Insuring the Maximum VA Aid & Attendance Pension for a Veteran or Surviving Spouse

By: Rita Files, Accredited Veteran Claim Agent

You have completed the an eligibility questionnaire which should always be the first step of the process of filing for VA Benefits for Housebound or Aid & Attendance. Now what?

The application process for Veteran Pension commonly referred to as the “VA Aid & Attendance Benefit”, at first glance can be overwhelming for some people since this may be their first interaction with the VA system since the day they were discharged. For many more, it takes time to gather all the necessary documentation and complete the application paperwork. Then there are those Veterans that avoid applying all together rather than take on this daunting task.

Since many people seeking VA Pension do so for the supplemental income to offset the cost of eldercare services through home care or assisted living, they are anxious to learn if they will be awarded the benefit and hastily complete the VA form, without much attention to detail. By doing so, they stand a good chance of submitting a claim that is not well grounded or fully supported; causing many months of delays and in some cases, even denial.

Relax! There is a solution. You can place the VA on notice of your intention to file a claim, secure an effective date plus allow 1 year in which to complete the formal claim process by filing what is called “an informal claim”. An informal claim is some type of communication to the VA in which you state your intention to apply for benefits. I suggest using VA form 4138. This can either be completed & submitted online or downloaded and mailed to the VA. If mailed, make sure you send it via certified mail with return receipt and make a copy for yourself!

When you file an informal claim with VA, you need to clearly identify the benefit for which you intend to apply for, give the VA your SSN and dates and branch of service, in the case of a surviving spouse; this would be the Veteran information under whom you are applying. Once received and acknowledged by the VA, this becomes the effective date. As long as you send the VA your formal claim within the one year of that date and your claim is approved, that date becomes the day your eligibility to receive the Pension benefit starts. Since the VA Pension is retroactive to the date you notified the VA of your intention to file a claim, this could mean a substantial amount of money in retroactive benefits. Payments for retroactive benefits are made back to the first of the month following the month of the effective date.

On the other hand, if you are well prepared to complete the formal application VA 21-526 (Veteran) or VA 21-534 (Surviving spouse) in short order, you are way ahead of things and that would be the most expeditious way to go.

Drug prices rise for seniors who reach Medicare Part D coverage Gap - Kaiser Health News

Seniors who hit the coverage gap in their Medicare prescription drug plans and must use their own money to buy drugs are facing price increases that are far outpacing inflation, a new study finds.

According to the Kaiser Family Foundation, prices paid by enrollees in standalone Part D plans who enter the coverage gap increased 5 percent or more since January 2009 for half of 10 brand-name drugs most commonly used by seniors. That's almost twice the rate of inflation over the same period. (KHN is a part of the foundation).

For example, the price of Actonel, a treatment for osteoporosis, increased 8 percent, from $91 per month in 2009 to $98 per month in 2010. Meanwhile, the prices for both Aricept, an Alzheimer’s medication, and Plavix, a drug used to prevent blood clots, both increased by 7 percent during the same period. Aricept's prices rose from $184 to $198 while Plavix's rose from $142 to $152. Lipitor, a cholesterol medication, was the only drug surveyed that decreased in price, from slightly more than $86 to just under $86 per month.

The rising prices are part of a longer-term trend. Between January 2006 and January 2010, the analysis showed, prices of drugs bought by seniors who hit the coverage gap increased 20 to 25 percent for Lipitor, Plavix, Nexium, a drug for acid-reflux, and Lexapro, a medication for depression and anxiety; 39 percent for Actonel, and 41 percent for Aricept. Over the same period, inflation has increased 9.2 percent while prices for medical care have surged 16.1 percent.

Researchers examined the prices for specific medications that don't have generic substitutes, using data from the Centers for Medicare & Medicaid Services. The prices paid by seniors in the coverage gap, also known as the "doughnut hole," vary by drug plan, and depend largely on prices negotiated between the drug plans and pharmaceutical companies.

Under Medicare Part D, seniors get government-subsidized drug coverage until their total drug spending – by them and their drug plans -- exceeds a specific threshold, which is $2,830 in 2010. They then enter the doughnut hole, and must spend their own money -- $3,610 this year -- this year before they get "catastrophic" drug coverage. This coverage is more generous than their initial coverage.

