Understanding VA Healthcare Benefits
Learn about the full range of VA healthcare benefits available to veterans, eligibility requirements, priority groups, and how to access services.
Key Takeaway
VA healthcare provides comprehensive medical services to eligible veterans, with costs and access determined by priority groups based on service-connected disabilities, income, and other factors.
Introduction
The Department of Veterans Affairs (VA) provides comprehensive healthcare services to eligible veterans through the largest integrated healthcare system in the United States. VA healthcare includes primary care, specialty care, mental health services, prescription drugs, and long-term care, all designed to meet the unique needs of those who have served our country.
Understanding your VA healthcare benefits, eligibility requirements, and how to access services is essential for maximizing the care you've earned through your service. This comprehensive guide will walk you through everything you need to know about VA healthcare, from eligibility to accessing services.
VA Healthcare System Overview
The VA healthcare system is a nationwide network of medical centers, outpatient clinics, and community-based services designed to provide comprehensive care to veterans.
1,300+ Facilities
Medical centers, outpatient clinics, and community-based outpatient clinics nationwide
9 Million+ Veterans
Enrolled in VA healthcare, with millions receiving care each year
Comprehensive Care
Primary care, specialty care, mental health, prescriptions, and long-term care
VA Priority Groups Explained
The VA uses priority groups (1-8) to determine when you can enroll in VA healthcare and how much you'll pay. Understanding your priority group helps you know what to expect in terms of costs and access.
Priority Group 1
Service-connected disabilities rated 50% or more, or unemployable due to service-connected conditions
Copays:
No copays for VA care
Priority Group 2
Service-connected disabilities rated 30% or 40%
Copays:
No copays for VA care
Priority Group 3
Service-connected disabilities rated 10% or 20%, former POWs, Purple Heart recipients
Copays:
No copays for VA care
Priority Group 4
Receiving aid and attendance or housebound benefits, catastrophically disabled
Copays:
No copays for VA care
Priority Group 5
Non-service-connected disabilities, low income, receiving VA pension
Copays:
May have copays based on income
Priority Group 6
Exposed to Agent Orange, ionizing radiation, or other environmental hazards
Copays:
No copays for related conditions
Priority Group 7
Income below geographic means test threshold, agree to copays
Copays:
Copays apply
Priority Group 8
Income above geographic means test threshold, agree to copays
Copays:
Copays apply
How Priority Groups Are Determined
Your priority group is determined by factors including:
- Service-connected disability rating percentage
- Income and net worth (for Priority Groups 7 and 8)
- Special circumstances (POW status, Purple Heart, exposure to environmental hazards)
- Receipt of VA pension or other benefits
- Catastrophic disability status
Eligibility Requirements
Understanding VA healthcare eligibility is the first step in accessing the care you've earned. Eligibility depends on several factors, and meeting the basic requirements doesn't guarantee enrollment if the VA has reached capacity for your priority group.
Military Service
Served in active military, naval, or air service
Most veterans who served in active duty and received an honorable or general (under honorable conditions) discharge are eligible.
Service Duration
Minimum service requirements
Generally, 24 months of continuous active duty service, or the full period for which you were called to active duty. Exceptions apply for service-connected disabilities.
Discharge Status
Type of discharge received
Honorable or general (under honorable conditions) discharge. Veterans with other than honorable discharges may still qualify in certain circumstances.
Income and Assets
Financial thresholds for some priority groups
Priority Groups 7 and 8 are based on income and net worth. Lower priority groups may have income-based copayments.
Services Covered by VA Healthcare
VA healthcare provides a comprehensive range of medical services designed to meet the diverse needs of veterans. Coverage varies by priority group and specific circumstances.
