Office of Public and Intergovernmental Affairs

Chapter 1 Health Care Benefits

https://www.va.gov/opa/publications/benefits_book/Chapter_1_Health_Care_Benefits.asp

More information on VA health care is available at the following resources:

www.va.gov/health

www.va.gov/healthbenefits

VA Health Benefits toll-free 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. EST

Basic Eligibility:

A person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable may qualify for VA health care benefits including qualifying Reserve and National Guard members.

Minimum Duty Requirements:

Veterans who enlisted after Sept. 7, 1980, or who entered active duty after Oct. 16, 1981, must have served 24-continuous months or the full period for which they were called to active duty in order to be eligible. This minimum duty requirement may not apply to Veterans discharged for hardship, early out or a disability incurred or aggravated in the line of duty.

Enrollment:

Veterans can complete applications for enrollment in VA health care by using one of the options below:

• To apply by phone, call 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. EST. VA staff members will collect the needed information and process the enrollment application for an enrollment determination.
• When applying online at Vets.gov, Veterans fill out the application and electronically submit it to VA for processing. VA will search for your supporting documentation through its electronic information systems and will contact you if it is unable to verify your military service.
• The application form can also be downloaded from www.vets.gov/healthcare/apply/. Mail the completed form to: Health Eligibility Center ATTN: Enrollment Eligibility Division 2957 Clairmont Road Suite 200 Atlanta, GA 30329-1647
• Apply in person at any VA health care facility or VA regional office. Once enrolled, Veterans can receive health care at VA health care facilities anywhere in the country.

The following four categories of Veterans are not required to enroll, but are urged to do so to permit better planning of health resources:

1. Veterans with a service-connected disability rated at 50 percent or more.
2. Veterans seeking care for a disability the military determined was incurred or aggravated in the line of duty, but which VA has not yet rated, within 12 months of discharge.
3. Veterans seeking care for a service-connected disability only.
4. Veterans seeking registry examinations (ionizing radiation, Agent Orange, Gulf War/Operation Enduring Freedom/ Operation Iraqi Freedom/ Operation New Dawn (OEF/OIF/OND) depleted uranium, airborne hazards and Airborne Hazards and Open Burn Pit Registry).

Priority Groups:

During enrollment, each Veteran is assigned to a priority group. VA uses priority groups to balance demand for VA health care enrollment with resources. Changes in available resources may reduce the number of priority groups VA can enroll. If this occurs, VA will publicize the changes and notify affected enrollees. A description of priority groups follows:

