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VA HEALTH CARE

Care At VA Run Facilities

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VA HEALTH CARE (Care At VA Run Facilities)

IMPORTANT NOTES:

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  • VA health care is NOT a health insurance program!

  • Veterans CAN receive treatment for Non-Service Connected Disabilities!

  • If you are a recently separated Veteran you may be eligible for TRICARE health insurance for you and your family. Click HERE for more information.

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The Veterans Health Administration (VHA) has a reputation for failing to meet the needs of Veterans - a simple search here on reddit will bring up numerous accounts of problems that Veterans have had with the VA. That said, the VA has made and continues to make huge strides, and supporting Veterans and their needs has bipartisan support at the Federal level. While the VA still has room to improve, the biggest problem you are likely to still experience is long wait times for appointments. If someone tells you the VA is no good, find out how recent their experience was.

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As this VA health care article is fairly expansive, please use the Table of Contents or the search feature to help you locate the information you are interested in. Alternatively, you can read everything. Cuz knowledge?

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However, be aware that it's impossible to cover every single program or niche benefit the VA provides here. If you don't see something explicitly mentioned you should bring it up to your VA Primary Care Provider, as they should be in the best position to advise you on your medical and health care needs.

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NOTES:

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  • This article is about receiving health care AT VA run facilities. For VA health care at VA approved facilities or emergency use of a non-VA Emergency Room (ER) please see the article on Community Care Program.

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Alternatively, another place that can help Veterans is your local Vet Center.

  • For Veterans who are traveling or living abroad they should click HERE.

Basic Eligibility Requirements

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  • Served prior to September 7, 1980.

  • If you enlisted after September 7, 1980, or entered active duty after October 16, 1981, you must have served 24 continuous months or the full period for which you were called to active duty, unless any of the descriptions below are true for you.

  • This minimum duty requirement may not apply if any of these are true:

  • You were discharged for a disability that was caused—or made worse—by your active-duty service, OR were discharged for a hardship or “early out,”

  • If you’re a current or former member of the Reserves or National Guard, you must have been called to active duty by a federal order and completed the full period for which you were called or ordered to active duty. If you had or have active duty status for training purposes only, you don’t qualify for VA health care.

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NOTE:

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  • Veterans who have a Dishonorable discharge are INELIGIBLE for VA health care. Veterans with an Other than Honorable (OTH) discharge may be eligible for VA health care.

PACT Act - Advanced Eligibility

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If you meet the requirements listed here, you can get FREE VA health care for any condition related to your service for up to 10 years from the date of your most recent discharge or separation. You can also enroll at any time during this period and get ANY care you need, but you may owe a copay for some care.

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If you were discharged or released on or AFTER October 1, 2013

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At least one of these must be true of your active-duty service:

  • You served in a theater of combat operations during a period of war after the Persian Gulf War, or

  • You served in combat against a hostile force during a period of hostilities after November 11, 1998

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If you were discharged or released on or BEFORE October 1, 2013

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At least one of these must be true of your active-duty service:

  • You served in a theater of combat operations during a period of war after the Persian Gulf War, or

  • You served in combat against a hostile force during a period of hostilities after November 11, 1998.

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And BOTH of these must be true for you:

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  • You were discharged or released between September 11, 2001, and October 1, 2013, AND

  • You haven’t enrolled in VA health care before.

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If you meet the requirements listed above, you can receive care and enroll during a special enrollment period between October 1, 2022, and October 1, 2023.

Further Eligibility Factors

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Having meet the basic requirements, you can increase the chances of being approved for VA health care by having any one of the following situations being true:

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  • Receive financial compensation (payments) from the VA for a service-connected disability.

  • Have a non-compensable (0%) service-connected disability.

  • Were discharged for a disability resulting from something that happened to you in the line of duty.

  • Were discharged for a disability that got worse in the line of duty.

  • Are a recently discharged combat Veteran (within 5 years).

  • Receive VA pension benefits.

  • Are a former prisoner of war.

  • Have received a Purple Heart.

  • Have received a Medal of Honor.

  • Receive (or qualify for) Medicaid benefits.

  • Served in Vietnam between January 9, 1962, and May 7, 1975.

  • Served in Southwest Asia during the Gulf War between August 2, 1990, and November 11, 1998.

