Written By: Devin Golden
VA Health Care for Mesothelioma
Health care coverage is one of the benefits offered by the U.S. Department of Veterans Affairs (VA) to veterans with mesothelioma. If you sign up for health insurance through the VA, you’ll have access to some of the top mesothelioma specialists and treatment options for free or at minimal costs.
Reviewed By
Retired LCDR Carl Jewett
VA-Accredited Claims Agent
Reviewed By
Retired LCDR Carl Jewett
VA-Accredited Claims Agent
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Important Facts About VA Health Care for Mesothelioma
- Veterans with mesothelioma are eligible for free health care coverage benefits through the VA. Veterans with a service-connected mesothelioma have no copays for treatment.
- VA Health Care covers the cost of major surgeries, chemotherapy treatment, immunotherapy, radiation sessions, diagnostic tests, biopsies, follow-up scans and medication.
- Veterans should seek out a VA hospital with mesothelioma specialists on staff. However, veterans are not required to seek treatment at a VA hospital.
- The copay amounts listed on this page are based on VA rates for 2024. The VA updated the rates as recently as Jan. 1, 2024.
Eligibility for VA Health Care
VA Health Care is one of many VA benefits available to veterans with mesothelioma. This benefit provides veterans free health insurance and little-to-no copayments for medical care, such as inpatient care, outpatient care, prescriptions, extended care, and urgent care.
Eligibility for the VA Health Care program is not automatic. As of 2003, veterans could not qualify simply because they were veterans. Now, veterans must have a service-connected disability, qualify for VA Pension or Aid & Attendance, fall into a specific group of veterans who were exposed to toxic substances while on active duty, or have an income below the limits set by Congress.
The VA divides these groups into priority groups. The highest priority groups receive preferential treatment with no out-of-pocket expenses, while lower priority groups have copays for treatment and medications.
To qualify for VA Health Care, you must fall into one of the following eight priority groups:
- Priority Group 1 – Veterans with service-connected disabilities rated at 50% or more, or have received the Medal of Honor
- Priority Group 2 – Veterans with service-connected disabilities rated at 30% or 40%
- Priority Group 3 – Veterans who are former POWs, have been awarded a Purple Heart, or have a service-connected disability rated at 10% or 20%
- Priority Group 4 – Veterans receiving Aid & Attendance (A&A) or housebound benefits or those determined to have a catastrophic non-service-connected disability
- Priority Group 5 – Veterans without a service-connected disability and those with a 0% rated service-connected disability, whose income is below the VA’s national annual income threshold, or veterans receiving VA Pension or veterans eligible for Medicaid
- Priority Group 6 – Veterans exposed to certain environmental hazards such as Agent Orange, ionizing radiation, burn pits or contaminated water at Camp Lejeune (veterans who participated in Project SHAD are also eligible)
- Priority Group 7 – Veterans with income below the VA’s geographically adjusted income limits (based on the zip code of the veteran’s primary residence) who agree to pay copays
- Priority Group 8 – Veterans with income above the VA’s national annual income threshold or geographical adjusted income limits by 10% or less (called the national annual income relaxation threshold)
If you don’t fit the criteria for one of the priority groups, and your income is more than 10% above the national annual income threshold and geographical adjusted income limit, you are not eligible for VA Health Care.
Veterans with service-connected mesothelioma will be enrolled in Priority Group 1. Since veterans with service-connected mesothelioma are awarded a 100% disability rating, any veteran receiving VA Disability Compensation for mesothelioma will be assigned to Priority Group 1.
Veterans with non-service-connected mesothelioma who meet the eligibility criteria for VA Pension will be enrolled in Priority Group 5. However, veterans with non-service-connected mesothelioma who are housebound or need A&A will be enrolled in Priority Group 4.
VA National Annual Income Thresholds
The VA has thresholds for annual income to qualify for VA Health Care. These thresholds depend on your location, as the VA considers your zip code when determining the threshold.
Contact LCDR and VA claims agent Carl Jewett at cjewett@mesotheliomaguide.com to learn more. He can also calculate your threshold based on your zip code.