• Group 1:
  Veterans with service-connected disabilities rated 50 percent or more; Veterans determined by VA to be unemployable due to service-connected conditions; and Veterans who have been awarded the Medal of Honor.
• Group 2:
  Veterans with service-connected disabilities rated 30 or 40 percent.
• Group 3:
  Veterans who are former Prisoners of War; Veterans awarded the Purple Heart medal; Veterans whose discharge was for a disability incurred or aggravated in the line of duty; Veterans with VA service-connected disabilities rated 10 or 20 percent; and, Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”
• Group 4:
  Veterans who receive increased compensation or pension based on their need for regular aid and attendance or by reason of being permanently housebound; and, Veterans determined by VA to be catastrophically disabled.
• Group 5:
  Nonservice-connected Veterans and non-compensable service-connected Veterans rated by VA as 0-percent disabled and who have an annual income below the VA’s geographically-adjusted income limit (based on your resident ZIP code); Veterans receiving VA Pension benefits; and Veterans eligible for Medicaid benefits.
• Group 6:
  Compensable 0 percent service-connected Veterans; Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki. Project 112/SHAD participants; Veterans who served in the Republic of Vietnam between Jan. 9, 1962 and May 7, 1975; Veterans who served in the Southwest Asia theater of operations from Aug. 2, 1990, through Nov. 11, 1998; Veterans who served in a theater of combat operations after Nov. 11, 1998, as follows: Veterans discharged from active duty on or after Jan. 28, 2003, for five years post discharge; and Veterans who served on active duty at Camp Lejeune for at least 30 days between Aug.1, 1953, and Dec. 31, 1987. Currently enrolled Veterans and new enrollees who served in a theater of combat operations after Nov.11, 1998 and those who were discharged from active duty on or after Jan. 28, 2003, are eligible for the enhanced benefits for five years post discharge.
  Note: At the end of this enhanced enrolment priority group placement time period, Veterans will be assigned to the highest priority group their eligibility for which their status at that time qualifies.
• Group 7:
  Veterans with gross household income below the geographically-adjusted VA income limit for their resident location and, who agree to pay copayments.
• Group 8:
  Veterans with gross household incomes above VA national income limit and the geographically-adjusted income limit for their resident location and, who agree to pay copayments. Veterans eligible for enrollment:
  Noncompensable 0-percent service-connected and are:
  • Subpriority a:
    Enrolled as of Jan. 16, 2003, and who have remained enrolled since that date and/or placed in this subpriority due to changed eligibility status.
  • Subpriority b:
    Enrolled on or after June 15, 2009, whose income exceeds the current VA national income limits or VA national geographic income limits by 10 percent or less Veterans eligible for enrollment: nonservice-connected and:
  • Subpriority c:
    Enrolled as of Jan. 16, 2003, and who remained enrolled since that date and/or placed in this subpriority due to changed eligibility status
  • Subpriority d:
    Enrolled on or after June 15, 2009 whose income exceeds the current VA national income limits or VA national geographic income limits by 10 percent or less
    Veterans NOT eligible for enrollment: Veterans not meeting the criteria above:
  • Subpriority e:
    Noncompensable 0-percent service-connected (eligible for care of their service-connected condition only.
  • Subpriority f:
    Nonservice-connected VA’s income limit change annually and current levels can be located at:
    http://nationalincomelimits.vaftl.us/.
  
  

  Veterans Choice Program:

  As directed by the Veterans Access, Choice and Accountability Act of 2014, VA implemented the Veterans Choice Program, which allows certain eligible Veterans to elect to receive care from community health care providers closer to home rather than wait for a VA appointment or travel a long distance to a VA facility. The Veterans Choice Program temporarily authorizes enrolled Veterans to receive health care from community providers. Any of the following conditions must apply:

  • Veteran told by his or her local VA medical facility that they will not be able to schedule an appointment for care within 30 days of the date the Veteran’s physician determines he/she needs to be seen or within 30 days of the date the Veteran wishes to be seen, if there is no specific date from his or her physician;
  • Veteran lives more than 40 miles driving distance from the closest VA medical facility with a full- time primary care physician;
  • Veteran needs to travel by air, boat or ferry to the VA medical facility closest to his/her home;
  • Veteran faces an unusual or excessive burden in traveling to the closest VA medical facility based on geographic challenges, environmental factors, a medical condition, the nature or simplicity or frequency of the care needed and whether an attendant is needed. Staff at the Veteran’s local VA medical facility will work with him/her to determine if the Veteran is eligible for any of these reasons; or
  • Veteran lives in a state or territory without a full-service VA medical facility. These locations include Alaska, Hawaii, New Hampshire (excluding New Hampshire Veterans who live within 20 miles of the White River Junction VAMC) and the United States territories (excluding Puerto Rico, which has a full service VA medical facility).

  Community care is only covered by VA for medical needs that have been approved by a VA physician. Veterans who choose to use their Choice Card should coordinate pre-approved care by calling 1-866-606-8198. For more information, visit www.va.gov/opa/choiceact/.

  Meeting the Unique Needs of Women Veterans:

  VA staff delivers the highest quality health care in a setting that ensures privacy, dignity, and sensitivity. Local VA facilities offer a variety of services, including women’s gender-specific health, screening and disease prevention and routine gynecologic services.