  • Served at least 30 days at Camp Lejeune between August 1, 1953, and December 31, 1987.

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If none of the above apply to you, you may still qualify for care based on your income.

Applying

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To apply for VA health care visit this link.

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Active Duty Service members

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While you may apply for VA health care while you are on terminal leave you CANNOT receive any treatment from the VA till after you have officially separated from the military, unless you meet any of the below conditions.

You may be able to use VA health care if:

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  • You need emergency or urgent care,

  • You need routine care and you have a valid TRICARE referral or authorization, or

  • The VA health care facility you’re visiting has a VA/DoD sharing agreement.

Priority Groups

When you apply for VA health care, you’ll be assigned 1 of 8 priority groups. This system helps to make sure that Veterans who need immediate care can get signed up quickly. Additionally, your priority group may determine if you owe co-pays for non-service connected care.

Veterans will be placed in the highest group they qualify for.

Priority Group

  • Qualifiers

1

  • Have a combined service-connected disability of 50% or more, or Received the Medal of Honor (MOH)

2

  • Have a combined service-connected disability of 30 or 40%

3

  • Have a combined service-connected disability of 10 or 20%, or Are a former prisoner of war (POW), or Received the Purple Heart, or were awarded special eligibility classification under Title 38, U.S.C § 1151, or "benefits for individuals disabled by treatment or vocational rehabilitation"

4

  • Are receiving VA aid and attendance or housebound benefits

5

  • Don't have a service-connected disability, or you have a 0% service-connected disability, AND you have an annual income level that's below our adjusted income limits (based on your resident zip code), or Are receiving VA pension benefits, or Are eligible for Medicaid programs

6

  • Combat Veterans separated from AD within 5 years, or Have a 0% combined rating, but being paid at 10%, or Were exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki, or Participated in Project 112/SHAD, or Served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, or Served in the Persian Gulf War between August 2, 1990, and November 11, 1998, or Served on active duty at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987

7

  • Your gross household income is below the geographically adjusted income limits (GMT) for where you live

8

  • Your gross household income is above VA income limits and geographically adjusted income limits for where you live

8a

  • Have a 0% combined rating, and Enrolled in the VA health care program before January 16, 2003, and Have remained enrolled since that date and/or were placed in this subpriority group because your eligibility status changed

8b

  • Have a 0% combined rating, Enrolled in the VA health care program on or after June 15, 2009, and Have income that exceeds current VA or geographical limits by 10% or less

8c

  • Don't have a service-connected condition, and Enrolled in the VA health care program as of January 16, 2003, and Have remained enrolled since that date and/or were placed in this subpriority group because your eligibility status changed

8d

  • Don't have a service-connected condition, and Enrolled in the VA health care program on or after June 15, 2009, and Have income that exceeds current VA or geographical limits by 10% or less

8e

  • Have a 0% combined rating, and Don't meet the criteria for subpriority group a or b above

8f

  • Don't have a service-connected condition, and Don't meet the criteria for subpriority group c or d above

Income Limits

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NOTE:

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Your priority group may change in some cases, such as if:

  • Your income changes, or

  • Your service-connected disability rating increases.

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If you want to manually update the VA about your income fill out, sign, date VA Form 10-10EZR and mail to

Failure to report increases in income may result in a debt being created when the IRS reports your income to the VA, if you are in a priority group based upon your income.

Coverage

Veterans once approved for VA health benefits are provided a wide breath of coverage at VA and VA approved medical facilities. Once enrolled, your Priority Group has no further effect on your eligibility for health care benefits, all groups are treated equally.

Preventive Care Services

Inpatient Care Services

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VA inpatient care includes a full spectrum of treatment services:

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You also have access to the VA’s specialized care units, which include:

Ancillary Services

 

VA health care providers may employ ancillary services to help diagnose or treat your medical condition. These services include:

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Specialty Care Services

 

Unique or complicated courses of care.

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Mental Health Care

 

VA provides specialty inpatient and outpatient mental health services at its medical centers and community-based outpatient clinics (in addition, readjustment counseling services may be available for you and members of your family at Vet Centers across the nation).

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Women’s Health

 

Women’s gender-specific health care includes things like (menopause evaluation and symptom management, osteoporosis, incontinence, birth control, breast and gynecological care, maternity, and limited infertility services).

