VA has programs that may help Veterans suffering from financial distress and struggling to pay VA copayments as a result of personal circumstances such as; a loss of job, a sudden decrease in income, or increases in out-of-pocket family health care expenses.
You have the right to establish a monthly repayment plan at any time during your enrollment in VA health care if you cannot pay your debt in full. To do so, submit a completed Agreement to Pay Indebtedness (VA Form 1100) found at: www.va.gov/vaforms/va/pdf/VA1100.pdf. Indicate your proposed monthly payment amount in paragraph 1A. Include your first payment with the completed form. Make check or money order payable to “VA” and include the account number and payment stub. VA will consider the size of your debt, your ability to pay and your ability to pay within a reasonable time. Typically, a repayment plan cannot extend beyond three (3) years.
Waiver of Existing Debt
You have the right to request a waiver of part or all of your debt. If the waiver is granted you will not be required to pay the amount waived. To do so, submit an explanation and a completed Financial Status Report (VA Form 5655) found at: www.va.gov/vaforms/va/pdf/VA5655.pdf. Your explanation should include why you are not responsible for the debt and any undue hardship the payment of the debt would cause you. You have the right to request a hearing in connection with your request for a waiver. To do so, submit a written request for hearing with your waiver request. VA will notify you of the date, time and place where the hearing will be held.
If your gross household income has decreased, you may be eligible for a hardship which may qualify you for copayment exemption for the remaining calendar year and enrollment in a higher Priority Group. To request a hardship determination, send a letter explaining the financial hardship your copayment charges will cause you and a completed Request for Hardship Determination (VA Form 10-10HS) found at: www.va.gov/vaforms/medical/pdf/vha-10-10HS.pdf.
Refer to the “Customer Service” and “Submitting Your Request” sections below for more information. It is important to note that Hardships do not apply to prescription copays.
Submitting Your Request
Submit the required VA forms or documents to apply for one of VA’s Financial Hardship Programs:
- In Person: At your local Veteran Affairs Medical Center’s Business Office or Health Administration Service Office
- By Mail: Send completed forms and/or other required documentation to the Business Office/Health Administration Service Office of your local VA Medical Center. Find the address of your local VA medical center here: www.va.gov/directory/guide/home.asp
For additional information, to request necessary forms or assistance in accessing forms online:
- In Person: Contact your Patient Advocate or Enrollment Coordinator at your local VA Medical Center
- By Phone: Contact VA at 1-866-400-1238
- Online: Visit www.va.gov/vaforms to retrieve VA forms