VA healthcare: what's covered, what's not, what are the VA Priority Groups...we've summed it all up in an easy to follow article.
It has come up several times in the Patients Rising Concierge that veterans, or the family members of veterans, need help understanding VA healthcare. We’ve put together this basic 101-type introduction to VA healthcare that we hope helps make things clearer.
The Department of Veterans Affairs (VA) offers veterans the option of enrolling in VA health care. VA healthcare is free if the illness or injury stem from the veteran’s military service. Some other free services may also be offered under the VA plan.
Care provided at care locations that contract with the VA will be covered, including minor illness-related visit to a health clinic or something more severe such as a cast or wound care at an urgent care clinic.
Emergency care at a non-VA clinic or hospital may or may not be covered. Additional information can be found here.
The VA assigns veterans signing up to receive care into eight priority groups, which can impact how quickly an individual receives care and what their out-of-pocket cost will be for the care they receive. The following factors influence placement in a priority group:
Higher income and absence of a service-related disability would place a veteran in the lowest priority group; service-related disability would qualify a veteran for the highest priority group. For those who qualify for more than one priority group, they will be placed in the highest priority group.
There are two additional VA Priority Groups;
Group 7 for those whose annual income is below the geographically adjusted income limits (GMT) for where you live, and who agree to pay copays.
Group 8 for those whose annual income is above VA income limits and geographically adjusted income limits for where you live, and who agree to pay copays.
Yes, you can. It is important, however, to share this information with the VA because non-service-related illnesses or injuries will be billed to the private plan or Medicare supplemental health insurance plan that the veteran may be enrolled in. The veteran may owe copay for non-service-related services not covered by the non-VA plan.
If dependents of veterans are not covered under the VA health plan, private health insurance or the Health Insurance Marketplace are available options. Low-cost options include Medicaid and Children’s Health Insurance Program.
Veterans who have separated from active duty could apply for Tricare coverage that can cover them and their families for a temporary period.
Patients Rising acknowledges the important contributions of Surabhi Dangi-Garimella, Ph.D. in this article. Improving patient access is our mission and we are happy to utilize a variety of experts to carry that out.
Get notified about new stories and resources to empower patients and caregivers.