Basic Eligibility for VA Health Care
If you served in the active military, naval or air service and are separated under any condition other than dishonorable, you may qualify for VA health care benefits. Current and former members of the Reserves or National Guard who were called to active duty (other than for training only) by a federal order and completed the full period for which they were called or ordered to active duty also may be eligible for VA health care.
Minimum Duty Requirements
Most Veterans who enlisted after September 7, 1980, or entered active duty after October 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty to be eligible. This minimum duty requirement may not apply to Veterans who were discharged for a disability incurred or aggravated in the line of duty, were discharged for a hardship or received an “early out.” Since there are a number of other exceptions to the minimum duty requirements, VA encourages all Veterans to apply to determine their enrollment eligibility.
Returning Service Members (OEF/OIF/OND)
Every VA medical center has a team ready to welcome OEF/OIF/OND Servicemembers and help coordinate their health care and other services. For more information about the various programs available for recently returned Servicemembers, log on to the Returning Servicemembers website at www.oefoif.va.gov.
Veterans who served in a theater of operations after November 11, 1998, are eligible for an extended period of eligibility for health care for five years after their discharge. In the case of multiple call-ups, the five-year enrollment period begins on the most recent discharge date. This special eligibility includes cost-free health care services and nursing home care for conditions possibly related to military service and enrollment in PG 6 or higher for five years from their date of discharge or release from active duty, unless they are eligible for enrollment in a higher priority group.
Combat Veterans who enroll with VA under this enhanced Combat Veteran authority will continue to be enrolled even after their enhanced eligibility period ends, although they may be shifted to a lower Priority Group, depending on their income level, and be required to make applicable copayments. Additionally, for care not related to combat service, copayments may be required, depending on their financial assessment and other special eligibility factors.
New Enrollees Will Receive a Welcome to the VA Call and a Personalized Veterans Health Benefits Handbook
Once you are enrolled, you can begin enjoying your VA health care benefits. You will receive a “Welcome to My VA” telephone call from VA staff. During that call, we can answer many of your initial questions, provide information regarding your health benefits and other services provided through VA and schedule your initial VA health care appointment. You also will receive a personalized letter and a Veterans Health Benefits Handbook in the mail. The handbook will detail your VA health care benefit information, based on your specific eligibility factors, in an organized, easy-to-read format. It also includes information on your preferred facility, copayment responsibilities, how to schedule appointments, ways to communicate treatment needs and more. For more information, visit www.va.gov/healthbenefits/vhbh.
Keep your Personal Information Updated with All VA Organizations
While you are enrolled, it is important to update or report changes to your address, phone number, name, health insurance or financial information. The three VA organizations’ (Veteran Health Administration (VHA), Veteran Benefits Administration (VBA) and National Cemetery Administration (NCA)) computer databases are not connected; therefore, you will need to notify each VA organization of your demographic and personal information changes. Keeping your information accurate allows VA to better inform you of updates to benefits and services. To update your information with VHA, complete VA Form 10-10EZR (Health Benefits Renewal Form) online at www.vets.gov/healthcare/apply/; call 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. ET. or contact the enrollment coordinator at your local medical facility. Self-service kiosks also are available at most VA health care facilities for use in updating your personal information. For more information, see “Self-Service Kiosks” on page 29.
Your Information is Secure with the Veteran Health Identification Card
VA issues enrolled Veterans a Veteran Health Identification Card (VHIC) for use at VA health care facilities. The VHIC safeguards your personal information – the member ID and card number have eliminated the need for your Social Security number to be on the card. Similar to a typical health insurance card, the VHIC signifies your enrollment in VA health care.
The VHIC is used as proof of identity and to check in for appointments at VA health care facilities. While the card is not required to receive health care, VA recommends all enrolled Veterans have one.
To obtain a VHIC, you will need to provide one form of primary identification: your driver’s license, passport, or other federal, state or local photo ID with your address, to your local VA health care facility and have your photo taken. The card will be mailed to you usually within seven to 10 days after it has been requested. For more information about the types of identification needed, go to “What document(s) do I need to prove my identity to receive a VHIC?” on page 40. You also can visit www.va.gov/healthbenefits/vhicor call 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. ET. If your card is lost or stolen, contact your local VAMC for assistance.