Screening and disease prevention programs (for example, mammograms, bone density screening, and cervical cancer screening).

Routine gynecologic services available through your local VA facility include:

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Your provider can assist with routine exams, diagnosis, and management of:

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Infertility Services

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The VA offers several infertility diagnostic testing and treatments for BOTH male and female Veterans.

Laboratory blood testing: follicle stimulating hormone (FSH); thyroid stimulating hormone (TSH)

Genetic counseling and testing

Pelvic and/or transvaginal ultrasound

Hysterosalpingogram

Saline-infused sonohysterogram

Laboratory blood testing: serum testosterone, FSH, LH, estradiol

Genetic counseling and testing

Pelvic and/or transvaginal ultrasound

Transrectal and/or scrotal ultrasonography

Postejaculatory urinalysis

FEMALES

MALES

The VA is NOT authorized to provide or cover the cost of in vitro fertilization (IVF). Unless:

The VA provides infertility treatment and services through Reproductive Endocrinology and Infertility (REI) community providers who are part of VA’s Patient-Centered Community Care (PC3) network.

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NOTE:

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  • The VA does not cover the costs associated with donor sperm, donor eggs, donor embryos, or gestational surrogacy.

Dental

Please see our write up on Dental care.

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Hearing

Please see our write up on Hearing.

 

Vision

Please see our write up on Vision care.

Pharmacy

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VA's prescription benefit provides medically necessary medications.

You can find a list of the medications on the VA National Formulary at the Pharmacy Benefit Management (PBM) Website, or you can call your local VA pharmacist to ask whether a medication is on the formulary.

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The VA will NOT automatically send Veterans refills for medications.

As such, it is important that Veterans place their refill orders in at least 2-3 weeks before they expect to run out, so that your request can be processed and allow time for your medications to be shipped to you

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To get refills use any of the following options:

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  • Online: HealtheVet.

  • Over the phone: Call the refill telephone number on the paperwork that came with your medication. You will need your prescription number for each medication you plan on having refilled.

  • Go to your VA pharmacy.

FAQ

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What should I do if I Run Out of my Medication?

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If your current prescription has no more refills, but your Primary Care Provider wants you to stay on your medication, you will need a new prescription.

Contact your VA provider as soon as possible to have the medication renewed. If your VA facility has the AudioRenewal system, you can use the automated telephone system to send a message to your provider and request a renewal. You may also send a secure message to your provider online from HealtheVet.

Certain narcotics and controlled substance medications cannot be refilled. In this case, a new prescription is required for each supply.

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Can I Receive a Drug that is Not on the VA National Formulary?

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Yes — there is a process that permits your VA health care provider to prescribe a “non-formulary” drug if your special needs require it.

Here are some of the reasons why your VA health care provider might consider prescribing a non-formulary medication for you:

  • You should not receive the formulary drug for safety reasons.

  • No response or not the desired response to the formulary drug(s).

  • The VA National Formulary offers no acceptable alternatives.

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My non-VA Primary Care Provider Wrote Me a Prescription. Will the VA Fill it?

 

The VA is generally not authorized to fill prescriptions unless they are written by a VA provider. The total medication management for a prescription is the responsibility of the provider who writes that prescription. If you are receiving care from a non-VA Primary Care Provider, your VA providers need to know about all of the medications (prescription, over-the-counter, and herbal supplements) that you are taking. You also need to make sure that your private provider is aware of the medical treatment and medications you are receiving from the VA.

If your non-VA Primary Care Provider has prescribed a medication that is not on the VA National Formulary (that is, a “non-formulary” medication), your VA Primary Care Provider may elect to re-write that prescription for a VA National Formulary medication. Sometimes this is as simple as substituting a generic for a name-brand.

If your VA health care provider believes that you should not receive the VA National Formulary medication, an alternative will be sought. Your VA health care provider may need to contact your non-VA Primary Care Provider to obtain access to medical documents that support using a non-formulary medication.

Exclusions

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The following health care services are NOT covered:

*except where determined by VA to be medically necessary.

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**if not approved by the Food and Drug Administration, unless part of formal clinical trial under an approved research program or when prescribed under a compassionate use exemption.

Cost (Co-pays)

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This section is for care the Veteran receives at a VA run facility NOT community care.

