7. Converted Minivans
VA
i) The VA offers a grant to PALS whose disability has been determined by the VA to be service-connected. The grant will help defray conversion expenditures, which can be very high ($15,000 and up). The veteran must bear the cost of the van itself.
Medicare
i) Medicare offers no assistance for a van purchase or conversion. IRS Itemized deduction may be possible.
8. Hospitalization
The VA charges a co-pay for hospital room and surgical charges, which in my case was covered by my secondary insurer. I believe that Medicare benefits are similar.
9. Respiratory Function
At the VA, neurologists or pulmonologists assigned to your case may prescribe an overnight sleep study at the hospital to measure oxygen in the blood and whether you can benefit from reduced strain on the muscles used in breathing. The hospital also performs various other pulmonary tests (fvc, nif). The VA will provide a BiPap machine when your forced vital capacity (FVC) is above 50%. It is my understanding the Medicare will provide a BiPap machine only after your FVC is below 50%. My machine was provided at no cost by the VA, and I received detailed instructions on how to use it.
Showing posts with label VA Benefits. Show all posts
Showing posts with label VA Benefits. Show all posts
Sunday, January 6, 2008
Outside Input on VA benefits for home care and medications
I received this personal experience comment from Lee Kramer. He has also posted it on the Yahoo Living with ALS group and on ALSA's advocacy site. It seems he has had a slightly different and in some ways more successful time with the VA.
His comment:
"You must request the home visit or no visit
happens. Monthly visits are still a dream but if you make enough noise it
can happen but there is a time limit and once that limit is reached you must
be recertified for more. Your GP is the one who authorizes med. Renewals,
except for ALS directed meds, Rilutek Lexapro etc., are refilled by your
neurologist. If you are 100% disabled there is no charge. Home health care
for vets with ALS has been fought by me so they supply me with 42 hrs a week
for a CNA
only. VA regulations state; “If one Veteran is supplied a specific service
or benefit, they MUST offer the same service or benefit to ALL veterans”.
If you can find a home health care agency that has a VA contract your
waiting is cut to weeks. Mine took 3 weeks from request to first visit. I
did have to write the VA Director in D.C. to get the fire started. The more
noise the vet makes the better the benefits adjust to their needs."
His comment:
"You must request the home visit or no visit
happens. Monthly visits are still a dream but if you make enough noise it
can happen but there is a time limit and once that limit is reached you must
be recertified for more. Your GP is the one who authorizes med. Renewals,
except for ALS directed meds, Rilutek Lexapro etc., are refilled by your
neurologist. If you are 100% disabled there is no charge. Home health care
for vets with ALS has been fought by me so they supply me with 42 hrs a week
for a CNA
only. VA regulations state; “If one Veteran is supplied a specific service
or benefit, they MUST offer the same service or benefit to ALL veterans”.
If you can find a home health care agency that has a VA contract your
waiting is cut to weeks. Mine took 3 weeks from request to first visit. I
did have to write the VA Director in D.C. to get the fire started. The more
noise the vet makes the better the benefits adjust to their needs."
Friday, January 4, 2008
VA versus Medicare - power chairs and orthotic devices
5. Power Chair
VA
i) The assigned VA neurologist arranges an appointment at a wheelchair clinic held at the VA center. At the clinic, an occupational therapist (OT) measures the patient for a chair and discusses with a representative of the prosthetics department the features that should be included in the chair, such as tilt and recline features. Within about 30 days, the VA delivers a new chair to the patient and provides information on its use. There is no charge to the patient for the chair, and the VA will provide an additional chair as needed. It also provides adaptive devices required as the patient becomes less capable of operating the chair, including caregiver controls.
Medicare
i) Under Medicare, PALS must locate a contractor who generally helps with Medicare processing. Medicare will provide only 1 wheelchair per patient, you have a co-pay, and Medicare does not cover devices that allow the caregiver to operate the chair.
6. Orthotic Devices
VA
i) Under the VA, orthotic devices such as hand splints and ankle-foot orthoses (AFOs) are provided at no charge and can be custom fitted by VA contractors who measure you in the VA medical center.
Medicare
i) Under Medicare, the patient must visit a specialist for a prescription, find a provider who can supply the orthoses, and pay a copay.
VA
i) The assigned VA neurologist arranges an appointment at a wheelchair clinic held at the VA center. At the clinic, an occupational therapist (OT) measures the patient for a chair and discusses with a representative of the prosthetics department the features that should be included in the chair, such as tilt and recline features. Within about 30 days, the VA delivers a new chair to the patient and provides information on its use. There is no charge to the patient for the chair, and the VA will provide an additional chair as needed. It also provides adaptive devices required as the patient becomes less capable of operating the chair, including caregiver controls.
