V.A. Medical Benefits

friends in the navy

Who's eligible for V.A. medical benefits?

Technically, all honorably discharged veterans are eligible for V.A. medical benefits, and most veterans do qualify. But due to financial strains on the V.A., since January 2003 some veterans with income or net worth over certain limits aren't eligible to newly enroll in the V.A. medical benefits system (see V.A. Priority Group System, below). A veteran already enrolled in the V.A. medical system before January 2003, however, can continue to receive benefits regardless of current income or net worth.

To be eligible for V.A. medical benefits, a veteran must have served in the active military, naval, or air service or must have served as a Reservist or National Guard member called to active duty (for other than training) and must have completed the full call-up period. The veteran must have been honorably discharged or released. Veterans who enlisted after September 7, 1980, or who entered active duty after October 16, 1981, must have served 24 continuous months, or the full period for which they were called to active duty, in order to be eligible. This minimum duty requirement may not apply to veterans discharged for hardship, early out, or a disability incurred or aggravated in the line of duty.

If a veteran meets those basic requirements, he or she can receive V.A. medical benefits regardless of income or net worth if one or more of the following is true:

  • The veteran was discharged or separated for medical reasons, early out, or hardship.

  • The veteran served in a theater of combat operations within the five years prior to applying for benefits.

  • The veteran was discharged because of a disability (not preexisting).

  • The veteran was a prisoner of war.

  • The veteran received a Purple Heart medal.

  • The veteran now receives V.A. pension or disability benefits or state Medicaid benefits.

If a veteran doesn't fall into one of the above categories, eligibility for medical benefits depends on the veteran's current income and net worth. There's a reduction in counted income for a veteran's regular medical expenses. The specific dollar limits on income and assets depend on the number of the veteran's dependents and where the veteran lives. The V.A. provides an online financial calculator to help veterans determine whether their income and assets make them eligible for veteran medical benefits.

But that's only an unofficial estimate, and a veteran won't know for sure if he or she is eligible for benefits until actually filing an application.

What's the priority group system for V.A. medical benefits?

Veterans who apply for V.A. medical benefits are placed in one of eight priority groups. The V.A. uses this system to decide priority in receiving certain V.A. medical benefits that are limited by budget or space. A veteran's assigned group might determine priority in scheduling medical care or a place in a V.A. long-term care facility. Also, veterans enrolled in Priority 7 and 8 must pay co-payments for many types of care (see below). And because of budget problems, after January 2003 the V.A. has not enrolled any veterans who fall into Category 8.

What V.A. medical benefits are available?

The basic medical care available to a veteran enrolled in the V.A. medical benefits program includes:

  • Inpatient hospital care

  • Hospital emergency room services

  • Outpatient hospital, clinic, doctor, and chiropractic services

  • Mental health and substance abuse care

  • Preventive care (physical examinations, immunizations, various disease screenings)

  • Medical supplies

  • Prescription (and some over-the-counter) medications, prescribed by a V.A. doctor, on the V.A.'s restricted drug "formulary" (list of covered drugs), and dispensed at a V.A. facility pharmacy

Note: The V.A. will pay for formulary drugs prescribed by non-V.A. doctors only for veterans authorized to receive V.A.-covered care from a non-V.A. provider.

Some other limited special benefits, such as eye exams and glasses, hearing tests and hearing aids, home health care, and dental care, are available to certain veterans, depending on their priority group and needs.

Where can a veteran obtain V.A. medical care?

Except in rare circumstances, all V.A. medical care must be provided by a V.A. medical provider at a V.A. medical facility. Once a veteran is enrolled in the V.A. medical system, the veteran can obtain care at any V.A. medical facility, though not all facilities provide every type of care. If the facility where a veteran normally receives care cannot provide the specific care needed, the veteran may be referred to another V.A. medical facility. If the veteran requires specialized care that no nearby V.A. facility can provide, the V.A. may pay for the expense of the veteran traveling to a V.A. facility that can provide the care, or the V.A. may make a special arrangement to have the veteran treated by a non-V.A. provider.

