Health

VA Health Benefits - Who is Eligible?

The first requirement is that you served in the armed forces on active duty and did not receive a dishonorable discharge. Honorable, general, medical, etc. – those are acceptable discharges for VA benefits. Dishonorable, other than honorable, and bad conduct discharges are not.

  • If you enlisted after September 7, 1980, or if you began your active duty after October 16, 1981, you must have served a minimum of 24 months active duty, unless:
    • You were discharged because of a disability that was caused or exacerbated by your active duty service, or
    • You received an “early out” because of a hardship discharge, or
    • You served prior to September 7, 1980.
  • You are a current or former member of the Reserves or National Guard and were called to active duty by a federal order, and you completed the tour of active duty specified in the order. Training duty does not count.

These are the basic requirements, but they do not guarantee you will receive the medical care you want. The VA has a priority system to determine who is first in line for health care benefits.

What are Priority Groups and How Do They Determine Who is Eligible for Care?

When you apply for VA health benefits, the VA examines your application and assigns you to one of eight priority groups. This priority system is designed to make sure that the veterans who most urgently need care receive it without delay. Your assigned priority group will determine (1) how soon you can be signed up and accepted for care; and (2) what you will be charged, if anything, toward the cost of the care you receive.

Priority groups are assigned based on the following factors:

  • Your military service history, and
  • Your disability rating, and
  • Your income level, and
  • Whether or not you qualify for Medicaid, and
  • Other benefits you may be recieving (example: a VA disability pension).

Veterans with a service-connected disability receive the highest priority for care. Those veterans with higher incomes who do not have a service-connected disability receive the lowest priority. Generally, the assumption is that veterans who have a higher income and are not disabled will either be employed and getting health benefits through group insurance, are economically able to pay for health care and health insurance, or on Medicare. If a veteran qualifies for more than one priority group, the VA will use the higher of the two priorities.

What are the Eight Priority Groups

Priority Group One

If any of the situations described below apply to you, you will be assigned to priority group one:

  • You have a service-connected disability rated as 50% or more disabling, or
  • You have a service-connected disability that renders you unable to work and earn a living (unemployable), or
  • You received the Medal of Honor for your service.

Priority Group Two

You have a service-connected disability that has been rated as 30-40% disabling.

Priority Group Three

If one or more of the following apply you are in group three:

  • You are a former prisoner of war, or
  • You received the Purple Heart, or
  • You were discharged for a disability that was caused or made waorse by your active duty military service, or
  • You have a special-connected disability that has been rated at 10-20% disabling, or
  • You were awarded special eligibility classification under 38 USC § 1151.

Priority Group Four

You are either receiving VA aid and attendance or housebound benefits, or you have received a VA determination of catastrophically disabled (not service-connected).

Priority Group Five

You may be assigned to group five is any of the following are true:

  • You have a disability that is not related to your service, or you have a service-connected disability that has been rated as 0% disabling, and you have an annual income that is below the VA's adjusted inome limits; or
  • You are receiving a VA pension, or
  • You are eligible for Medicaid.

Priority Group Six

The criteria for group six are:

  • You have a service-connected disability rated as 0% disabling, or
  • You were exposed to ionizing radiation during atmospheric testing of the atomic bomb or were part of the U.S. military force occupying Hiroshima and Nagasaki after World War II, or
  • You participated in Project 112/SHAD (a chemical and biologic testing program that ran from 1962-1973), or
  • You served in Vietnam between January 9, 1962, and May 7, 1975, or
  • You served in the Persian Gulf between August 2, 1990, and November 11, 1998, or
  • You served on active duty at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987 (the water was found to be contaminated with industrial solvents that are linked to certain adverse health conditions).
  • You may also qualify for group six if all of the following are true:
    • Currently or recently enrolled in VA health care, and
    • Served in a combat theater after November 11, 1998, or were discharged from active duty after January 28, 2003, and
    • Were discharged within the past five years.

Priority Group Seven

Your income is below the geographically adjusted income limits the VA uses, and you agree to pay copays for your care.

Priority Group Eight

Your income is above the geographically adjusted income limits, and you agree to pay copays.

If your service-connected disability becomes worse or if your income decreases, your priority group can change.

What Types of Health Care Benefits are Offered by the VA?

The VA system offers basic health care benefits, including annual examinations, health education, immunizations, counseling on genetic diseases, clinic visits to monitor ongoing conditions, and visits for episodic illnesses like colds, flu, etc. The VA also offers screening exams that are gender specific like mammograms, prostate exams, etc. The specific exams available at your local VA may vary from one VA facility to another.

The VA also offers inpatient services like surgeries, inpatient medical treatment, kidney dialysis, acute hospital care and post-operative care. If you need an organ transplant, intensive care for a mental illness, or specialized care for a traumatic injury, the VA may send you to another facility if your local VA hospital does not provide that service.

Some VA facilities offer urgent care and emergency department services. There is usually a walk-in clinic for episodic illnesses, wound care, and minor injuries. The VA also offers prescription service through its pharmacies when your VA doctor writes a prescription. It may also fill prescriptions written by non-VA physicians if the following are true:

  • You are enrolled in VA health care,
  • You have an assigned VA physician,
  • Your VA doctor has your medical records from that outside provider,
  • Your VA doctor approves the prescription written by the outside physician.

What Documents do I Need to Apply for VA Health Care?

Once you figure out if you are eligible, you will need to gather the required documents for your application. You will need:

  • Your most recent tax returns for federal and state income tax;
  • Your social security number and the social security numbers of all your qualified dependents;
  • The account numbers for any health insurance coverage you currently have. It may be Medicare, privately purchased health coverage, health care benefit package that is part of your retirement plan, or group health insurance coverage through your employer.

How Do I Apply for VA Health Care?

There are multiple ways to apply for VA health care:

  • In person by making an appointment at your local VA office and submitting your application there.
  • Online at the VA website.
  • Over the phone by calling the toll-free number at (877) 222-8387 from 8:00 a.m. to 8:00 p.m. Eastern Time.
  • By mail by filling out VA Form 10-10EZ. The form can be downloaded from the VA website. You or someone acting as your power of attorney must sign and date the form. Then, mail it to:

Health Eligibility Center

2957 Clairmont Road, Suite 200

Atlanta, Georgia 30329

Resources

Veterans Health Benefits Guide

VA Health Care Providers

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This website has been prepared for general information purposes only. The information on this website is not legal advice. Legal advice is dependent upon the specific circumstances of each situation. Also, the law may vary from state-to-state or county-to-county, so that some information in this website may not be correct for your situation. Finally, the information contained on this website is not guaranteed to be up to date. Therefore, the information contained in this website cannot replace the advice of competent legal counsel licensed in your jurisdiction.

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