  Women Veterans are potentially eligible to receive care provided in the community when authorized by VA; however, the decision to use such care is left to the facility providing care. By law, purchased care can only be provided when the treating facility cannot provide the care required or because of geographical inaccessibility.

  Contact a local VA facility’s Women Veterans Program Manager for more information on available services, call 1-855-VA-WOMEN (1-855-829-6636) or visit www.womenshealth.va.gov/.

  Lesbian Gay Bisexual and Transgender (LGBT) Veterans:

  LGBT Veterans are eligible for the same VA benefits as any other Veteran and will be treated in a welcoming environment. Transgender Veterans will be treated based upon their self-identified gender, including room assignments in residential and inpatient settings. Same-sex couples: VA launched a website to inform Veterans and beneficiaries of the recent changes in the law and procedures involving same-sex marriages. Veterans can learn more about VA’s guidance regarding same-sex marriages at www.va.gov/opa/marriage.

  Military Sexual Trauma

  (MST) is the term that VA uses to refer to sexual assault or repeated, threatening sexual harassment occurring during a Veteran’s military service. VA has expanded eligibility for Veterans in need of mental health care due to sexual assault or sexual harassment to Reservists and National Guard members participating in weekend drill. To receive free treatment related to MST, Veterans do not need a VA service-connected disability. Veterans do not need to have reported the incident when it happened or have other documentation that it occurred. There are no length-of-service requirements to receive care, and some Veterans may be able to receive free MST-related care even if they are not eligible for other VA care. Veterans can learn more about VA’s MST-related services online at www.mentalhealth.va.gov/msthome.asp.

  OEF/OIF/OND Care Management:

  Each VA medical center has an Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Care Management team in place to coordinate patient care activities and ensure that Veterans are receiving patient-centered, integrated care and benefits. Veterans who served in a theater of operations after Nov. 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 Priority Group 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. More information for connecting with OEF/OIF/OND Care Management teams can be found at www.oefoif.va.gov

  Tax Credit:

  Veterans who are enrolled with VA for their health care meet the standard for minimum health care coverage; therefore, they are not eligible for assistance to lower their cost of health insurance premiums if they chose to purchase additional health insurance outside of their VA health care coverage. Remember, Veterans cannot receive a tax credit for themselves when enrolling within the marketplace, if they are currently enrolled with VA for their health care. For the latest information about VA and the health care law, visit www.va.gov/health/aca/FAQ.asp or call 1-877-222-VETS (8387).

  Financial Assessment:

  Most Veterans not receiving VA disability compensation or pension payments must provide a financial assessment upon initial application to determine their eligibility for free medical care, medications and/or travel benefits. 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 toll-free 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. EST or contact the enrollment coordinator at your local VA medical facility. VA’s income limits are located at nationalincomelimits.vaftl.us/.

  VA no longer requires enrolled non-service connected and 0-percent non-compensable service connected Veterans to provide their financial information annually. An assessment will continue to be collected from Veterans at the time of application for enrollment. In lieu of the annual financial reporting, VA will confirm the Veteran’s financial information using information obtained from the Internal Revenue Service and Social Security Administration.

  Medical Services and Medication Copayments:

  While many Veterans qualify for free health care based on a VA compensable service-connected condition or other special eligibilities, most Veterans are required to complete a financial assessment at the time of enrollment to determine if they qualify for free health care services. Veterans whose income exceeds the 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 copayments for care to become eligible for VA healthcare services. For more information on medical services and copays, visit https://www.va.gov/HEALTHBENEFITS/cost/copays.asp

  Private Health Insurance Billing:

  Veterans with private health insurance may choose to use these sources of coverage as a supplement to their VA benefits. Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance.

  By law, VA is obligated to bill health insurance carriers for services provided to treat a Veteran’s nonservice- connected conditions. Veterans are asked to disclose all relevant health insurance information to ensure current insurance information is on file, including coverage through a spouse.