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Reference: IB10-431.

Copayment by Priority Group

NOTES:

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  • Veterans never owe co-pays for treatment/medication related to service connected disabilities, regardless of what priority group they may be in.

  • Former POWs do NOT owe co-pays for non-service connected medications.

  • Veterans who the VA determines to be catastrophically disabled, as defined in 38 CFR 17.36 e. Do NOT owe co-pays for non-service connected medications.

  • Veterans awarded the Medal of Honor do NOT owe co-pays for non-service connected medications.

Special Copayments for Maternity

*Childbirth, parenting classes, nutrition counseling, and breastfeeding support and lactation classes. Based on type of education provided, $15 copay may apply.

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**Only charged 20% of VA’s inpatient co-payment rate for hospital stays.

Additional Exemptions from Co-Pays for Certain Veterans

 

Many Veterans qualify for cost-free health care and/or medications based on:

​Care received that is potentially related to combat service of Veterans who served in a theater of combat operations after November 11, 1998. This benefit is effective for five years after the date of the Veteran’s most recent discharge from active duty.

Co-pay Rates

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See Publication IB 10-430.

Help Paying Co-pays

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See Publication IB 10-430.

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VA offers a few options for those who may have difficulty paying their Co-pays.

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  • Hardship Determination:

A hardship determination provides an exemption from outpatient and inpatient co-payments for the remaining calendar year. If your projected household income is substantially below your prior year’s income, you may request a hardship determination by contacting your local enrollment coordinator.

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  • Waiver:

Veterans can request a waiver of part or all of their debt. If a waiver is granted, the Veteran will not be required to pay the amount waived. Veterans may submit a completed VA Form 5655 (Financial Status Report), along with an explanation of why the debt would cause a financial hardship.

Veterans also may submit in writing a request for a waiver hearing. The VA will notify the Veteran of the date, time, and place where the hearing will be held.

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  • Offer in Compromise:

Veterans can apply for a compromise and propose a lesser amount as full settlement of their debt by submitting a request in writing specifying the dollar amount they can pay along with a completed VA Form 5655 (Financial Status Report).

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  • Repayment Plans:

Veterans can establish a monthly repayment plan if they cannot pay their copayment charges when due by submitting a VA Form 1100 (Agreement to Pay Indebtedness) indicating a proposed monthly payment amount and including the account number and payment stub.

Having Private Health Insurance

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VA is required by law to bill any health insurance carrier that provides coverage for you, including policies held by your spouse. Only Veterans treated for non service-connected conditions should see their insurance company billed for their treatment. Veterans who are treated for service-connected conditions should not have their insurance company billed for treatment.

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Any payment received by VA may be used to offset “dollar for dollar” a Veteran’s VA co-pay responsibility.

!!IMPORTANT NOTE:!! If the Veteran is in a priority group that does not require the Veteran to pay a co-pay for non-service connected conditions, their insurance will STILL BE BILLED! HOWEVER, the Veteran will NOT be responsible for paying their deductible or any amount that the private health insurance does not cover!

 

If the Veteran receives a bill (not an Explanation of Benefits/EOB) from their insurance anyway, they need to resolve the issue by speaking to their regional VAMC's billing department.

Travel Reimbursement

 

Qualifying Veterans may be entitled to reimbursement of:

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*Includes train, subway, bus, ferry, or light rail.

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**Like an ambulance or wheelchair van, when needed and approved.

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***In some cases, the VA may reimburse you for the actual cost, up to 50% of the local government employee rate, for meals or lodging (You’ll need to provide all receipts).

 

Factors that are considered:

​Except in certain unusual cases, you can only get this reimbursement if approved before you travel. The VA won’t reimburse you for lodging or meals if you chose to stop or take a less direct route to a VA or VA-authorized health care facility.

Additional Transportation Options

 

Depending on your area there might be additional ways to make it to appointments:

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General health care travel

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You’re traveling for care at a VA health facility or for VA-approved care at a facility in your community.

  • Have a disability rating of 30% or higher, OR

  • Are traveling for treatment of a service-connected condition (even if your rating is less than 30%), OR

  • Receive a VA pension, OR

  • Have an income that’s below the maximum annual VA pension rate, OR

  • Are traveling for a scheduled VA claim exam (also called a compensation and pension or C&P exam), OR

  • Are traveling to get a service dog

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Filing a claim

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Be sure to submit your claim within 30 days of your appointment. If you become eligible for travel reimbursement after your appointment, submit your claim within 30 days of when you become eligible.