Copayments By Priority Group
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | |
|---|---|---|---|---|---|---|---|---|
| Outpatient Care
$50 for specialty care and tests |
$0 | $0 | $0 | $15 | $15 | $15 | $15 | $15 |
| Inpatient Care | $0 | $0 | $0 | $0 | $15 | $15 | $326.40 +$2/day | $1,623 +$10/day |
| Prescriptions
No copayments when prescribed for service connected disabilities |
$0 | $5 - $11 | $5 - $11 | $5 - $11 | $5 - $11 | $5 - $11 | $5 - $11 | $5 - $11 |
| Extended Care (Inpatient)
No copayments when catestrophically disabled |
$0 | $0 | $0 | $97 | $97 | $97 | $97 | $97 |
| Extended Care (Outpatient)
No copayments when catestrophically disabled |
$0 | $0 | $0 | $15 | $15 | $15 | $15 | $15 |
| Urgent Care
No copayments for 1st three visits per year, then $30 |
$0 | $0 | $0 | $0 | $0 | $30 | $30 | $30 |
Priority Group
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | |
|---|---|---|---|---|---|---|---|---|
| Outpatient Care
$50 for specialty care and tests |
$0 | $0 | $0 | $15 | $15 | $15 | $15 | $15 |
| Inpatient Care | $0 | $0 | $0 | $0 | $15 | $15 | $326.40 +$2/day | $1,623 +$10/day |
| Prescriptions
No copayments when prescribed for service connected disabilities |
$0 | $5 - $11 | $5 - $11 | $5 - $11 | $5 - $11 | $5 - $11 | $5 - $11 | $5 - $11 |
| Extended Care (Inpatient)
No copayments when catestrophically disabled |
$0 | $0 | $0 | $97 | $97 | $97 | $97 | $97 |
| Extended Care (Outpatient)
No copayments when catestrophically disabled |
$0 | $0 | $0 | $15 | $15 | $15 | $15 | $15 |
| Urgent Care
No copayments for 1st three visits per year, then $30 |
$0 | $0 | $0 | $0 | $0 | $30 | $30 | $30 |
Notes: 30-day prescription costs can vary depending on whether the veteran is prescribed a preferred generic, non-preferred generic or brand-name prescription
How to Sign Up for VA Health Care for Mesothelioma
Signing up for VA Health Care for mesothelioma can be completed online through the VA website, by phone, mail, or in person at a VA medical center.
The best way to apply for VA Health Care is with assistance from a VA-accredited claims agent. Mesothelioma Guide’s VA expert, Navy veteran Carl Jewett, can guide you through the VA Health Care for mesothelioma application process. He will ensure all forms are completed properly and submitted in a timely manner.
Veterans with mesothelioma who do not qualify for enrollment in VA Health Care, can file for VA Disability Compensation or VA Pension, and enroll once approved. Once eligibility is determined, veterans can apply by submitting VA Form 10-10EZ. Veterans must also submit the letter from the VA approving their VA Disability Compensation or VA Pension claim.
What Does VA Health Care Cover for Mesothelioma?
VA Health Care covers most diagnostic tests and treatment options for mesothelioma, including:
- Major surgeries
- Chemotherapy
- Immunotherapy
- Radiation
- Diagnostic imaging tests
- Biopsies
- Follow-up scans
- Medication
Mesothelioma Treatment Costs for Veterans
Mesothelioma treatment costs for veterans will depend on the type of VA Health Care coverage they qualify for under their specific priority group. Therefore, treatment costs vary for each veteran.
For example, veterans with service-related mesothelioma who qualify for VA Health Care with no out-of-pocket expenses will not have to pay for treatment. Veterans with non-service-connected mesothelioma may have copays and deductibles before their treatment is fully covered.
According to the website Rare Tumors, the average cost of mesothelioma treatment in the United States in 2014 was around $24,000 per hospitalization. This amount has likely increased since the report was published.
The costs of chemotherapy, immunotherapy and radiation can range from a few thousand to tens of thousands of dollars. The amount fluctuates based on the type of treatment, the brand of chemotherapy or immunotherapy, and how long the veteran receives the treatment (how many cycles or sessions).
Reminder: VA Health Care coverage significantly reduces or eliminates the cost of treatment for veterans with mesothelioma. Many veterans can receive health care with no copayments – including for surgery, chemotherapy, immunotherapy and more cancer treatments – so the prices above do not reflect what veterans must pay if they are covered under VA Health Care.
The Benefits of Mesothelioma Treatment for Veterans
Because mesothelioma is an aggressive cancer, it is crucial for veterans to begin treatment immediately after diagnosis. Undergoing mesothelioma treatment, such as surgery, chemotherapy, radiation or immunotherapy, can add valuable time to a veteran’s life and improve their prognosis significantly.
For veterans who only receive medical care through the VA Health Care System, Mesothelioma Guide recommends receiving treatment from a VA hospital with mesothelioma specialists on staff who can perform aggressive surgeries, which have the highest likelihood of extending survival by multiple years. The two VA hospitals qualified to provide this level of treatment are the West Los Angeles VA Medical Center and the Michael E. DeBakey VA Medical Center in Houston, Texas.