Once enrolled in the system, a veteran can find nearby V.A. medical facilities by going to the V.A.'s online facility locator. Then the veteran must make appointments directly with the facility where he or she is to receive care.

Emergency medical care can be obtained at any V.A. medical facility. If an emergency requires treatment at a non-V.A. facility because no V.A. facility was reasonably available, the V.A. usually pays for that emergency care. If emergency services are obtained at a non-V.A. facility, a claim for reimbursement must be filed at the V.A. facility closest to where the emergency service was provided.

What's the cost to a veteran for V.A. medical benefits?

Some veterans must make co-payments when they receive V.A. health care or medications. Which veterans must make a co-payment, and how much they must pay, depends on the priority group they're assigned to and the type of medical service they receive.

Inpatient care: Veterans in Priority Groups 1 through 6 have no co-payments for inpatient hospital care.

Veterans in Priority Group 7 are responsible for paying $213.60 for the first 90 days of inpatient hospital care during any 365-day period. For each additional 90 days, the charge is $106.80. There's also a $2 per day charge.

Veterans in Priority Group 8 must pay $1,068 for the first 90 days of inpatient hospital care during any 365-day period. For each additional 90 days, the charge is $534. There's also a $10 per day charge.

Outpatient care: Veterans in Priority Groups 1 through 6 have no co-payments for outpatient medical care.

For veterans in Priority Groups 7 and 8, there's a three-tiered co-payment system for outpatient services:

  • A $15 co-payment for a primary care visit

  • A $50 co-payment for specialist care

  • No co-payment for many services, including preventive screening, immunizations, weight reduction, smoking cessation counseling (individual and group), laboratory testing, radiology (X-rays), electrocardiograms, and hospice care

Medication: Some veterans owe no co-payments for medications, including veterans with a 50 percent or higher service-connected disability rating, veterans receiving medication for service-connected conditions, and veterans whose annual income doesn't exceed the maximum annual rate of the V.A. pension.

Veterans who aren't exempt from co-payments pay $8 for each 30-day (or less) supply of medication provided by the V.A.. For veterans enrolled in Priority Groups 2 through 6, there's a maximum annual co-payment of $960 for medications.

How are V.A. medical benefits and Medicare connected?

Many veterans enrolled in the V.A. medical system are also enrolled in Medicare. If so, the veteran may have a choice about which system covers a particular medical treatment or service. But the V.A. and Medicare won't both pay for the same treatment -- it's one or the other. If a veteran receives a medical treatment from the V.A. medical system, the V.A. pays for it. This can include a few health care services that Medicare doesn't cover, or that the V.A. provides more extensive care for. Also, for many veterans there are no co-payments; when a veteran does have a co-payment, it's often lower than Medicare's.

But a veteran enrolled in Medicare may prefer to receive some treatment outside the V.A. medical system and have Medicare cover it. If so, the V.A. will not pay any part of the bills that Medicare doesn't pay (except for some emergency care). More details about how coverage works when a veteran has both Medicare and V.A. medical benefits are included in Medicare's booklet Medicare and Other Health Benefits: Your Guide to Who Pays First.

How can I apply for V.A. medical benefits?

To enroll in the V.A. healthcare system, a veteran fills out V.A. Form 10-10EZ (Application for Health Benefits). This form can be obtained from any V.A. healthcare facility or regional benefits office. The form can also be downloaded online. Or a veteran or caregiver can call 877-222-VETS (8387) and request that the form be sent by mail.

What will I need to apply for V.A. medical benefits?

You must provide a certified copy of the veteran's military discharge document. Form DD 214 is the standard discharge document that's been used for the past 60 years. (For World War II veterans discharged before 1950, the documents might instead be titled WD AGO 53, WD AGO 55, WD AGO 53-55, NAVPERS 553, NAVMC 78PD, or NAVCG 553.)