The amount seniors must pay in the coverage gap is projected to increase to $5,755 by 2018. In 2007, an estimated 3.4 million Part D enrollees hit the coverage gap. The Democrats' health care legislation now being debated in Congress would gradually close the doughnut hole. The study said that previous research showed that some enrollees who reach the coverage gap sometimes skip needed medications when faced with the full cost.

If you are a veteran or the surviving spouse of a veteran you might be eligible for a monthly pension benefit, to help defray the cost of medications not covered under Medicare Part D. For additional information please visit www.awgveteranservices.net

Chubby Checker announces a new "Twist" on Medicare

by Patricia Grace, Aging with Grace

“If you’ve been thinking about applying for extra help with your Medicare prescription drug costs, then now’s the time to get on the dance floor and hop to it,” says Elizabeth Foster, Social Security Manager, South Philadelphia Office.

Chubby Checker, the Grammy Award winning rock and roll and Philadelphia legend most known for his hit, “The Twist,” has teamed up with Michael J. Astrue, Commissioner of Social Security, to tell people about a new “twist” in the law. The change in the law makes it easier for people with Medicare to qualify for extra help with their prescription drug costs.

“The changes in the Medicare law will allow hundreds of thousands of Americans who are struggling to pay their prescription drug costs to get extra help during these tough economic times,” said Commissioner Astrue. “ I am thrilled that Chubby Checker has volunteered to help us spread this important message through a new television, radio, and Internet spot as well as pamphlets and posters.”
“Listen up, America! For 50 years, people of all ages and backgrounds have danced the Twist,” Chubby Checker said. “Now it’s important everyone learn about this new twist in the law. Check it out at www.socialsecurity.gov.”

There are income and resource limits a person needs to meet to qualify for the extra help. But the new
Medicare law eases those requirements in two ways:

• The cash value of life insurance no longer counts as a resource; and
• Assistance people receive from others to pay for household expenses, such as food, rent, mortgage, or utilities, no longer counts as income.

A bonus “twist” is that the application you file for extra help can now start the application process for Medicare Savings Programs as well — state programs that provide help with other Medicare costs. These programs help pay Medicare Part B (medical insurance) premiums. For some people, the Medicare Savings Programs also pay Medicare Part A (hospital insurance) premiums, if any, and Part A and B deductibles and co-payments.

To learn more about the extra help program and to view the new television spot featuring Chubby Checker, visit Social Security online at www.socialsecurity.gov/extrahelp.

What is the VA Aid & Attendance Benefit program?

"I called the VA directly for information and was told there is no such benefit".

Unfortunately this is a common response. The VA Aid & Attendance benefit program is a descriptor commonly used in the civilian arena when providing information about the VA Non-Service Connected Pension. “Aid & attendance” is actually one tier of a three tiered benefit known in the VA system as VA Pension or Disability Pension. Over the course of years, the VA Pension took on the name Aid & Attendance causing much confusion especially when contacting the VA directly. Read more on caring.com ...

Finding a good nursing home

It is a decision filled with stress and emotion: placing a parent, spouse or other loved one in a nursing home after assisted living or home health care is no longer an option.

“Unfortunately, the typical search for a nursing home is made under duress. More than 60 percent of admissions come from hospitals,” writes Walecia Konrad in this week’s Patient Money,New York Times. “In such situations, you have precious little time to do your research….Paying for a nursing home is another huge source of stress.”

We at Aging with Grace recommend whenever possible that a family visit a nursing home more than once and at least one visit during off hours...Sunday morning at 9am is best. Sunday is generally the day that all hell breaks loose...staff doesn't show, people call out sick, etc.

It's important to observe how the facility handles these types of situations. Is the staff running around like chickens without heads, or are they pulling together to make sure that residents receive the care they need.

We also suggest that a family meet with the Administrator and review the facility's most recent state survey.

Unraveling the Mysteries of VA Benefits

By Rita Files, Accredited VSR

As a provider of senior services’ it is important to understand the difference between 2 major Veteran Benefit programs.

If your company has a contract with the VA to provide community based services’ you are caring for compensated Veterans who have “service connected status.” However, there are many more Veterans to reach through the “Non Service Connected Pension.”


