Veterans Assistance for Durable Medical Equipment: TRICARE, CHAMPVA & VD-HCBS
The Department of Veterans' Affairs has many different programs that provide coverage or financial assistance for home or durable medical equipment (DME). Each of the following programs provides different benefits.
TRICARE for Life
TRICARE for Life (TFL) is supplemental health insurance for elderly and retired members of all seven of the uniformed services and their families. TFL serves as a secondary payer to Medicare; in other words, individuals are required to have Medicare Part A and Part B. Medicare Part B covers most durable medical equipment when medically necessary, but they typically require enrollees to pay 20% of the cost. TFL works to cover Medicare co-payments. Therefore, TRICARE for Life will pay for the remaining 20% of the cost of durable medical equipment that Medicare does not cover. Having said that, it is strongly suggested that one confirm with TRICARE for Life that they will cover the 20% for any DME item prior to purchase.
TRICARE (as opposed to TRICARE for Life) will pay for durable medical equipment when a doctor has determined the item is medically necessary. However, there are certain exceptions. For individuals that reside in nursing homes, typically the facility will provide the DME as part of their coverage (and therefore TRICARE will not). Items considered to contain features that may be desirable but are not necessary are excluded. For example, a walker with rollers and a handbrake might be excluded while a standard walker might be covered. Duplicate items are excluded as well, unless they serve as a fail-safe for life support.
CHAMPVA for Life
CHAMPVA for Life (CFL) is the VA health insurance program for aging persons 65+ years old who are family members of permanently disabled veterans or of those killed in the line of duty. To be eligible for CFL, one cannot also be eligible for TRICARE for Life. CFL serves as the secondary payer to minimize out-of-pocket expenses by covering the Medicare’s coinsurance and deductibles. Medicare Part B covers the cost of durable / home medical equipment, which is approved by Medicare. CFL covers the 20% co-payment for which Medicare will not pay.
Veterans Directed Home and Community Based Services (VD-HCBS)
VD-HCBS, also known as Cash and Counseling for Veterans, is a program managed at the local VA Medical Center, that provides veterans with a care budget and allows them to self-direct their services and supplies. As such, the program will pay for durable medical equipment that is medically necessary. Veterans are operating within a defined budget; however, they have flexibility in how that budget is spent. For example, one might choose to allocate a larger portion of their budget for a nicer wheelchair and make up for that by purchasing a less expensive hospital bed. Since they are working with a set budget, it is in their best interest to find the least expensive purchase price available. Read more about Veterans Directed Home and Community Based Services.
SAH, SHA and HISA Grants
These grants are intended more for home modifications than for durable medical equipment. However, there is not always a clear distinction between the two. Improvements made to a bathroom, for example, often blur the lines between what is medical equipment and what is a home modification. Are the grab bars that are installed in a shower considered to be medical equipment or part of the home modification? Read more about the SAH, SHA and HISA Grants.
Pensions, such as the Aid and Attendance Program, provide cash assistance to those veterans that meet the income limits. This financial assistance can be used towards any purpose the veteran chooses including the purchase of durable medical equipment and supplies not otherwise provided.