Unreimbursed Medical Expenses

Discussion in 'General Discussion' started by daughterkaren, Jun 27, 2012.

  1. daughterkaren

    daughterkaren Newbie

    My mother currently receives $1,094/mo. from the VA for aid and attendance. The VA recently approved her yearly renewal, but did not address her annual reimbursements. I believe that an error was made and that she is entitled to receive some reimbursement for the past two years: As I understand it, the VA can reimburse medical expenses paid by the beneficiary up to the amount of their other countable income. An Eligibility Verification Report is mailed to the individual annually to report the amount of medical expenses paid during the preceding 12 month period. The date and nature of each expense must be reported on the report. Based on this information, a determination will be made as to what percentage of the total can be reimbursed. A five percent deductible amount is first subtracted from the total amount of the expenses reported.

    So, as an example:

    1. Look at the veteran’s annual income other than VA Pension. The VA adjustment cannot exceed this amount after considering the medical expenses. This would be social security of $11,986.00.

    2. Total the medical expenses for the year: 2010: $33,122 2011: $44,757.00

    3. $33,122 x 5% = $1,656.10; $44,757 x 5%=$2237.85

    4. $33,122 – $1,656.10 = $31,465

    5. $44,757 - $2,237.85=$42,520

    These two years are excessively above her social security and I believe she is entitled to $23,972.00 in reimbursement
  2. vetwife

    vetwife Full Member

    I could very well be wrong, but I think maybe when you are receiving the max benefit amount, you have reached the threshold of how much the va will pay. I am sure Debbie will have more knowledge...
  3. cfess

    cfess Newbie

    I'm also interested in the answer to this question.
  4. detaildevil

    detaildevil Newbie

    This is a confusing topic, but no one here seems to know the answer. Here's what my Dad's award letter states:

    How Can You Claim Family Medical Expenses?
    To claim family medical expenses, complete the enclosed VA Form 21-8416,
    "Medical Expense Report," and return it to this office no later than
    December 31, 2013. We may consider family medical expenses you paid after
    September 30,2011.

    So, it's certainly implied that apart from the pension award, the VA MAY consider family medical expenses. What does that mean "may consider"? It goes on to suggests the pension award can change based on these expenses. Yet the countable income discussions here and the initial award calculation only include "recurring" expenses. If Dad went to the dentist this year, he's going to have to go next year, etc. and also true for the spouse. I guess this is to be sure no money goes out the door unless it is virtually guaranteed to be needed. The problem is when folks are low on money, they don't go to the dentist, etc., so then there are no expenses...just teeth falling out.

    Are these expenses ever reimbursed for folks? Are they reimbursed on any basis other than annually?
  5. Max

    Max Hero Member

    So here's the deal.

    Recurring expenses are expenses that will be exactly the same every month. Good examples would be assisted living costs, Medicare Part B premiums, or private medical insurance.

    Prescriptions, dentists, doctor visits, etc aren't recurring because they won't be exactly the same.

    Only recurring expenses are projected into the future. Expenses that aren't recurring can still be reported, but only after they have been paid. Then VA can count them retroactively.

    In respect to the "reimbursement", it actually isn't a reimbursement. For beneficiaries who are receiving benefits at the maximum rate, reporting additional expenses won't change anything. For beneficiaries who are receiving benefits at a rate less than the maximum, reporting expenses will increase their award (potentially retroactively) up to the maximum rate.

    For example, daughterkaren's mother will not see any increases or other payments (aside from cost of living) because she already has been granted at the maximum rate payable.
  6. detaildevil

    detaildevil Newbie

    Thanks, VSR.

    I do understand recurring versus non-recurring. I think a lot of people are confused about where and when they are used in this process.

    My Dad does not receive the max benefit, so I guess you are saying he MAY receive an adjustment due to non-recurring expenses. It sounds like you are saying it might ONLY be an increase in future pension amounts OR it might also be retroactive.

    This makes a big difference, obviously. And given that the expenses form COULD be returned as late as Dec. 2013 (date we were given in the award letter), then the expenses would be occurring for over two years in my Dad's case without any change from the VA. That's a tough situation when funds are dwindling (actually we are into significant credit card debt).

    Can I submit these forms earlier? I only read here of a typical report at one-year, so it sounds like no increased financial assistance until at least a year after the pension starts. I don't read much about this here so it might be nice to have it added to the FAQs.

    Thanks. Sorry if I sound frustrated. I can't get any answers from the VA phone line.
  7. Max

    Max Hero Member

    The award can be increased retroactively.

    And you can submit expenses at any time. The time limit in the letter is just the deadline. If you want to turn them in earlier, feel free.
  8. detaildevil

    detaildevil Newbie


    Thank you very much for explaining the process to me. I'll get my forms in as soon as possible.

    Happy Holidays,

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