Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

Community Care

Menu
Menu

Quick Links

Veterans Crisis Line Badge
My healthevet badge
EBenefits Badge
 

Copayments

Veterans are charged a copayment for nonservice-connected care provided directly by VA or through a community provider (doctor) outside of VA. The copayment amount is based on the type of health care service you receive and your financial situation. Copayment rates for each service are listed below.

Some Veterans may be exempt from paying copayments, and may qualify for free health care and/or prescriptions based on special eligibility factors. You can explore your eligibility for VA health care beneftis using the online Health Benefits Explorer tool or by contacting VA at 877-222-VETS (8387).

Veteran Copayments— Published October 6, 2017

For information on how to pay your bill or copayment, visit our Billing page.

Outpatient Care

Outpatient care is defined as primary or specialty care that does not require an overnight stay. Copayments for outpatient care are listed in the table.

NOTE: Veterans who have a service-connected rating of 10% or higher are not required to pay a copayment for outpatient medical care.

Copayment rates for outpatient care
Examples of Outpatient CareCopay
Primary Care Services $15 per visit
Specialty Care Services: Services such as surgeon, radiologist, audiologist, optometrist, cardiologist, and specialty tests like MRI or CAT scan $50 per visit

Inpatient Care

Inpatient care occurs when a patient’s condition requires admission to a hospital. There are two inpatient copayment rates: the full rate and the reduced rate. Veterans living in high cost areas may qualify for a reduced inpatient copayment rate. Copayment rates for an inpatient hospital stay are listed in the table below.

NOTE: Veterans who have a service-connected disability rating of 10% or higher are not required to pay a copayment for inpatient medical care.

Copayment rates for an inpatient hospital stay
Veteran Priority GroupsCopay
(2018)
Period of Service/Care
Priority Group 7 Veterans
Veterans with gross household incomes below the geographically-adjusted VA income limits for their resident location and who agree to pay copayments.
$268 First 90 days of care during a 365-day period
$134 Each additional 90 days of care during a 365-day period
$2 Per day charge
 
Priority Group 8 Veterans
Veterans with gross household incomes above the geographically-adjusted VA income limits for their resident location, who agree to pay copayments, and meet other specific enrollment and service-connected eligibility criteria.
$1,340 First 90 days of care during a 365-day period
$670 Each additional 90 days of care during a 365-day period
$10 Per day charge

Medications

Medication copayments are required for each prescription, including each 30-day (or less) supply of maintenance medications prescribed on an outpatient basis for nonservice-connected conditions. This copayment may change annually.

Medication copayments are also charged for all over-the-counter (OTC) medications (like aspirin, cough syrup, and vitamins) that are dispensed from a VA pharmacy. You may want to consider purchasing over-the-counter medications on your own.

NOTE: There is an annual medication copayment cap of $700 for Veterans in Priority Groups 2 through 8. The medication copayment cap goes by calendar year (January 1 – December 31).

Veterans who have a service-connected rating of 40% or less, and whose income is at or below the applicable national income thresholds may wish to complete a medication copayment exemption test.

VA National Income LimitsVA Financial Assessment information
 
Tiered medication copayment rates effective January 1, 2018
Veteran Priority GroupsCopay
Priority Group 1 Veterans
Veterans with VA-rated service-connected disabilities 50% or more disabling or Veterans determined by VA to be unemployable due to service-connected conditions or Medal of Honor recipients.


No copayment
Priority Group 2-8 Veterans
Required to pay for each 30-day or less supply of medication for treatment of nonservice-connected condition (unless otherwise exempt). Limited to $700 annual cap.

IMPORTANT: Some Veterans may qualify for reduced or no-cost prescriptions based on special eligibility factors.
Prescription Drug Tier Days of Supply
  1‑30 31‑60 61‑90
Tier 1: Preferred generics $5 $10 $15
Tier 2: Non-preferred generics and some OTC medications $8 $16 $24
Tier 3: Brand-name $11 $22 $33

Additional information on tiered medication copays can be found on the VA Pharmacy Benefits Management Services website.

VA Pharmacy Benefits Management Services website

Geriatrics and Extended Care

Copayments for health care for older Veterans are based on three levels of care—inpatient, outpatient, and domiciliary (see below). Copayment rates will vary from Veteran to Veteran depending upon financial information submitted on VA Form 10-10EC, Application for Extended Care Services.

NOTE: 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.

Geriatrics and extended care copayment rates
Inpatient CareCopay
Community Living Centers (formerly known as nursing homes)
VA Community Living Centers are long-term care services provided to Veterans who need a skilled environment for short-term and long-term stays.
Up to $97/day
Respite Care
Respite Care is a service that pays for someone to come to a Veteran's home or for a Veteran to go to a program while your family caregiver takes a break. Respite Care services may be available up to 30 days each calendar year.
Up to $97/day
Geriatric Evaluation
A multidisciplinary team consisting of a doctor, nurse, and several other health providers conduct an evaluation to promote, preserve, or restore a Veteran’s health. The information gained from the Geriatric Evaluation helps you and your family decide what type of services and support would best meet your needs and preferences.
Up to $97/day
Outpatient Senior Care Copay
Adult Day Health Care
Adult Day Health Care is a program Veterans can go to during the day for social activities, peer support, companionship, and recreation. Adult Day Health Care is for Veterans who need skilled services, case management, and assistance with activities of daily living (e.g., bathing and getting dressed); instrumental activities of daily living (e.g., fixing meals and taking medicines); and/or are isolated or your caregiver is experiencing burden. Adult Day Health Care can provide respite care for your family caregiver and can also help you and your caregiver gain skills to manage your care at home.
Up to $15/day
Respite Care
Respite Care is a service that pays for someone to come to a Veteran's home or for a Veteran to go to a program while your family caregiver takes a break. Respite Care services may be available up to 30 days each calendar year.
Up to $15/day
Geriatric Evaluation
A multidisciplinary team consisting of a doctor, nurse, and several other health providers conduct an evaluation to promote, preserve, or restore a Veteran’s health. The information gained from the Geriatric Evaluation helps you and your family decide what type of services and support would best meet your needs and preferences.
Up to $15/day
Domiciliary Care for Homeless Veterans  Copay
Short-Term Rehabilitation and Long-Term Health Maintenance Care
VA offers two types of Domiciliary Care: short-term rehabilitation and long-term health maintenance care. This program provides clinically appropriate levels of care for homeless Veterans whose health care needs are not severe enough to require more intensive levels of treatment.
Up to $5/day

Resources

877-222-VETS (8387)
Monday – Friday
8 a.m. – 8 p.m. EST

Health Benefits Explorer