Medicare
i) Under Medicare, PALS must locate a contractor who generally helps with Medicare processing. Medicare will provide only 1 wheelchair per patient, you have a co-pay, and Medicare does not cover devices that allow the caregiver to operate the chair.
6. Orthotic Devices
VA
i) Under the VA, orthotic devices such as hand splints and ankle-foot orthoses (AFOs) are provided at no charge and can be custom fitted by VA contractors who measure you in the VA medical center.
Medicare
i) Under Medicare, the patient must visit a specialist for a prescription, find a provider who can supply the orthoses, and pay a copay.
Tuesday, January 1, 2008
VA versus Medicare - Home Care and Specialists
3. Home-based Care
VA
i) After your appointment with the primary care doctor, the VA will schedule a home visit from a nurse practitioner and a social worker. The nurse practitioner will visit monthly, checking vital signs, renewing prescriptions and adding new medications, if necessary. There is a modest charge for these visits ($15), with an annual cap of $150. The VA offers up to six months of visits by a home care worker for up to 10 hours each week. The problem is that there is a very long waitlist for this service (a year or more, we were told). Patients are not eligible for the VA home-based care program if they are already enrolled in a hospice program.
Medicare
i) It is my understanding that Medicare does not provide in-home care unless your physician orders it for a skilled need (usually PT, RN or SLP). Medicare does not cover custodial care (help with activities of daily living) unless you also have a skilled need. Coverage of custodial and skilled care is very limited.
4. Specialists (neurologists, speech therapists, occupational and physical therapists, pulmonologists, etc.)
VA
i) In the Washington, DC area, the VA hospital provides a one-stop shop. That is, all of the medical personnel who treat PALS are located in one place. After meeting with a new primary care doctor, you are assigned to a neurologist who will give you a comprehensive examination, write prescriptions for medications and medical devices, and refer you to other specialists in the hospital. The Washington, DC VA center has recently established its own ALS Clinic to provide comprehensive, interdisciplinary care for PALS.
Medicare
i) Under Medicare, a one-stop shop option may be available but is not as seamless. PALS can enroll in an ALS clinic such as the one at George Washington University and see a number of practitioners every three months for a half day session. If the patient has both Medicare Parts A and B coverage and the facility is an approved provider under the patient's healthcare program, the medical expenses should be very low. VA would be preferable, however, because there are no billing issues or medical need issues connected with the care that is provided.
VA
i) After your appointment with the primary care doctor, the VA will schedule a home visit from a nurse practitioner and a social worker. The nurse practitioner will visit monthly, checking vital signs, renewing prescriptions and adding new medications, if necessary. There is a modest charge for these visits ($15), with an annual cap of $150. The VA offers up to six months of visits by a home care worker for up to 10 hours each week. The problem is that there is a very long waitlist for this service (a year or more, we were told). Patients are not eligible for the VA home-based care program if they are already enrolled in a hospice program.
Medicare
i) It is my understanding that Medicare does not provide in-home care unless your physician orders it for a skilled need (usually PT, RN or SLP). Medicare does not cover custodial care (help with activities of daily living) unless you also have a skilled need. Coverage of custodial and skilled care is very limited.
4. Specialists (neurologists, speech therapists, occupational and physical therapists, pulmonologists, etc.)
VA
i) In the Washington, DC area, the VA hospital provides a one-stop shop. That is, all of the medical personnel who treat PALS are located in one place. After meeting with a new primary care doctor, you are assigned to a neurologist who will give you a comprehensive examination, write prescriptions for medications and medical devices, and refer you to other specialists in the hospital. The Washington, DC VA center has recently established its own ALS Clinic to provide comprehensive, interdisciplinary care for PALS.
Medicare
i) Under Medicare, a one-stop shop option may be available but is not as seamless. PALS can enroll in an ALS clinic such as the one at George Washington University and see a number of practitioners every three months for a half day session. If the patient has both Medicare Parts A and B coverage and the facility is an approved provider under the patient's healthcare program, the medical expenses should be very low. VA would be preferable, however, because there are no billing issues or medical need issues connected with the care that is provided.
VA versus Medicare for PALS - Medications
2. Medications
VA
i) For the appointment with the primary care physician, you should bring along a list of all your medications. The doctor will then arrange for you to obtain these medications from the VA. For most medications the charge is $8 for a month’s supply of each medication, including Rilutek and a wide range of other medications. In some cases, the VA will only have one of a particular type of medication on its formulary; for example, it supplies Claritin rather than Zyrtec. Prescriptions can be refilled by telephone, and they usually reach you within 10 days.
