Written By: Devin Golden
VA Health Care for Mesothelioma
Free health care is one of many VA benefits available to veterans with mesothelioma. If you sign up for health insurance through the U.S. Department of Veterans Affairs, you’ll have access to some of the top mesothelioma specialists in the country.
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
- Eligibility for VA Health Care depends on whether the veteran meets the requirements for one of the eight priority groups.
- VA Health Care covers major surgeries, chemotherapy treatment, immunotherapy, radiation sessions, diagnostic tests, biopsies, follow-up scans and medication.
- Veterans and dependents with VA Health Care may seek treatment at a VA hospital or obtain a referral to an external civilian specialist.
Eligibility for VA Health Care
Eligibility for the VA Health Care program is not automatic. As of 2003, veterans cannot qualify simply because they are 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 breaks up these various groups into priority levels, with the highest priority levels receiving preferential treatment with no out-of-pocket expenses. Lower priority groups are required to pay co-pays for both 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 are 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 into one of the following 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. Veterans with non-service-connected mesothelioma but 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 bumped up to Priority Group 4.
VA National Annual Income Thresholds
| VA National Income Threshold | VA National Income Relaxation Threshold | |
|---|---|---|
| Veteran Alone | $39,849.00 | $43,834.00 |
| Veteran & Spouse or Dependent Child | $47,818.00 | $52,600.00 |
| Veteran & Spouse & Dependent Child | $50,561.00 | $55,617.00 |
| Veteran & Spouse & 2 Dependent Child | $53,304.00 | $58,634.00 |
| For Each Addtional Dependent | $2,743.00 | $2,743.00 |
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 | $320 +$2/day | $320 +$2/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 | $320 +$2/day | $320 +$2/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
You can sign up for VA health care for mesothelioma online through the VA website or in person at a VA medical center. We suggest getting help from a VA-Accredited Claims Agent. MesotheliomaGuide’s VA expert, Navy Veteran Carl Jewett, can guide you through the VA Health Care for mesothelioma application process.
Veterans with mesothelioma who do not otherwise qualify for enrollment in VA Health Care, can file for VA Disability Compensation or Pension, and enroll once approved. Once eligibility is determined, veterans can apply by submitting VA Form 10-10EZ. Veterans will also need to submit the letter from the VA approving either their VA Disability Compensation or Pension claim.
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. These facilities typically have oncologists on-staff who are qualified to treat veterans with mesothelioma. Common mesothelioma treatment options may include chemotherapy, radiation and possibly even immunotherapy. However, few VA hospitals have programs established that specialize in mesothelioma treatment.
Veterans can get a referral to an outside, civilian mesothelioma specialist. If a veteran obtains a referral, then 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 in order for the VA to cover the costs of travel.
VA MISSION Act
The VA MISSION Act, signed into law in 2018, creates a permanent, new, and improved Veteran Community Care Program, expanding veteran’s 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 provider.
The law also gets rid of the pre-existing requirements a patient 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 they had waited more than 30 days for an appointment.
Veterans with mesothelioma will now have a chance to get connected to civilian treatment options and specialists they might not have had access to before.
What Does VA Health Care Cover for Mesothelioma?
VA Health Care covers most diagnostic tests and treatment for mesothelioma, including:
- Major surgeries
- Chemotherapy treatment
- Immunotherapy
- Radiation sessions
- Diagnostic tests
- Biopsies
- Follow-up scans
- Medication
VA Hospitals with Mesothelioma Treatment Programs
Mesothelioma patients should prioritize finding a specialist for treatment. Fortunately, there are two VA hospitals that offer mesothelioma treatment for veterans. These hospitals feature specialists from highly regarded cancer centers, and they are part of the VA health care system.
The VA hospitals with mesothelioma specialists on-staff include:
- West Los Angeles VA Medical Center
- Michael E. DeBakey VA Medical Center (Houston, Texas)
Each facility collaborates with a top-ranked mesothelioma cancer center to provide life-saving treatment for veterans who only have VA Health Care. These VA hospitals offer veterans with mesothelioma a chance to undergo surgery, chemotherapy, radiation or other treatment methods that can significantly improve chances of survival and quality of life.
West Los Angeles VA Medical Center
The West Los Angeles VA Medical Center is the only VA hospital with a dedicated team of pleural mesothelioma specialists. The program is headed 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.
The West Los Angeles VA Medical Center accepts patients throughout the United States. Your VA health insurance will cover costs and qualify you for treatment. A referral to Dr. Cameron is only necessary if you want the VA to also cover travel costs.
Michael E. DeBakey VA Medical Center
Towards the end of 2019, the Michael E. DeBakey VA Medical Center in Houston announced a new peritoneal mesothelioma program. The VA center partners with Baylor St. Luke’s Medical Center, one of the leading peritoneal mesothelioma institutions in the country.
Aspirations to begin treating patients in 2020 stalled due to the COVID-19, but the vision remains the same and the program has been up and running since 2021. The Houston-based VA hospital provides another option for veterans living in Texas, neighboring states or anywhere in the United States.
Baylor St. Luke’s has a prestigious mesothelioma treatment department. One of Baylor’s surgeons, Dr. Eugene Choi, a peritoneal mesothelioma specialist, serves the Veteran mesothelioma community by treating veterans at the Houston VA. His team is an invaluable resource for veterans with peritoneal mesothelioma who have no civilian health coverage.
Veterans with VA Health Care can receive treatment at the Houston VA Hospital without a referral and without any additional copays. However, 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), assistance was only available to caregivers of post-9/11 injured veterans. Under the VA MISSION Act, benefits and assistance will now be available to caregivers of veterans from all eras.
Prior to 2001, caregivers of veterans didn’t receive the same benefits. They weren’t eligible for cash stipends or medical benefits.
The VA MISSION Act provides all caregivers of veterans with mesothelioma these benefits. They will also receive training, respite care, and peer suppor. This new law will greatly help caregivers of veterans with disabilities like mesothelioma.
Frequently Asked Questions About VA Health Care for Mesothelioma
Which 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.
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 almost 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:
- $39,849 (no dependents)
- $47,818 (one dependent)
- $53,304 (two dependents)
- $56,047 (three dependents)
- $58,790 (four dependents)
Does Social Security count as income for VA health care eligibility for mesothelioma?
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 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.
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. Many veterans have private insurance plans and choose to see a civilian specialist through their private health insurance plan. 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. Veterans can also request a referral to either the Los Angeles or Houston VA hospital. However, a referral to another 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/healthbenefits/apps/explorer/AnnualIncomeLimits/LegacyVAThresholds?FiscalYear=2020. 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/application/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.
