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.
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)
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.