VA definition of Compensation

People with “service connected disabilities’ who receive compensation benefits from the VA on a monthly basis for service related injuries and medical conditions as a result of their military service or conditions that may have been exacerbated as a result of their service to our country. The amount of monthly funding is directly related to their percentage of disability.

Most home care providers, adult day centers and nursing homes are familiar with this VA benefit. If you are approved by the Department of Veteran Affairs to provide home care to a veteran, you fall into this category.

The Non-Service Connected Pension

The NSC Pension, is commonly referred to as the “Veteran’s Benefit for Aid & Attendance” is the other benefit provided by the VA. This little known, underutilized program is intended to supplement low income Veterans and surviving spouses or those with high monthly medical expense. Approval for this benefit is not dependent on service related injuries and the additional income goes directly to the recipient and not the provider of care. Veterans who served a minimum of 90 days in the military with one day during war time and who have a discharge other than dishonorable and are age 65 or older or deemed permanently and totally disabled and surviving spouses of Veterans, who have not remarried, may be eligible for this benefit.

The NSC Pension is actually a 3 tiered benefit.

• Basic – does not require that you be physically disabled, but the person must have an annual income lower than $11.830

• Housebound – a veteran or surviving spouse whose physical limitations require a certain level of regular assistance with their daily routine may be eligible to receive “Housebound” benefits.

• Aid & Attendance – It the VA determines you meet their criteria, Aid & Attendance is the highest level of Improved Pension available to any US Military veteran (or surviving spouse) who satisfies the service, financial and physical criteria. A person does not have to reside in assisted living to be eligible for this level of the benefit and services do not have to be provided by a VA approved agency.

In addition, the NSC Pension benefit can be used to cover all approved monthly out of pocket expenses such as Medicare premiums, co-pays, emergency medical response systems, incontinence products to name a few.

One important question to ask all prospects that call your office, “are you or your spouse a veteran of the Armed Forces?” If they answer yes, that might be all that is needed to turn that prospect into a client.

Aging with Grace is committed to educating both caregivers and providers about this VA Benefit. Through our VA accreditation in VA Benefits and our experience working with the elderly, we provide the counseling and tools needed to help Veterans determine if they are eligible for NSC benefits and how to apply.

Does your aging parent need help with Medicare?

by Sheri Samotin, Aging with Grace, Ask the Expert

Have you ever walked into your aging parent's home and seen a stack of Medicare papers on the kitchen table? Has the thought crossed your mind that maybe you should have these papers come directly to you since they seem so confusing to your Mom? Is your Dad asking you which Part D drug plan he should select, or whether he should consider a Medicare Advantage program? Have claims been denied that your parents thought were for covered services? If so, you're not alone. Many seniors find dealing with their medical paperwork to be overwhelming.
Dealing with the sheer volume of medical paperwork can be intimidating for many beneficiaries. It is important that the explanations of benefits that are received from both Medicare and any supplemental insurance policy be reviewed promptly and if errors are detected, those should be reported immediately. Similarly, if claims are denied, they must be reviewed and possibly resubmitted if you believe they were denied in error. Time is of the essence for these matters, since there is a time limit for appealing the carrier's decision. If you decide that handling these tasks are too much for your parent, you might consider handling it for them or enlisting the help of a medical billing advocate who will review all of the paperwork on a monthly basis, ensuring that your parent is getting the benefits for which she has paid. In either case, you should be aware that Medicare will only send the paperwork to the beneficiary's address on file with the Social Security Administration or to a properly documented Representative Payee. (Further information is available at http://www.ssa.gov/.)

What about if your parent simply needs help selecting the right plans? Each year, Medicare-eligible people are allowed to switch their plan during "open enrollment". This process begins on November 15th and ends on December 31st. The best place to start is the Medicare website at http://www.medicare.gov/. There you can learn about "original Medicare", as well as about "Medicare health plans", "Medigap policies", and "Medicare prescription drug plans." Which offering is right for your parent will be determined based on a number of factors, including their overall health, finances, and the degree of choice they desire. You may find that while one approach works well for Mom, Dad is better off on a different plan due to the maintenance medications he takes. It is perfectly fine for your parents to each select the coverage that works best for him or her as an individual.