Contact our VA-accredited claims agent, Navy veteran Carl Jewett, for more information about each hospital and help connecting with their staff. He will also help you get a referral from your local VA hospital to cover travel costs and assist you with other VA benefits.
How to Receive Mesothelioma Treatment through the VA
Once enrolled in VA Health Care, veterans have three options when seeking treatment via the VA Health Care system:
- Veterans can seek care directly from their local VA Hospital. With only two VA hospitals with mesothelioma specialists on staff, most VA hospitals are not qualified to treat veterans with mesothelioma.
- Veterans can be referred to an outside, civilian mesothelioma specialist. If a veteran obtains a referral, the VA will pay for treatment costs and reimburse any incurred travel costs.
- The VA Health Care system has two dedicated mesothelioma programs: one in Los Angeles for pleural mesothelioma patients and one in Houston for peritoneal mesothelioma patients. These programs are on par with, if not better equipped than, many civilian mesothelioma treatment centers.
Veterans can receive treatment from any VA hospital of their choosing. There are no additional costs when seeking treatment from a different VA hospital. However, a referral from your local VA doctor is necessary for the VA to cover travel costs.
VA MISSION Act
The VA MISSION Act, signed into law in 2018, created a permanent, new and improved Veteran Community Care Program, expanding veterans’ choices when seeking treatment from a civilian specialist. This program replaced the Veteran Choice Program created in 2014. Under the VA MISSION Act, veterans now have a choice to seek care from either the VA or from a private medical provider.
The law also eliminated the pre-existing requirements a veteran had to meet when accessing civilian medical care. For example, without a referral to a civilian specialist, a veteran could only receive community care if they lived more than 40 miles from a VA facility or had waited more than 30 days for an appointment. This no longer applies. Veterans with mesothelioma now have access to civilian treatment options and specialists.
CHAMPVA for Veteran Family Members
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program available to eligible family members of veterans with certain disabilities, such as mesothelioma.
The main eligibility criteria is the veteran’s disability rating. To meet the criteria, the veteran must have a permanent 100% disability rating by the VA for a service-related condition, such as mesothelioma. This means many families of veterans with mesothelioma are eligible for this health care program.
CHAMPVA provides medical coverage to those not eligible for TRICARE or Department of Defense health care programs. Spouses and dependent children of veterans with a permanent 100% disability rating are eligible for CHAMPVA. Surviving spouses and dependent children are also eligible if the veteran passed away from a service-connected disability.
VA Hospitals with Mesothelioma Treatment Programs
Mesothelioma patients should prioritize finding a specialist for treatment. Fortunately, two VA hospitals have mesothelioma programs and specialists on staff.
These VA mesothelioma hospitals, which are part of the VA Health Care system, have specialists on staff who can provide chemotherapy or immunotherapy treatments and perform aggressive surgery to remove tumors. Each facility collaborates with a top-ranked mesothelioma cancer center to provide life-saving treatment for veterans who have VA Health Care.
The VA hospitals with mesothelioma specialists on staff include:
- West Los Angeles VA Medical Center
- Michael E. DeBakey VA Medical Center (Houston, Texas)
West Los Angeles VA Medical Center
The West Los Angeles VA Medical Center is the only VA hospital with a team of pleural mesothelioma specialists. The program is led by Dr. Robert Cameron, one of the nation’s leading pleural mesothelioma surgeons. Dr. Cameron works with the UCLA Medical Center to offer veterans a team of specialists and multiple treatment options through a multimodal treatment program.
VA Health Care will cover treatment costs, such as surgery, chemotherapy, immunotherapy, radiation, medication, follow-up scans and more. The program at the Los Angeles VA hospital accepts patients from all over the country. If you are not local and required to travel to Los Angeles for treatment, you can request a referral to Dr. Cameron if you want the VA to cover travel costs.
Michael E. DeBakey VA Medical Center
The Michael E. DeBakey VA Medical Center in Houston is the only VA hospital with a program specializing in peritoneal mesothelioma treatment. The Houston VA hospital partners with Baylor St. Luke’s Medical Center, one of the leading peritoneal mesothelioma institutions in the country.
Baylor St. Luke’s has a prestigious mesothelioma treatment department. Dr. Eugene Choi, a peritoneal mesothelioma specialist and surgeon at Baylor St. Luke’s, treats veterans with mesothelioma at the Houston VA Medical Center. His team is an invaluable resource for veterans with peritoneal mesothelioma who have no civilian health coverage.
Veterans with VA Health Care can receive mesothelioma treatment at the Houston VA Hospital without a referral and any additional copays. However, if you are not local to Houston and must travel for treatment, a referral from your local VA doctor will ensure the VA covers travel costs incurred when traveling to and from Houston.