To file a claim go to the AccessVA website.

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Special mode transportation

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Ambulance, ambulette, or wheelchair van

Eligibility:

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  • You’re eligible for general health care travel reimbursement, and

  • A VA health care provider determines that your medical condition requires an ambulance or a specially equipped van for travel, and

  • The VA has approved your travel in advance, unless the travel is for an emergency situation where a delay would threaten your life or health.

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For non-emergency transportation

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Before using non-emergency transportation, be sure to contact your local travel office and get approval.

If the VA orders the service for your transport,

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  • You don't need to file a claim.

If you order the transport and need to pay the cost,

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  • You must submit a claim within 30 calendar days of the date of travel. You'll also need to include a copy of your paid invoice.

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Filing a claim

Complete and submit VA Form 10-3532

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For emergency transport to a VA facility

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The VA SHOULD handle this for you automatically.

MyHealtheVet

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MyHealththeVet is a very helpful website that you can use to do a number of things such as:​

Pharmacy

Appointments

Secure Messaging

Communicate with your treatment team and other VHA departments about non-emergency issues.

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Access Health Records

View, print, or download your VA medical record

This includes any C&P exam reports completed by the VA (but not examinations conducted by third-party contractors).

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Patient Advocate

Are you having issues with VA health care? Before you call the White House or your Congressperson, give your local VA a chance to address it. The VA Patient Advocate's job is to help resolve your issues.

Patient Advocates can help you:

Note:

 

  • Your VAMC might not call it the "Patient Advocate" For example, the VA Sierra Nevada Health Care System calls it the "Veteran Experience Program.

Durable Medical Equipment (DME)/Expendable Medical Supplies
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If your Primary Care Provider has deemed it medically necessary, you are eligible for various free medical equipment/supplies. Here are some examples. If you feel like you should be eligible for something speak with your Primary Care Provider!

Prosthetic socks
Hearing aids
Hearing aid batteries
Hearing aid accessories
Shoe inserts
Blood pressure monitor
Pill box
Pill cutter
Electric hospital beds
Catheters
Incontinence supplies
Manual wheelchairs
Electric wheelchairs/scooters
Oxygen + supplies
Invalid Lifts
Stair Glides
Porch Lifts
Ramps
Air Conditioner
Environmental Control Unit (ECU)
Mobility and/or Walking Aids
Seat Lift Mechanisms
Specialized sporting equipment
Standing tables
Shower bar
Shower chair

Here is a list of things are are expressly NOT allowed:

​Remote controls
Stair climbing wheelchairs
Queen/king size beds
Sporting equipment (normal)
Exercise equipment
Spas
Hot tubs
Swimming pools
Recliner chairs
Bed linens
Items prescribed solely for convenience or personal comfort

FAQ

​Is VA health care insurance?
 

No. However, for the purposes of the Affordable Care Act it fulfills the coverage requirement.
 

How do I change my Primary Care Provider?

Speak with your patient advocate. If you don't have a good rapport with your PCP and feel that your health care would benefit from a different PCP, the Patient Advocate can guide you through that process. There is no uniform process across the VA for this, every VAMC has their own process. You will probably have to have at least one "get to know you" appointment with your new PCP before the change will be finalized.
 

NOTE:

  • You can only switch your Primary Care Provider once a year.
     

Do I need to use VA health care to maintain a VA disability rating?

No, there is no requirement to use the VHA to maintain benefits. The Veterans Benefits Administration (VBA) is almost completely separate from the Veterans Health Administration (VHA), though they are both part of the US Department of Veterans Affairs.

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Note:

  • This question comes up because SSDI recipients can have their benefits discontinued for failing to follow prescribed medical treatment. If someone tells you they heard your VA benefits can be terminated for not using the VHA they are probably confusing VBA benefits with Social Security benefits.

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References

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Additional health care Articles

NumberArticle Name

1Dental

2Hearing

3Vision

4Community Care

5Vet Centers

6Foreign Medical Program

7CHAMPVA - Dependent health care

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