Purpose and direction in life could stave off Alzheimer's

KRISTINA FIORE, MedPage Today

People who view life with a sense of purpose and who set goals are less likely to develop Alzheimer's disease or dementia, new research indicates.
To determine sense of purpose, researchers at Rush University Medical Center, Chicago, questioned 951 elderly participants on their views of their past and future lives, and whether they felt they had a direction in life. Answers were tabulated and scores were rated on a five-point scale. During the average four-year follow up period, 155 participants developed Alzheimer's. Those who scored in the 90th percentile were 2.4 times less likely to develop Alzheimer's than those in the bottom 10th percentile, according to the report.

Researchers say the findings could provide new treatment interventions for elderly adults. The report appears in the March issue of the Archives of General Psychiatry.

Eye diseases of the elderly

by Patricia Grace


Glaucoma, cataracts, age-related macular degeneration and diabetic retinopathy are the most common vision-related diseases that affect millions of seniors every year and contribute to low vision.

Low vision is the loss of sight that is not correctable with prescription eyeglasses, contact lenses, or surgery. It includes different degrees of sight loss from having blind spots, poor night vision, and problems with glare to almost a complete loss of sight. The American Optometric Association divides low vision into two categories based on the vision in the best eye. There are multiple possible causes of low vision. Low vision is usually the result of disorders or injuries affecting the eye -- or a condition such as diabetes that affects the entire body. Some of the most common causes of low vision include: age-related macular degeneration, diabetes, cataracts and glaucoma. If you have or are at risk of having these disorders, you are at an increased risk for having low vision.

Age Related Macular Degeneration (AMD) is a condition where the cells at the back of the eye deteriorate and cause the central vision to become blurred or distorted. There are two forms of the disease, 'dry' which is more common and milder and 'wet' which can lead to severe vision loss. It is the leading cause of blindness in people over 65, will increase from 1.75 million people to almost 3 million people by the year 2020, according to a study by researchers at Johns Hopkins and in the Eye Diseases Prevalence Research Group.
The diagnosis of macular degeneration is becoming increasingly more common due to patient awareness, physician access, groundbreaking improvements in treatment, and the relentless graying of the population exponentially increases the percentage of the population at risk for this condition. Thus, macular degeneration is a formidable challenge to patients, their doctors, and our society as the costs for deliver.

Cataracts is a condition that develops in the lens of the eye. They are made from a protein that has altered from its natural state, distorting and eventually prohibiting required light from entering into the retina, the part of the eye that receives light. It is the leading cause of visual loss among adults 55 and older. Eye injuries, certain medications, and diseases such as diabetes and alcoholism can contribute to the cause of cataracts.

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. Diabetic retinopathy has four stages:

1. Mild Nonproliferative Retinopathy - At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.

2. Moderate Nonproliferative Retinopathy - As the disease progresses, some blood vessels that nourish the retina are blocked.

3. Severe Nonproliferative Retinopathy - Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

4. Proliferative Retinopathy - At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is known as proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. If they leak blood, severe vision loss and even blindness can result.


Glaucoma is not a single disease entity but a group of conditions characterized by damage to the optic nerve (detected by pathological cupping of the optic disc) and loss of the field of vision. The two main types are primary open-angle glaucoma and primary angle-closure glaucoma.
The prevalence of chronic glaucoma increases with age. In a major study, 0.6% of people aged 60 to 64 had primary open-angle glaucoma. Among people who were ten years older, the prevalence had more than doubled to 1.3%, and among those who were aged 80 to 84, it had more than doubled again to 3%.

If you are providing care for a person with low vision the following is a list of suggestions to improve in- home safety and quality of life.

• Check lighting in the home and ensure the space is adequately lit
• Keep eyeglass or contact lens prescriptions up-to-date and have regular eye exams
• Adjust carpets and furniture to avoid potential hazards
• Take advantage of low-vision aids and adaptive technologies such as video enlargement systems, large print items and speech software for computer systems, which can help people with impaired vision make the best use of their remaining vision
• For those with macular degeneration - Check the vision in each eye using an Amsler grid every day or as often as the doctor recommends. If any of the lines on the grid change or begin to appear wavy and curved, or if you notice that your vision is getting worse, contact an opthalmologist.