Schedule an Appointment
You can request a doctor’s appointment when you apply for enrollment. We also can help you schedule your first appointment during your “Welcome to My VA” call. An appointment will be made with a VA doctor or other health care provider and you will be notified via mail of the appointment date and time. If you need health care before your scheduled appointment, you can contact the enrollment coordinator, the urgent care clinic or the emergency room staff at your local VA medical facility.
You Will Be Assigned a Personal Care Team
Every patient is assigned a Patient Aligned Care Team (PACT) they can count on to help coordinate and personalize their care. Every PACT includes a primary care provider, clinical pharmacist, registered nurse care manager, licensed practical nurse or medical assistant and clerk. Veterans can expect their PACT to help them use health care services, including eHealth technologies, which are necessary to optimize their health and well-being. For more information, visit www.patientcare.va.gov/primarycare/PACT.aspor contact the enrollment coordinator at your local VA medical facility.
VA wants to ensure your health care is coordinated and seamless, whether you are seen at your local VA health care facility or at an alternate VA health care facility as you travel or have a temporary change of address (for example, if you live in one state during the winter and another during summer). If you know you will be traveling, your experience can be enhanced if you contact your VA PACT or Specialty Care Provider(s) four to six weeks before traveling, or as soon as possible. If you see a VA provider while traveling, that care will be recorded in your electronic medical record for follow-up treatment options with your PACT. When you contact your PACT, be sure to have the following information available:
- Travel destination(s) and temporary address(es)
- A valid telephone number
- Arrival and departure dates
- Specific care concerns
For more information, contact your PACT or a Traveling Veteran Coordinator at your local VA facility.
Coordination of Care among VA Facilities
You may receive specialized medical treatments and services in a variety of VA settings - clinic, hospital, emergency room, VA Community Living Center or your own residence. To manage the different aspects of care effectively, your PACT will use our electronic medical record system to ensure the coordination of your care, whether at your preferred site of care or an alternate facility.
For more information, contact your PACT or a traveling Veteran coordinator at your local VA facility.
Enrolled, but Later Determined Ineligible
Enrolled Veterans who are receiving health care benefits and are later determined to not be eligible for enrollment will be notified via letter 60 days prior to disenrollment. This will give the Veteran adequate time to provide VA with the needed information to finalize the enrollment decision and, if necessary, transfer his or her medical care to the private sector or to seek other options for medical care.
The pre-termination of enrollment letter will indicate:
- The reason for the decision (lack of proof of Veteran status, eligibility, etc.)
- The proposed effective date of the decision
- Appeal procedures and the right to present evidence
- Request a personal hearing and have representation During the 60-day period, the Veteran has the right to:
- Contest or provide additional information before a final eligibility determination is made
- Remain in his/her current enrollment group and continue to receive health care benefits
At the end of the 60 days and after thoroughly reviewing any new evidence or information submitted, VA will make a final eligibility determination. If the information provided assists in determining that the Veteran is eligible for enrollment, the Veteran will receive a notification letter indicating continued eligibility status. If the Veteran is determined not eligible for enrollment, the Veteran will receive a notification letter indicating the:
- Reason for disenrollment
- Date of disenrollment
- Instructions for submitting VA Form 4107 VHA (Your Right to Appeal Our Decision)
Financial Reporting Requirements
While many Veterans qualify for enrollment and cost-free health care services based on a compensable service-connected condition or other qualifying factors, certain Veterans will be asked to complete a financial assessment at the time of enrollment to determine their eligibility for free medical care, medications and/or travel benefits. The assessment is based on the previous year gross household income of the Veteran and his or her spouse and dependents, if any. This financial information also may be used to determine the Veteran’s enrollment Priority Group.
For more information, visit www.va.gov/healthbenefits/cost/financial_assessment.asp, call 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. ET or contact the enrollment coordinator at your local VA medical facility.
Note:VA has eliminated the annual requirement for updated financial information. VA now uses information from the Internal Revenue Service (IRS) and Social Security Administration (SSA) to automatically match individual Veteran’s income information, reducing the burden on Veterans to keep their health care eligibility up to date.
Net Worth Information No Longer Required
In January 2015, VA eliminated the use of net worth information as a determining factor for eligibility and copayment responsibilities. VA will only consider a Veteran’s gross household income and deductible expenses from the previous year. This change makes VA health care benefits more affordable to lower- income Veterans who have no service-connected condition or other qualifying factors.
Use Our Online Tool to Determine Your Eligibility Based on Income
Our financial calculator at hbexplorer.vacloud.uscan help you determine whether your income would be considered in determining your enrollment eligibility.