You must provide information about all current health insurance, including Medicare and Medicaid. The veteran's Medicare and/or Medicaid card will have the enrollee's identification number for that program; the Medicare card will also indicate whether the veteran has both Medicare Part A and Part B. Similarly, a private insurance card will have the insurance company, the policy number, and the member's number.

For a veteran whose income is part of the eligibility determination, the V.A. will need to know what the household (veteran plus spouse) income was for the previous year.

Where can I get help applying for V.A. medical benefits?

If you're unable to locate a discharge document, you can get a copy online through the National Archives' eVetRecs request system or by calling the V.A.'s toll-free help line at 800-827-1000.

You can get free assistance with any V.A.-related question or problem by phone or in person through one of the V.A.'s Vet Centers, which are located in every state. You can also get assistance by contacting the V.A.'s Veterans Benefits Administration office nearest you. The V.A.'s toll-free telephone help line, at 800-827-1000, is also available for any questions.

3 months ago, said...

I served 16 yrs AD Army 71-87. diagnosed with "ill defined disease of central nervous system " at WRAMC in 78. Now that same diesease is disgnosed as Lambert-Eaton Myasthenia Syndrome, no cure, rear 1/1 million. Should be service connected. How do I proceed.

6 months ago, said...

I am a priority 2 veteran and just diagnosed with mesothelioma. I am trying to find somewhere a breakdown on healthcare and health benefits for priority 2

9 months ago, said...

My father is a Veteran and is in need of a walker. Can I get this through the VA? If yes, how to I go about doing this?

12 months ago, said...

If my insurance denies an extremely expensive drug for me would I be able to get that drug through the VA?

about 1 year ago, said...

I spent 3 1/2 years in the US Army from 75 - 79. I wasn't aware of the wage cap that was put on in getting VA benefits. I haven't had any medical problems since getting out but because of my age I thought I would enroll just in case. Nope, declined! I make too much money. Getting the benefits was one of the reasons I enlisted. What a rip off! I know of two healthy fellow co workers that didn't know that they could get benefits either but because they were in or near Vietnam they applied and not only got free medical benefits but they were back payed over $2000 dollars a month for several years and receive several hundred dollars a month for life! What the heck!?

over 1 year ago, said...

Nearly all Veterans will have a financial obligation to the VA. The "copays" are based on your Service Connected Injuries or Illnesses ALONG WITH your ability to pay copays; based on your income. The VA used to trust that the veterans accurately reported their income; but that has allowed the VA to become $3 billion dollars in debt. The veterans have no choice now in honest reporting because the VA uses SS, IRS and tax refunds to gauge their income. There is no such thing as FREE HEALTH CARE. The only vets who do NOT pay are 100% SC, POW's and other special categories. Your recruiter stated health care; if they said FREE it was the Department of Defense who lied NOT the VA. Choice is a mess because of Congress. They knee-jerked reacted to the Phoenix fiasco without properly contracting the Choice service out, without training the VA staff, and because veterans do not pay attention to the rules and policies of the Plan. IT IS NOT FREE; if you have a VA co-pay you will have a Choice copay. It is for those who 1) can't get an appointment in less than 30 days and/or those who live over 40 miles away. The Choice Program has put an undue strain on the entire VA staff; remember staff? Those people employed to HELP you; not be harassed by you because Congress messed this up.

over 1 year ago, said...

Your VA Inpatient copay rates are vastly out of date. For 2015 it is $1260.00

about 2 years ago, said...

