VA versus Medicare for PALS - Eligibility

Many PALS have done military service and have Medicare insurance due to age or receive Medicare due to their Social Security Disability Benefits. The purpose of this paper (divided into a few separate posts) is to compare the two programs, Medicare and the VA, with respect to benefits for PALS. Hopefully it will serve as a guide, helping PALS decide which programs are advantageous at each of the succeeding stages of the disease. The information in this paper, especially with regard to benefits, reflects my own experience with the medical treatments and services I have received for my disease.

1. Eligibility

VA:
i) To begin the process at VA, you must go to the Eligibility Office in the main lobby of the local VA Medical Center (which in the DC area is located near Washington Hospital Center and Catholic University.) You must bring with you your military discharge paper (form DD 214) and information on your financial condition such as a net worth statement and tax return, and enough medical records to establish that you have a firm diagnosis of ALS.
ii) The eligibility officer will enter your data into the computer and, as happened to me, tell you that your income makes you ineligible for benefits. Insist that you are eligible because you have a catastrophic disability that puts you in Category 4 and makes you eligible for VA benefits because of your ALS diagnosis. The $35,000 a year income cap does not apply to veterans in Category 4.
iii) The Eligibility Office will then assign you to one of the six primary care sections at the hospital and schedule an appointment with a primary care physician to get the process of providing services and treatment started.

Medicare:
i) In order to be eligible for Medicare benefits, especially if you are under the age of 65 and not able to work, contact your local Social Security Administration office and apply for Social Security Disability Insurance (SSDI). When you are approved for SSDI with a diagnosis of ALS you will also receive Medicare Insurance. As in the case with VA, you must provide sufficient medical records to confirm your diagnosis. As a result of the successful lobbying effort by the ALS Association, you will receive SSDI and Medicare insurance after the SSDI waiting period of 5 months.