase income thresholds. You may be eligible for enrollment under this new provision.
- VA is required by law to verify Veterans' household income. The Income Verification (IV) process is used to match Veterans’ household income with the Internal Revenue Service (IRS) and Social Security Administration (SSA). Veterans subject to this process are Veterans who receive free medical care and/or medications based on their household income.
- If a Veteran’s income is below VA's income limits but the income information received from IRS/SSA indicates the Veteran’s household income is above VA’s income limits, the Veteran and spouse, if applicable, will be notified by letter and given an opportunity to verify or dispute this information. The VA Income Verification Office Benefits Case Managers will assist the Veteran in identifying and reviewing all documents including those that may reduce the Veterans’ total gross household income by identifying and using authorized deduction. If the information does not reduce the Veteran’s income below VA’s income limits, the Veteran’s copay status will be changed and the Veteran will be required to pay copays for care received during the income year under review.
- If the Veteran is unable to pay the copay charges, there are options (waiver, compromise or repayment plan) available that may help the Veteran. These options are available through the Veteran’s servicing VA healthcare facility or by calling 1-877-222-VETS (8387).
- Because of the timeframe for taxpayers to report income to the IRS, the IV process typically begins in July of the following year of reported income. For example, income for the 2010 income year will not be available from IRS/SSA until July of 2011.
Income Verification Communication Timeline
- IRS/SSA report indicates income discrepancies.
- Initial notification to the Veteran and Spouse (if applicable).
- Veteran mailed an initial notification letter and a reminder letter within 45 days if no response, offering the opportunity for the Veteran to verify or dispute the income reported by IRS/SSA and to submit additional deductible expenses, if any.
- An IV Benefits Case Manager will be assigned to work with the Veteran and/or the Veteran’s representative once a response is received. The Case Manager will provide assistance and guidance to the Veteran through the income verification process. It is our goal to work closely with the Veteran to resolve and close the income verification case within 75 days.
If no response is received within 75 days, it is assumed the IRS/SSA information is correct and a letter will be sent informing the Veteran that his/her copay status will be changed and of their copay responsibility.