Medicare
i) Medicare offers assistance in reducing the cost of medicines through the Medicare Part D program for beneficiaries. Since the monthly cost of Rilutek is about $800, Medicare benefits are much more costly than VA benefits for medicines. PALS would find themselves in the famous “doughnut hole” about halfway through each year. It may be more cost-effective to obtain medicines through your traditional health insurance, but in my case VA medicines were by far the least expensive.
VA
i) For the appointment with the primary care physician, you should bring along a list of all your medications. The doctor will then arrange for you to obtain these medications from the VA. For most medications the charge is $8 for a month’s supply of each medication, including Rilutek and a wide range of other medications. In some cases, the VA will only have one of a particular type of medication on its formulary; for example, it supplies Claritin rather than Zyrtec. Prescriptions can be refilled by telephone, and they usually reach you within 10 days.
Medicare
i) Medicare offers assistance in reducing the cost of medicines through the Medicare Part D program for beneficiaries. Since the monthly cost of Rilutek is about $800, Medicare benefits are much more costly than VA benefits for medicines. PALS would find themselves in the famous “doughnut hole” about halfway through each year. It may be more cost-effective to obtain medicines through your traditional health insurance, but in my case VA medicines were by far the least expensive.
Sunday, December 30, 2007
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.
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.
Benefits for PALS who are veterans
About a year ago, I learned about programs offered by the VA for PALS who had done active military service. The VA doctor visited the George Washington University ALS Clinic. She was interested in setting up a similar multi-disciplinary clinic at the VA Center in Washington, D.C. I learned from her that, even with as little as two years active duty, I was eligible for some VA benefits that would help me defray the costs of this disease.
The VA offers two programs for PALS vets: the first program provides major medical benefits. The extent to which a veteran can enjoy these benefits depends on whether he or she can prove that ALS is service-connected. The discussion of health benefits which follows covers programs offered by the Washington VA Center and may not apply to all other VA Centers in the country. The second major program provides pension benefits for disabled vets. Again, service connection results in more benefits and the VA goes through a detailed disability assessment to determine the level of pension benefits.
The extent and quality of the VA medical benefits I am receiving from this facility is outstanding. The doctors are excellent and highly knowledgeable. Because my illness is not service-connected, I am not eligible for all the benefits offered; for example, a grant to help cover the cost of a van conversion. I have not applied for a VA disability pension because many other vets have a greater need than I for this support. The local chapter of the ALS Association has worked closely with the DC VA in the cases of PALS veterans. In the area of medical benefits, ALSA has helped to increase VA support. In the pension area, it will take a great deal of time and effort to get the VA to tailor its disability criteria to the vets with our unusual disease. The progression of ALS rapidly reaches the condition of total disability but the military yardstick is more appropriate to vets who have lost a limb. Many PALS with full military careers have found it very difficult to get disability benefits commensurate with their condition. ALSA is putting together a briefing package on VA benefits that I contributed to; it should appear on their national website soon. What follows in the next few posts is a piece which will summarize the medical benefits I am receiving from the DC VA Center relative to those that I am familiar with under Medicare.
The VA offers two programs for PALS vets: the first program provides major medical benefits. The extent to which a veteran can enjoy these benefits depends on whether he or she can prove that ALS is service-connected. The discussion of health benefits which follows covers programs offered by the Washington VA Center and may not apply to all other VA Centers in the country. The second major program provides pension benefits for disabled vets. Again, service connection results in more benefits and the VA goes through a detailed disability assessment to determine the level of pension benefits.
The extent and quality of the VA medical benefits I am receiving from this facility is outstanding. The doctors are excellent and highly knowledgeable. Because my illness is not service-connected, I am not eligible for all the benefits offered; for example, a grant to help cover the cost of a van conversion. I have not applied for a VA disability pension because many other vets have a greater need than I for this support. The local chapter of the ALS Association has worked closely with the DC VA in the cases of PALS veterans. In the area of medical benefits, ALSA has helped to increase VA support. In the pension area, it will take a great deal of time and effort to get the VA to tailor its disability criteria to the vets with our unusual disease. The progression of ALS rapidly reaches the condition of total disability but the military yardstick is more appropriate to vets who have lost a limb. Many PALS with full military careers have found it very difficult to get disability benefits commensurate with their condition. ALSA is putting together a briefing package on VA benefits that I contributed to; it should appear on their national website soon. What follows in the next few posts is a piece which will summarize the medical benefits I am receiving from the DC VA Center relative to those that I am familiar with under Medicare.
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