Primary Care
Routine checkups, preventive care, and management of chronic conditions
- Annual physical exams
- Health screenings
- Chronic disease management
- Preventive care services
Specialty Care
Specialized medical services including cardiology, oncology, orthopedics, and more
- Cardiology and heart care
- Cancer treatment
- Orthopedic services
- Neurology
- Dermatology
Mental Health Services
Comprehensive mental health care including counseling, therapy, and treatment programs
- Individual and group therapy
- PTSD treatment
- Substance abuse treatment
- Crisis intervention
- Mental health medications
Prescription Drugs
Prescription medications through VA pharmacies and mail-order services
- VA formulary medications
- Mail-order pharmacy
- Local VA pharmacy pickup
- 90-day supply options
Emergency Care
Emergency medical services at VA facilities and authorized non-VA facilities
- VA emergency departments
- Authorized non-VA emergency care
- Urgent care services
- Emergency transportation
Long-Term Care
Nursing home care, assisted living, and home health services
- Nursing home care
- Assisted living
- Home health services
- Adult day health care
How to Access VA Facilities
Accessing VA healthcare begins with enrollment and establishing care at a VA facility. Here's how to get started:
Step 1: Apply for VA Healthcare
Complete and submit VA Form 10-10EZ (Application for Health Benefits) online, by mail, or in person at a VA facility.
Step 2: Wait for Enrollment Decision
The VA will review your application and determine your eligibility and priority group. This process typically takes a few weeks.
You'll receive a letter notifying you of your enrollment status, priority group, and any copayments you may be responsible for.
Step 3: Choose Your Primary Care Provider
Once enrolled, you'll be assigned or can choose a primary care provider at your local VA facility.
Your primary care provider will coordinate your healthcare and make referrals to specialists as needed.
Step 4: Schedule Appointments
Use My HealtheVet, call your VA facility, or use the VA mobile app to schedule appointments.
Prescription Drug Coverage Through VA
VA provides comprehensive prescription drug coverage to enrolled veterans. VA prescription coverage is considered "creditable" for Medicare Part D, meaning you won't face a Part D penalty if you maintain VA coverage.
VA Formulary
The VA maintains a formulary (list of approved medications) that includes thousands of prescription drugs.
- Most commonly prescribed medications are covered
- Generic medications are preferred when available
- Brand-name medications may require prior authorization
- Non-formulary medications may be available in special circumstances
How to Get Prescriptions
VA offers multiple ways to obtain your prescriptions:
VA Pharmacy
Pick up prescriptions at your local VA facility
Mail-Order Pharmacy
90-day supply delivered to your home
Community Care
Authorized non-VA pharmacies when VA pharmacy isn't accessible
Copayments
Vary by priority group, typically $5-$11 per 30-day supply
Cost Structure and Copayments
VA healthcare costs vary by priority group. Higher priority groups (1-6) typically have no or minimal copayments, while lower priority groups (7-8) may have copayments for certain services.
Copayment Structure
Primary Care Visits
Priority Groups 1-6: No copay | Priority Groups 7-8: $15 per visit
Specialty Care Visits
Priority Groups 1-6: No copay | Priority Groups 7-8: $50 per visit
Prescription Drugs
Priority Groups 1-6: $5-$11 per 30-day supply | Priority Groups 7-8: $5-$11 per 30-day supply
Inpatient Care
Priority Groups 1-6: No copay | Priority Groups 7-8: $1,429 per 90 days
Extended Care
Varies by priority group and income. Some veterans may pay a portion of costs.
Appeals Process for Denied Services
If the VA denies a service or you disagree with a decision, you have the right to appeal. Understanding the appeals process helps you get the care you need.
Step 1: File a Notice of Disagreement
Within one year of the decision, file a Notice of Disagreement (NOD) with the VA.
You can file online, by mail, or in person. Be specific about what you disagree with and why.
Step 2: Choose Your Appeal Lane
The VA offers three appeal options:
Supplemental Claim Lane
Submit new evidence to support your claim
Higher-Level Review Lane
Request review by a senior VA adjudicator
Board of Veterans' Appeals Lane
Appeal directly to the Board of Veterans' Appeals
Step 3: Get Help if Needed
You don't have to navigate the appeals process alone. Consider getting help from:
- Accredited Veterans Service Organizations (VSOs)
- VA-accredited attorneys or agents
- State or county veterans service officers
- VA patient advocates
Related Resources
Need Help Understanding Your VA Benefits?
Our expert advisors can help you understand your VA healthcare benefits, navigate the enrollment process, and coordinate VA benefits with Medicare. Get personalized guidance tailored to your situation.