  Any payment received by VA may be used to offset "dollar for dollar" a Veteran’s VA copay responsibility. Funds that VA receives from third party health insurance carriers go directly back to VA medical center’s operational budget. That money can be used to hire more staff or buy medical equipment to improve Veterans healthcare. Enrolled Veterans can provide or update their insurance information by:

  • 1. Using the online Health Benefits Renewal form (10-10-EZR) at www.vets.gov/healthcare/apply/
  • 2. Calling 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. EST
  • 3. Presenting their health insurance card to the clinic clerk or using the self-service Kiosks available at their local VA health care facility. VA health care is NOT considered a health insurance plan.

  Reimbursement of Travel Costs:

  Eligible Veterans and non-Veterans may be provided mileage reimbursement or, when medically indicated, special mode transport (e.g., wheelchair van, ambulance), when travel is in relation to VA medical care. Mileage reimbursement is 41.5 cents per mile and is subject to a deductible of $3 for each one-way trip and $6 for a round trip; with a maximum deductible of $18 or the amount after six one-way trips (whichever occurs first) per calendar month. The deductible may be waived when travel is; in relation to a VA compensation or pension examination; by a special mode of transportation; by an eligible non-Veteran; or will cause a severe financial hardship, as defined by current regulatory guidelines.

  Eligibility:

  A Veteran may be eligible for beneficiary travel services if the following criteria are met:

  • have a service-connected (SC) rating of 30 percent or more, or
  • are traveling for treatment of a SC condition, or
  • receive a VA pension, or your income does not exceed the maximum annual VA pension rate, or
  • are traveling for a scheduled compensation or pension, or if not otherwise eligible as noted above and;
  • have a vision impairment, spinal cord injury or disorder, or a double or multiple amputation who’s travel in connection with care provided through a VA special disabilities rehabilitation program (including programs provided by spinal cord injury centers, blind rehabilitation centers and prosthetics rehabilitation centers) if such care is provided on an in-patient basis or during a period in which you are provided with temporary lodging at a facility of the Department to make such care more accessible.

  Veterans may qualify for special mode transportation (ambulance, wheelchair van etc.) if they meet one of the eligibility criteria in the list above, and have a medical condition requiring an ambulance or a specially equipped van as determined by a VA clinician, and the travel is pre-authorized (authorization is not required for emergencies if a delay would be hazardous to life or health). More information on Beneficiary Travel is available at: www.va.gov/healthbenefits/vtp/beneficiary_travel.asp

  Veteran Health Registries:

  Certain Veterans can participate in a VA health registry and receive free evaluations. VA maintains health registries to provide special health evaluations and health-related information. To participate, contact the environmental health coordinator at the nearest VA health care facility or visit www.publichealth.va.gov/exposures to see a directory which lists environmental health coordinators by state and U.S. territory. Veterans should be aware that a health registry evaluation is not a disability compensation exam. A registry evaluation does not start a claim for compensation and is not required for any VA benefits. No in-person medical evaluation is required to become registered. Veterans not already enrolled in VA health care should contact an environmental health coordinator at a nearby VA facility by visiting the following link: (http://www.publichealth.va.gov/exposures/coordinators.asp) or calling 1-877-222-8387. To learn more and for a list of current health registries, visit: www.publichealth.va.gov/exposures/benefits/registry-evaluation.asp.

  Vet Center Readjustment Counseling Services:

  VA provides free readjustment counseling services to Veterans who served in a theater of operations (combat zone) through community-based counseling centers, called Vet Centers. Services also are available for their family members regarding military-related issues. Vet Center counselors provide individual, group, marriage, and family readjustment counseling through direct counseling, outreach, and referral, in 300 community-based Vet Centers located in all 50 states, the District of Columbia, Guam, Puerto Rico, and American Samoa. Vet Center staffs are available during normal business hours at toll-free 1-800-905-4675 EST and 1-866-496-8838 PST. For more information, visit www.vetcenter.va.gov.

