Chapter 115 is a Massachusetts program that offers financial assistance to many veterans and their families. That assistance usually comes in the form of monthly cash payments.
Some people do not qualify for monthly cash payments through the Chapter 115 program because their income is too high. But even for people who do not meet income eligibility requirements, Chapter 115 “medical only” benefits can offer financial relief from out-of-pocket medical expenses. Below we will outline what “medical only” benefits are, why they are important, and how to find out if you are eligible.
The Chapter 115 program has rules about who can receive assistance. One of the rules is that people with more than a certain amount of income are not eligible for regular monthly benefits. But some people with higher incomes can still receive assistance with medical costs through the Chapter 115 program’s “medical only” option.
If you are approved for “medical only” benefits, your local Veterans’ Service Officer (VSO) could reimburse the out-of-pocket cost of certain medical care. That means that once you meet the program requirements, your VSO could pay for eligible out-of-pocket medical costs for things like co-pays and prescription medicines.
Chapter 115 benefits are available to veterans and to certain family members and survivors of veterans. To learn more about who is eligible, please visit our Chapter 115 self-help guide.
For example, suppose you are married, live with your spouse, and have income of $600 per week (about $2,600 per month), after taxes and any required payments toward retirement or health insurance. You might not qualify for monthly Chapter 115 cash benefits in that situation because of the program’s income limits, but you could still be eligible for “medical only” benefits.
What counts as an out-of-pocket medical expense? If you qualify for “medical only” benefits, your VSO may be able to reimburse you for your out-of-pocket costs for some of your medical expenses, including co-pays, doctor visits, prescription drugs, and hospitalizations. Not all expenses are reimbursable, and some require pre-approval. Talk with your VSO to find out what expenses they can reimburse. Your VSO can also tell you which expenses require pre-approval. Find contact information for your local VSO.
Eligibility for “medical only” benefits depends on how many people are in your household. If two people live in your household, you may be eligible for “medical only” benefits right away if your income is less than $2,904 per month. (If you live with your spouse and your income is less than about $1,900 per month, you may also qualify for monthly cash payments. Please visit our Chapter 115 benefits calculator to learn more.)
Even if you earn more than $2,904 per month, you might still be eligible for relief from out-of-pocket medical costs once you “spend down” some of your income on medical care.
Income levels for “medical only” benefits for different household sizes
|Number of people in household||Income level for “medical only” benefits|
For example, if you are married, live with your spouse, and earn $800 per week (about $3,450 per month), after taxes and any required payments toward retirement or health insurance. You would not be eligible for reimbursement of out-of-pocket medical costs right away. But you may still be eligible for “medical only” benefits. These benefits would cover the amount you spend over about $350 per month on certain types of medical care. In this case, $350 would be your “spend down” amount. In other words, $350 is the amount you pay each month before “medical only” benefits could kick in. After you pay that share, your VSO may reimburse you for some of your other out-of-pocket medical costs.
Who pays for out-of-pocket medical costs?
Example based on a married “medical only” benefits recipient who earns about $800 per week and lives with a spouse.
|Monthly out-of-pocket medical expenses||You pay as little as *||Your VSO pays up to *|
How much you need to “spend down” depends on your income and the number of people in your household. And how much financial assistance you receive depends on your out-of-pocket medical costs. Some people have a large “spend down” amount but still receive valuable assistance from the “medical only” option because they have lots of out-of-pocket medical costs each month.
If you qualify for “medical only” benefits, you should keep receipts for your out-of-pocket medical expenses. You will need to give your VSO documentation of how much you spent and what you spent it on. For some eligible expenses, your VSO can reimburse you for the full amount you spent out-of-pocket once you have reached your “spend down” amount. For certain other expenses, the rules of Chapter 115 or another state regulation cap the reimbursement amount. For those kinds of expenses, your VSO might reimburse you a smaller amount than you paid. Please note that there are different rules for different kinds of medical care and costs. Your VSO can help you find out what documentation you need and how much you will be reimbursed.
Not sure where to start? Help is available.
Your VSO must help you apply for Chapter 115 benefits, including “medical only” benefits. Each town and district in Massachusetts has a VSO whose job it is to help veterans, family members, and survivors access benefits and other resources. Click here to find your VSO.
Make sure to ask your VSO about “medical only” benefits. Many people do not know about the “medical only” option. Even your VSO might not realize at first that the “medical only” option might apply to you.
Asking about “medical only” can help remind your VSO to check whether might help you get benefits. Asking about “medical only” also helps keep the option on VSOs’ radar screens when they are helping other people.
The Veterans Legal Clinic encourages people who need financial assistance to apply for Chapter 115 benefits. You have a legal right to apply for these benefits.
Before you apply for benefits, you can try our online calculator. The calculator can help you find out if you might receive Chapter 115 benefits if you apply. The calculator can also tell you about how much your monthly benefit might be. Finally, it can tell you whether “medical only” benefits might be an option for you.
Once you are ready to apply, contact your local VSO. You can find contact information for your local VSO here.
Your VSO must provide you with an application. You can also find the Chapter 115 benefits application here. To complete the application, you will need several documents. You should have your discharge papers, proof of residency, and recent bank statements ready. If you need help gathering any documents, ask your VSO for assistance.
If the Department of Veterans’ Services (DVS) denies your application, you can appeal. You can also appeal if DVS cuts off your benefits. You can find more information about how to file an appeal and your appeal rights here. If you want to request free legal help with an appeal or have questions about Chapter 115 rules, please contact the Veterans Legal Clinic. You can call our intake line at 617-390-2525. You can also email us at email@example.com.