Veterans Choice now exist. I received the card but it does not work. To add to the long wait times the new sec of va has opened the system to vets no matter their income. I wait 3-4 months to see pcp. Then if i need to c ortho doc or othet specialisy i could wait months for that appointment. The system was broken b4 now it is just useless. I had to buy insurance policy so i can go elsewhere. I am about to lose part of my hand because of the chaos in the va system. Prob now since the increase in patients because of the sec of va generosity the wait time for appointment will increase. All this being blamed on vha. In houston the problems r caused by vba!! The houston varo just plain "sucks"!! But bottom line is the new sec is all mouth. Nothing he has done esp. Vets Choice Card is useless. To me it is all just 1 big failure. Oh well i am out. Absolutely a shame that i have to pay for injuries i got on active duty!! my recommendation do not join military esp army. Never thought i would say this but being treated worse than a convicted felon opened my eyes.

about 2 years ago, said...

i'm already in the VA Syatem and get care at the Auburn, CA outpatient clinic. I'm very satisfied with the care I receive.

over 2 years ago, said...

Where can I get help being reimbursed for fee based medication I am being given the run around patient advocate is no help there certainly must be some where to receive assistance with this.

over 2 years ago, said...

i'am a 100 percent disable veteran do I need to get medicare

almost 3 years ago, said...

need help Please. Have outside Doctor who I have been seeing for 10 Years. Need VA To now fill prescription or outsource me to local Doctor I have been seeing. How do I maoe this happen?

almost 3 years ago, said...

I think it is unfair that a 7 year 9 month US Navy Veteran cannot at least get his drugs through the VA system in order to save on co-pays. We do not means test SS payments but we means test veterans who just happen to have skills and make a good wage. My co-pays range from $10-$40 per script and while trying to send a child to college any help would be appreciated.

almost 3 years ago, said...

Will the V.A. honor a prescription from a privTe Doctor if I bri g it in.. I am a priority 5 veteran..I also have Medicare..

almost 3 years ago, said...

Can spouses of a veteran attend doctors appointments?

about 3 years ago, said...

Served in Navy for 3 years watching submarines from aircraft. Never in battle, didnt win a purple heart, and was told by my recruiter that I would receive health care coverage for the rest of my life. A promise by the government. Now I find out that was a lie. Now I have to prove my income to apply for what is rightfully my benefits. I have two disabled kids to take care of, but they wont consider that. I should have gone to Nam with others but the navy said I had aptitude for other things.

over 3 years ago, said...

Served in USMC as reservist from 1967 through 1973. Active duty training in 1967 and 1968. Not called up at all. I have been diagnosed with MDS and my Medicare and supplement plan are paying for the treatment but there may be prescription drugs that will be required that my drug plan will not pick up in total. Do I enroll and role the dice as to the balance of drugs not paid would be by my enrolling or should I not even try?

over 3 years ago, said...

Like to welcome our vets to OPERATION BACKBONE, Brain & Spine Surgery around the world for soldiers. the site link is, www.operationbackbone.com

over 3 years ago, said...

Retired from US Navy in 1975. (20 yrs). Signed up with VA in past few years. Was put in 8G category, without a medical exam. Navy medical record does not show aircraft accident in 1961, shark bite and PTDS, which was then unknown (1961). Just want coverage for hearing aids. Why no physical evaul ?? Does Threshold limits have bearing? Retired E-6 that sure as Hell ain't rich !!

over 3 years ago, said...

I only need information about acquiring hearing aids for my Viet Nam vet husband.

almost 4 years ago, said...

Got excellentt care at the portland va medical facility.had surgery april 8th, everthing was taken care of.the doctors, nurses, and everyone on the surgical team was first rate.

about 4 years ago, said...

i am a vietnam widow, is there a health insurance i can apply for

over 4 years ago, said...

can i receive va benifets with stage 2 kidney diease?

over 4 years ago, said...

Grat article I wonder if you know this information. My dad is retired 25 years Navy he is 91 on Tri Care and because he has no one I hve become his caregiver, which means I am unable to work due to his doctors appts and needs. He told me today he heard some where that the VA will pay a monthly fee to a caregiver is that true and if so how does one find out more information about it. I need to care for him but I also need to make some funds as well for myself to survive. I am 77.