Health Benefits Copays
While many Veterans qualify for free healthcare services based on a VA compensable service-connected condition or other special eligibilities, most Veterans are required to complete a financial assessment or means test at the time of enrollment to determine if they qualify for free health care services. Veterans whose income exceed VA income limits as well as those who choose not to complete the financial assessment at the time of enrollment, must agree to pay required copays for health care services to become eligible for VA healthcare services.
- Primary Care Services: $15
- Specialty Care Services: $50
- 30-day or less supply for certain Veterans: $8
- 30-day or less supply for higher income Veterans: $9
There are two inpatient copay rates, the full rate and the reduced rate.
Priority Group 7 and certain other Veterans are responsible for paying 20 percent of VA's inpatient copay rate.
- Inpatient Copay for the first 90 days of care during a 365-day period……………$257.60
- Inpatient Copay for each additional 90 days of care during a 365-day period……………$128.00
- Daily Charge……………$2/day
Priority Group 8 and certain other Veterans are responsible for VA's full inpatient copay rate.
- Inpatient Copay for the first 90 days of care during a 365-day period……………$1,288.00
- Inpatient Copay for each additional 90 days of care during a 365-day period……………$644
- Daily Charge……………$10/day
Veterans living in high cost areas may qualify for a reduced inpatient copay rate. For more information contact VA toll-free at 877-222-VETS (8387).
Veterans can use the Health Benefits Explorer to see what copays may apply to their health care plan.
Geriatrics and Extended Care
Long term care copays are based on three levels of care:
- Inpatient: Up to $97 per day (Community Living (Nursing home), Respite, Geriatric Evaluation)
- Outpatient: $15 per day (Adult Day Health Care, Respite, Geriatric Evaluation)
- Domiciliary: $5 per day
**Copayments for Long-Term Care services start on the 22nd day of care during any 12-month period — there is no copayment requirement for the first 21 days. Actual copayment charges will vary from Veteran to Veteran depending upon financial information submitted on VA Form 10-10EC.
Veterans Not Required To Make Copays
Some Veterans qualify for free healthcare and/or prescriptions based on special eligibility factors including but not limited to:
- Former Prisoner of War status
- 50% or more compensable VA service-connected disabilities (0-40% compensable service- connected may take copay test to determine prescription copay status)
- Veterans deemed catastrophically disabled by a VA provider
Services Exempt from Inpatient and Outpatient Copays
- Special registry examinations offered by VA to evaluate possible health risks associated with military service
- Counseling and care for military sexual trauma
- Compensation and Pension examinations.
- Care that is part of a VA research project
- Care related to a VA-rated service-connected disability
- Readjustment counseling and related mental health services
- Care for cancer of head or neck caused by nose or throat radium treatments received while in the military
- Individual or Group Smoking Cessation or Weight Reduction services
- Publicly announced VA public health initiatives, for example, health fairs
- Care potentially related to combat service for Veterans that served in a theater of combat operations after November 11, 1998.
- Laboratory and electrocardiograms
- Hospice care