  Home Improvements and Structural Alterations:

  VA provides up to $6,800 lifetime benefits for service-connected Veterans/ and up to $2,000 lifetime benefits for nonservice-connected Veterans to make home improvements and/or structural changes necessary for the continuation of treatment or for disability access to the Veterans/ home and essential lavatory and sanitary facilities. For application information, contact the prosthetic representative at the nearest VA medical center.

  Special Eligibility Programs:

  VA provides comprehensive health care benefits, including outpatient, inpatient, pharmacy, prosthetics, medical equipment, and supplies for certain Korea and Vietnam Veterans’ birth children diagnosed with spina bifida (except spina bifida occulta).

  Services for Blind and Visually Impaired Veterans:

  Severely disabled blind Veterans may be eligible for case management services at a VA medical center and for admission to an inpatient or outpatient VA blind or vision rehabilitation program.

  Mental Health Care Treatment:

  Veterans eligible for VA medical care may receive general and specialty mental health treatment as needed. Mental health services are available in primary care clinics (including Home Based Primary Care), general and specialty mental health outpatient clinics, inpatient mental health units, residential rehabilitation and treatment programs, specialty medical clinics, and Community Living Centers. For more information on VA mental health services, visit www.va.gov/healthbenefits/access/mental_health_care.asp and www.mentalhealth.va.gov or contact your local VA health care facility’s Enrollment Office.

  Veterans Crisis Line:

  The Veterans Crisis Line is a toll-free, confidential resource that connects Veterans in crisis and their families and friends with qualified, caring VA responders. Veterans and their loved ones can call 1-800-273-8255 and Press 1, chat online at www.vets.gov, or send a text message to 838255 to receive confidential support 24-hours a day, 7-days a week, 365-days a year even if they are not registered with VA or enrolled in VA health care. The professionals at the Veterans Crisis Line are specially trained and experienced in helping Veterans of all ages and circumstances — from Veterans coping with mental health issues that were never addressed to Veterans struggling with relationships or the transition back to civilian life. European access: Veterans and members of the military community in Europe may dial 0800-1273-8255 or DSN 118. For more information about VA’s suicide prevention program, visit: www.Veteranscrisisline.net.

  VA Dental Insurance Program:

  VA would like all Veterans to have access to good oral health care; however, VA is limited to providing dental benefits to those Veterans who meet certain eligibility criteria. To help Veterans who are not eligible for VA dental benefits or need more comprehensive dental care, VA offers enrolled Veterans and beneficiaries of CHAMPVA the opportunity to purchase dental insurance at a reduced cost through its VA Dental Insurance Program (VADIP).

  VADIP has been extended for an additional five years, until Dec. 31, 2021 by the VA Dental Insurance Reauthorization Act of 2016. Delta Dental of California and MetLife will be offering private dental insurance plans for enrolled Veterans and beneficiaries of CHAMPVA for VADIP. VADIP provides eligible individuals the opportunity to purchase discounted dental insurance coverage, including diagnostic services, preventive services, endodontic and other restorative services, surgical services and emergency services. Individuals who enroll in one of the dental insurance plans will pay the entire premium in addition to the full cost of any copayments.  Enrollment is voluntary and does not affect eligibility for VA outpatient dental services and treatment. 

  The plans are available to eligible individuals in the United States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa and the Commonwealth of the Northern Mariana Islands. Individuals who were enrolled in VADIP during the pilot period (Jan. 1, 2013 – Jan. 31, 2017) must re- enroll in one of the new plans offered by Delta Dental or MetLife. While the insurance providers will remain the same, plan options, fees and other factors may have changed from those offered during the pilot.

