Geographic Means Test (GMT) Frequently Asked Questions (FAQs)
Questions
- What is a Geographically-Based Financial Assessment (Means Test)?
- How does VA determine the area in which a veteran resides for purposes of determining the applicable "low income" limits?
- How does VA calculate a veteran's income for Geographic Means Testing (GMT)?
- What are the current income thresholds?
- Which enrollment priority groups apply to veterans affected by GMT?
- What is a Geographic copay reduction?
- What is the current inpatient copay?
- If veterans have questions, who can they contact?
Answers
Recognizing that the cost of living can vary significantly from one geographic area to another, a geographic financial assessment determines whether lower-income veterans who live in high-cost areas are eligible for an enhanced enrollment priority and a reduction the amount of their inpatient copay.
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The address used to determine your geographically-based income threshold is your permanent address. Typically, it is the location in which you declare residency for voting and tax purposes.
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The veteran's income is based on the previous calendar year's total gross household income that the veteran, the spouse and dependent children earned. The number of persons in the veteran's family will be factored into the calculation to determine the applicable low-income threshold for the veteran's geographic region. At the veteran's request, VA may use projected income for the current year on a case-by-case basis to avoid a hardship to a veteran. For more information about hardship, contact the Enrollment Coordinator at your local VA.
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The current geographic income thresholds for all locations can be found at: http://www.va.gov/healtheligibility/Library/pubs/GMTIncomeThresholds/
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Nonservice-connected and 0% noncompensable service-connected veterans (Priority Group 7) treated for nonservice-connected disabilities and have a gross household income and/or net worth ABOVE the VA National income threshold and income BELOW the geographically-based income threshold for their resident location who do not otherwise qualify for placement in a higher enrollment priority group.
NOTE: Certain Priority Group 4 or 6 veterans may be subject to copays if moved from Priority Group 7 based solely on catastrophic disability, combat after November 11, 1998, exposure to ionizing radiation or other factors such as having participated in Project 112/SHAD.
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Those veterans whose incomes and assets fall between the VA national income limits and the geographically-adjusted income limits will have their inpatient medical care copays reduced by 80%. Outpatient, pharmaceutical and extended care copays are not reduced.
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Priority Group 8 and certain other veterans are responsible for VA's inpatient copay of $1024 for the first 90 days of care during any 365-day period. For each additional 90 days, this charge is $512. In addition, there is a $10 per diem charge.
NOTE: VA's inpatient copay rate is based on the current Medicare deductible of $1024.
Priority Group 7 and certain other veterans are responsible for paying 20 percent of VA's inpatient copay or $204.80 for the first 90 days on inpatient hospital care during any 35-day period. For each additional 90 days, this charge is $102.40. In addition, there is a $2 per diem charge.
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Contact the VA Health Benefits Service Center at the toll-free number, 1-877-222-VETS (8387). More information on eligibility and enrollment appears on VA's web site at www.va.gov/healtheligibility.
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