Financial Assessment
A financial assessment is a means of collecting the Veteran’s household income information which is used to determine whether a Veteran is eligible for enrollment and whether or not the Veteran would be required to pay copays for care or prescription medication. VA is required by law to collect this information.
There is no change in VA’s long-standing policy to provide no-cost care to Veterans who cannot afford to pay for their care, 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.”
Veterans Required to Provide a Financial Assessment
Not all Veterans are required to provide their income information to VA when applying for enrollment. Only certain Veterans who do not have a VA-rated service connected disability, who do not receive a VA pension payment or have a special eligibility, such as a recently discharged Combat Veteran or a Purple Heart recipient, must provide their gross household income (which includes spouse/partner and dependent children, if applicable) for the previous year when applying for enrollment for VA health care. This part of the application process is called an ‘income assessment or financial assessment” (also formerly called a means test) and is used to determine if these Veterans are eligible for enrollment and whether or not they have to pay copays for their health care or prescription medication.
Financial Assessments are not Required to be Updated Yearly
Enrolled Veterans are no longer required to provide their financial assessment on an annual basis if they had a current financial assessment on file as of March 24, 2014. This means Veterans can enjoy their VA health care benefits without worrying about having to submit updated income information to VA every year.
If the enrolled Veteran does not have a financial assessment on file as of March 24, 2014, the Veteran will be required to provide updated income information. Veterans may update their financial assessment when they visit their VA facility at their next appointment. Veterans may also update their information by submitting VA Form 1010EZR, which is available online, at their local VA medical center or by contacting 1-877-222-VETS (8387), to have the form mailed. This form is available online at https://www.1010ez.med.va.gov
Income Updates from IRS and SSA
VA securely receives income information from the IRS and SSA to confirm Veterans’ continued enrollment eligibility. VA will contact the Veteran (and spouse/partner and dependents, if applicable) only if the income information received from IRS and SSA indicates a change in the Veteran’s eligibility or copay requirements. Veterans will still have access to care during the period of review should they do not agree with the information VA receives from IRS and SSA.
Exceptions
- Veterans applying for enrollment must provide income information by using VA Form 1010EZ. This form is available online at https://www.1010ez.med.va.gov/ and can also be obtained at any VA medical center, Veteran Service Office, or by contacting 1-877-222-VETS (8387), to have the form mailed.
- Enrolled Veterans who are eligible because their household income is below the VA income limit (e.g., NSC and 0% SC Veterans without any special eligibility) will:
- Not be required to update their income on a yearly basis.
- Be required to complete a financial assessment at their next health care visit if they do not have a current financial assessment on file as of March 24, 2014.
Veterans Required to Provide Yearly Income Updates
Veterans who complete a financial assessment to determine their eligibility for cost-free medications or for Beneficiary Travel only are required to submit their income yearly.
Recent Combat Veterans
Combat Veterans who served in combat after the Gulf War or in combat against a hostile force after November 11, 1998, are eligible for free care for five years for any illness that may be related to their military service beginning on the date of the Veteran’s discharge. These Veterans are now eligible for an additional year of eligibility based on the Clay Hunt Act. For more information, please visit the Clay Hunt webpage.
These Combat Veterans are not required to provide their income for care related to their service in the theater of operations; however, they may complete the financial assessment to determine their eligibility for a higher priority status in the VA health care system, eligibility for beneficiary travel benefits, or for cost-free care for treatment not related to their military service.
Veterans Exposed to Agent Orange, Ionizing Radiation or Environmental Contaminants
Veterans who were exposed to Agent Orange in Vietnam, ionizing radiation, or exposed to environmental contaminants in the Persian Gulf receive free care for treatment related to their exposure. These Veterans are not required to provide their income; however, they may complete the financial assessment to determine if they are required to pay copays for care not related to their exposure.
Veterans who Decline to Provide Income Information
Veterans who decline to provide their income information and agree to pay copays for their care are not required to provide their income information; however, unless otherwise eligible (e.g. Compensable service-connected, former POW, Combat Veterans, served in the Republic of Vietnam, service during certain periods in Southwest Asia) the Veteran’s enrollment may be denied based on the enrollment restriction.
Information from IRS and SSA
If the information received from IRS and SSA may result in a change in the Veteran’s eligibility or copay requirement, VA will notify the Veteran and give the Veteran an opportunity to provide input. For more information about the income verification process, see the “Income Verification” section below.
Changes to Income and Personal Information
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. These changes can be submitted at any time.
Income Verification
VA is required by law to verify Veterans’ self-reported household income (including spouse/partner and dependents, if any) with the Internal Revenue Service (IRS) and Social Security Administration (SSA).
The Income Verification (IV) process is used to confirm the accuracy of Veterans eligibility for VA health care, copay status and enrollment priority group assignment. 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 year 2015 is available from IRS/SSA in July of 2016.
Veterans Included in the Income Verification Process
VA does not verify all enrolled Veterans’ income. Only Veterans who receive free medical care and/or medications based on their self-reported household income are included in the income verification process.
Income Verification Process
If a Veteran’s income is below VA's income limits (see income limits table), but the income information received from the IRS/SSA indicates the Veteran’s household income is above VA’s income limits, the Veteran and spouse/partner, if applicable, will be notified by letter and given an opportunity to verify or dispute this information.
If no response is received after 45 days, a reminder letter is mailed, offering the opportunity for the Veteran to verify or dispute the income reported by IRS/SSA and to submit additional deductible expenses, if any.
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 his/her copay status will be changed and of their copay responsibility. This may also impact the Veteran’s eligibility for enrollment. The Veteran will also receive information on how to appeal the decision.
When VA receives a response, an IV case manager will be assigned to work with the Veteran and/or the Veteran’s representative. The IV case manager will provide assistance and guidance to the Veteran through the income verification process, and will assist the Veteran in identifying any authorized deductions that may reduce the Veterans’ total gross household income below VA’s income limits. It is our goal to work closely with the Veteran to resolve and close the income verification case within 75 days.
If after the review process the information does not reduce the Veteran’s income below VA’s income limits, a final letter is mailed to the Veteran explaining that the Veteran will be responsible for copays and required to pay copays for care received during the income year under review. The letter also contains information on how to appeal the decision.
Financial Hardship
VA has programs that may help if the Veteran is unable to pay the copay charges. For more information, visit http://www.va.gov/HEALTHBENEFITS/cost/financialhardship.asp.
For more Information about the Income Verification program or financial assessments, contact the Income Verification office at 1-800-929-VETS (8387).