  For more information about this program, call toll free 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. EST or visit www.va.gov/healthbenefits/vadip . Veterans may also review each insurer for specific information regarding their registration, rates and services: Delta Dental at deltadentalins.com/vadip or call 1-855-370-3303; MetLife at metlife.com/VADIP or call 1-888-310-1681.

  Long-term Services:

  VA provides institution based services (nursing home level of care) to Veterans through three national programs: VA owned and operated Community Living Centers (CLC), State Veterans’ Homes owned and operated by the states, and the community nursing home program. Each program has admission and eligibility criteria specific to the program. VA is obligated to pay the full cost of nursing home services for enrolled Veterans who need nursing home care for a service-connected disability, or Veterans who have a 70 percent or greater service-connected disability and Veterans with a rating of total disability based on individual un-employability. VA-provided nursing home care for all other Veterans is based on available resources. For more information on Extended Care Services and Geriatrics, visit www.va.gov/healthbenefits/access/geriatrics.asp.

  Emergency Medical Care in U.S. Community Facilities:

  A medical emergency is generally defined as a condition of such a nature that a sensible person would expect that a delay in seeking immediate medical attention would be hazardous to life or health. Eligible Veterans may receive emergency care at a community health care facility, possibly at VA expense, when a VA facility (or other Federal health care facility with which VA has an agreement) cannot furnish efficient care due to the distance from the facility, or when VA is unable to furnish the needed emergency services. Since payment may be limited to the point when the condition is stable enough for the Veteran to travel to a VA facility, a family member or friend must contact the closest VA medical facility as soon as possible. The emergency is deemed to have ended when a VA provider has determined that, based on sound medical judgment; the Veteran could be transferred from the community facility to a VA medical center. For more information on urgent care, visit https://www.va.gov/COMMUNITYCARE/programs/Veterans/Emergency_Care.asp

  Foreign Medical Program:

  VA’s Foreign Medical Program (FMP) provides health care payment/reimbursement for U.S. Veterans with VA-rated service-connected conditions who live or travel abroad. Veterans calling from within the Philippines may contact the VA Medical Services office at 1-800-1888-8782. If calling from outside of the Philippines, the number is 011-632-318-8387. Veterans may also register by email at IRIS.va.gov. All other Veterans living or planning to travel outside the U.S. should register with the Foreign Medical Program, P.O. Box 469061, Denver, CO 80246-9061, USA; telephone 303-331-7590. For information, visit: https://www.va.gov/COMMUNITYCARE/programs/Veterans/fmp/index.asp

  Caregiver Programs and Services:

  The Caregivers Benefit Program provides certain medical, travel, training and financial benefits to caregivers of certain Veterans and who were seriously injured during their military service on or after Sept.11, 2001. Eligible primary family caregivers can receive a stipend, training, mental health services, travel and lodging reimbursement and access to health insurance if they are not already under a health care plan. For more information, contact your local VA medical facility and speak with a caregiver support coordinator, visit www.caregiver.va.gov or call toll-free at 1-855-260-3274.

  Traveling Veterans Enrolled Veterans, who receive their health care with VA, will receive the same, coordinated care, whether at their local VA treatment site or an alternate VA site of care. In order to help VA ensure Veterans receive consistent care while they are traveling, Veterans are asked to notify their VA Patient Aligned Care Team (PACT) and specialty care provider(s) four to six weeks before traveling, or as soon as possible. Early planning will allow time for PACT and the Traveling Veteran Coordinator to coordinate care at an alternate VA facility. VA providers at the alternate site will record the care in the Veteran’s electronic medical record for follow-up treatment options with their PACT. To coordinate health care with another VA health care facility, Veterans should inform their PACT of the following:

  • travel destination(s), and temporary address
  • travel destination(s), and temporary address
  • a valid telephone number
  • arrival and departure dates
  • specific care concerns

  Their PACT will contact the Traveling Veteran Coordinator, who will assist in coordinating care at the alternate facility. For more information, contact PACT or a Traveling Veteran Coordinator at the local VA facility.

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