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Request VA financial hardship assistance

If you're struggling because of life situations like losing your job, having a sudden decrease in income, or having an increase in out-of-pocket family health care expenses, we can help. You can request financial hardship assistance to manage your current VA copay debt or request an exemption from future copays.

What can I do if I can't afford to pay my current VA copay debt?

You can request either of the 2 financial hardship assistance options below, depending on your situation. To avoid late charges, including interest and other fees, you'll need to take action within 30 days of receiving your bill.

Learn more about VA late charges and debt collection

Option 1: Set up a repayment plan to pay your debt over time

If you can't pay your copay debt all at once, you can set up a monthly repayment plan at any time. We'll review your proposed payment plan based on the amount of debt you owe and your ability to pay within a reasonable time. We usually require you to pay off the full debt within 3 years.

To set up a repayment plan:

 

  1. Fill out an Agreement to Pay Indebtedness (VA Form 1100). 

    In paragraph 1A, tell us how much you can pay each month.

    Download VA Form 1100 (PDF)

  2. Submit your completed form and any other needed documentation to us.

    You can send these by mail, or bring them in person, to the business office or health administration office at your nearest VA medical center.

    Find the address of your nearest VA medical center

  3. Once we approve your repayment plan, begin sending your monthly payments.

    If you receive a coupon book with your approved repayment plan, please send payments to the address on the coupon. You can also make a payment by mail or in person at your VA medical center's revenue office.

Note: Repayment plans don't include new charges you may receive after submitting your proposed plan. If you submit your plan and then receive a bill with new charges, please submit a new VA Form 1100 for the new charges. If you keep receiving new charges, please call us at 866-400-1238 every 90 days to request a new repayment plan. We're here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET. If you have hearing loss, call TTY: 711.

Option 2: Request debt relief for some or all of your copay debt

If you don't think you can pay your debt with a monthly repayment plan, you can request debt relief for all or part of your balance. You can request a waiver (asking us to stop collection action on the debt), write-off (asking us to cancel the debt), or compromise (asking us to accept a lower amount of money as full payment of the debt). If we grant part or all of your request, you won't have to pay the amount of the balance we agree to relieve.

To request debt relief:

  1. Fill out a Financial Status Report (VA Form 5655).

    Download VA Form 5655 (PDF)

  2. Write a letter explaining why you're requesting debt relief.

    The letter should describe the financial issues that make it hard for you to pay your copay debt. You also have the right to request a hearing to explain your request. We’ll send you notice about the date, time, and place where we’ll hold the hearing.

  3. Submit your completed form and letter to us.

    You can send these by mail, or bring them in person, to the business office or health administration office at your nearest VA medical center.

    Find the address of your nearest VA medical center

If you need more information or help with filling out your forms, please call us at 866-400-1238. We're here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.

What can I do if my income has decreased and I won't be able to pay future copays?

You may be eligible for a hardship determination, which would qualify you for a copay exemption. This means we'll assign you to a higher priority group, and you won't have to pay any VA copays for the rest of the calendar year.

To request a VA hardship determination and copay exemption:

  1. Fill out a Request for Hardship Determination (VA Form 10-10HS).

    Download VA Form 10-10HS (PDF)

  2. Write a letter explaining why you're requesting a hardship determination.

    The letter should describe the financial issues that make it hard for you to pay your copays.

  3. Submit your completed form and letter to us.

    You can send these by mail, or bring them in person, to the business office or health administration office at your nearest VA medical center.

    Find the address of your nearest VA medical center

Note: A hardship copay exemption doesn't apply to copays for pharmacy medications.

If you need more information or help with filling out your forms, please call us at 866-400-1238. We're here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET. 

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