Helping Caregivers of Veterans With Mesothelioma
Under the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC), financial assistance, health benefits and certain travel benefits are available to family members of veterans who act as their caregivers. This program is mainly for the primary caregiver or two secondary caregivers.
Originally, this benefit was only for caregivers of veterans injured on or after Sept. 11, 2001. Under the VA MISSION Act, benefits and assistance are available to caregivers of all veterans regardless of when they were injured. This new law provides benefits to caregivers of all veterans with mesothelioma.
Caregivers will also receive training, respite care, peer support and other benefits. This law greatly helps caregivers of veterans with disabilities like mesothelioma. The new law went into full effect in October of 2022.
Frequently Asked Questions About VA Health Care for Mesothelioma
Can Veterans Get Free VA Health Care for Their Mesothelioma?
Veterans with a service-connected mesothelioma get free health benefits from the VA. The VA determines whether you have a service-related disease based on where most of your exposures to asbestos occurred. Other veterans with mesothelioma may also qualify for VA Health Care but with copays.
Will the VA Pay for My Mesothelioma Surgery?
VA health benefits cover copays for inpatient care in most mesothelioma cases. According to the VA website, inpatient care is covered for the first six priority groups, which applies to nearly all veterans with mesothelioma. Surgery is considered inpatient care as the veteran will stay in the medical center for multiple days.
What Are the Income Limits for Receiving VA Health Care?
The income limits for receiving cost-free VA health care apply only to instances when the veteran’s mesothelioma is not service-related. These veterans qualify for Priority Group 5 coverage, which has income limits:
- $41,125 (no dependents)
- $49,349 (one dependent)
- $52,180 (two dependents)
- $55,011 (three dependents)
- $57,842 (four dependents)
Does Social Security Count as Income for VA Health Care Eligibility for Mesothelioma?
Yes, Social Security counts as income for the purposes of determining your eligibility for VA health care. This factor is only relevant if your mesothelioma is not service-connected and you don’t qualify for VA Pension. If your disease is mostly related to your military service, then you’ll qualify for VA Disability Compensation and free VA health care regardless of your income or Social Security.
Do Veterans With Mesothelioma Have to Go to a VA Hospital?
No. There is no requirement that veterans must use their VA Health Care if they are enrolled or where they must go for medical care. Many veterans have private insurance plans and choose to see a civilian specialist. However, veterans seeking treatment through their local VA hospital will likely find that their VA hospital does not have a specialized mesothelioma program. In these cases, veterans can request that their VA doctor refer them to a civilian hospital with medical costs covered by the VA. This is beneficial, especially if the veteran has free VA Health Care with no copays. Veterans can also request a referral to either of the two VA hospitals: the West Los Angeles VA Medical Center or the Houston VA Medical Center in Texas. However, a referral to visit a non-local VA hospital is only necessary to get the VA to cover travel costs.
Sources & Author
- Eligibility for VA health care. United States Department of Veterans Affairs. Retrieved from: https://www.va.gov/health-care/eligibility/. Accessed: 11/17/2020.
- Your health care costs. United States Department of Veterans Affairs. Retrieved from: https://www.va.gov/health-care/about-va-health-benefits/cost-of-care/. Accessed: 11/17/2020.
- VA health care copay rates. United States Department of Veterans Affairs. Retrieved from: https://www.va.gov/health-care/copay-rates/. Accessed: 11/17/2020.
- VA priority groups. United States Department of Veterans Affairs. Retrieved from: https://www.va.gov/health-care/eligibility/priority-groups/. Accessed: 11/17/2020.
- Annual Income Limits – Health Benefits. United States Department of Veterans Affairs. https://www.va.gov/health-care/income-limits/introduction. Accessed: 11/17/2020.
- How to apply for VA health care. United States Department of Veterans Affairs. Retrieved from: https://www.va.gov/health-care/how-to-apply/. Accessed: 11/17/2020.
- Apply for health care benefits. United States Department of Veterans Affairs. Retrieved from: https://www.va.gov/health-care/apply-for-health-care-form-10-10ez/introduction. Accessed: 11/17/2020.
- Hassan A Khalil, MD. Brigham and Women’s Hospital. Retrieved from: https://physiciandirectory.brighamandwomens.org/details/14537/hassan-khalil-thoracic_surgery-boston. Accessed: 12/02/2020.
- The Program of Comprehensive Assistance for Family Caregivers. U.S. Department of Veterans Affairs. Retrieved from: https://www.va.gov/family-and-caregiver-benefits/health-and-disability/comprehensive-assistance-for-family-caregivers/. Accessed: 02/19/2024.
