2

This guide is designed to provide veterans and their families with the 

information they will need to understand VA’s health care system—its 

enrollment process including enrollment priority groups, required copayments, 

if applicable, and what services are covered. In addition to a narrative 

description, we have also added frequently asked questions to each segment. 

If we have not addressed your specific questions, additional help is available 

at the following sources.

• your local VA health care facility’s Enrollment Office

• the eligibility page on our web site

www.va.gov/elig

• Veterans Health Benefits Service Center

1-877-222-VETS (8387)

Over time, VA health care has changed significantly. In recent 

years, legislative changes have dramatically enhanced 

veterans’ health care benefits as well as access to those 

benefits. Today’s veterans have a comprehensive benefits 

package, which VA administers through an annual patient enrollment system. The enrollment system 

is based on priority groups to ensure that health care benefits are readily available to all enrolled 

veterans (see Enrollment Priority Groups on page 7).

Complementing the expansion of benefits and improved access is our ongoing commitment to 

providing the very best in quality service. Our goal is to ensure that our patients receive the finest 

quality of health care regardless of the treatment program, regardless of the location. In addition to 

our ongoing quality assurance activities, we’ve made it easier for veterans to get the health care 

they need. Additional locations continue to be added to the VA health care system—bringing the total 

number of treatment sites to over 1,600 nationwide.

As explained further in this guide, most veterans must be enrolled to receive VA health care. While 

some veterans are not required to enroll due to their special eligibility status, all veterans—including 

those who have special eligibility—are encouraged to apply for enrollment. Enrollment helps us to 

determine the number of potential veterans who may seek VA health care services and, thus, is a 

very important part of our planning efforts.

Enrollment in the VA health care system provides veterans with the assurance that comprehensive 

health care services will be available when and where they are needed during that enrollment period. 

In addition to the assurance that services will be available, enrolled veterans will appreciate not 

having to repeat the application process—regardless of where they seek their care or how often.

OVERVIEW
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Do I have to enroll to receive VA health care?

While most veterans must be enrolled to receive 

VA health care, some veterans are exempt from 

the enrollment requirement due to meeting special eligibility 

criteria. If you fall into one of the following categories, you are 

not required to enroll.

• if you are seeking care for a VA-rated service-connected disability

• if VA has rated you with a service-connected disability of 50% or more

• if less than one year has passed since you were discharged for a disability that the military 

determined was incurred or aggravated in the line of duty, but that VA has not yet rated

Why does VA encourage enrollment from those veterans who Congress specifically 

exempted from the process?

The reason we encourage all potential VA health care patients to enroll is for planning and 

budgeting purposes. Enrollment numbers help to identify the potential demand for VA services. 

By including all potential patients in the enrollment count, including those that are exempt, we 

are in a much better position to identify necessary funding levels to Congress.

What if the demand for VA services exceeds its budget?

When the demand for services exceeds our ability to provide quality and timely health 

care, decisions will be made to ensure that the level of services for enrolled veterans is not 

compromised. Those decisions may include suspending enrollment of veterans in lower 

priority groups (such as VA’s decision to restrict higher income veterans who fall into Priority 

Group 8 if they apply for care after January 16, 2003) or, in more drastic times, may include 

removing (disenrolling) lower priority group veterans from our enrollment system.

I already receive VA care, but I don’t remember enrolling. How can I verify my 

enrollment?

If you are uncertain of your enrollment status, check with the Enrollment Coordinator at your 

local VA health care facility or you may call the VA Health Benefits Service Center at 

1-877-222-VETS (8387).

Frequently Asked Questions (FAQs)

Veterans Choose the VA Facility

As part of the enrollment process, a veteran may select any VA 

health care facility to serve as his/her primary treatment facility.

Benefits on the Go

VA enrollment also allows health care benefits to become completely 

portable throughout the entire VA system. Enrolled veterans who are 

traveling or who spend time away from their primary treatment facility 

may obtain care at any VA health care facility across the country 

without the worry of having to reapply.
VA HEALTH CARE ENROLLMENT

Veterans can apply for enrollment in the VA health care 

system by completing VA Form 10-10EZ, APPLICATION FOR 

HEALTH BENEFITS. The application form can be obtained by 

visiting, calling, or writing any VA health care facility or veterans’ 

benefits office. Forms can also be requested toll-free from VA’s 

Health Benefits Service Center at 1-877-222-VETS (8387) 

or accessed from our web site at www.va.gov/1010ez.htm. 

Completed applications must be signed and dated and may be returned in person 

or by mail to any VA health care facility. If you apply in person at a VA health care 

facility, VA staff will assign you to an initial priority group. After your application is 

processed, the VA Health Eligibility Center 

in Atlanta will confirm your enrollment status 

and priority group and will notify you of your 

enrollment status.

Financial Assessment 

(Means Testing)

While many veterans qualify for enrollment 

and cost-free health care services based on 

a compensable service-connected condition 

or other qualifying factor, most veterans will 

be asked to complete a financial assessment 

as part of their enrollment application 

process. Otherwise known as the Means 

Test, this financial information will be used to determine the applicant’s enrollment priority group 

(see Enrollment Priority Groups on page 7) and whether he/she is eligible for cost-free VA health 

care. Higher-income veterans may be required to share in the expense of their care by making 

copayments (see Copayment Requirements on pages 10 and 11). Veterans who choose not to 

complete the financial assessment must agree to pay the required copayments as a condition of 

their eligibility. Due to VA’s restricting enrollment of new Priority Group 8 veterans who apply on 

or after January 17, 2003, veterans who decline to provide financial information and who agree to 

copayments will not be accepted for enrollment. 

Veterans who are required to provide their financial information generally must do so on an 

annual basis. To simplify this annual reporting requirement, VA recently introduced a new, 

shorter version of its application form to be used for this annual reporting requirement. The new 

form, VA Form 10-10EZR, is to be used by enrolled veterans to update their previously reported 

information such as Address, Insurance, Employment and Financial information. It will save 

veterans time by eliminating the collection of information previously collected. The form can also 

be requested toll-free from VA’s Health Benefits Service Center at 1-877-222-VETS (8387) or 

accessed from our web site at www.va.gov/1010ez.htm.

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5

Health Insurance Coverage?

Since VA health care depends primarily on annual 

congressional appropriations, VA encourages veterans to 

retain any health care coverage they may already have—

especially those in the lower enrollment priority groups as 

further described on pages 7 & 8, Enrollment Priority Groups. 

Veterans with private health insurance or with federally funded 

coverage through the Department of Defense (TRICARE), 

Medicare, or Medicaid, may choose to use these sources of 

coverage as a supplement to their VA benefits.

CAUTION! Before canceling insurance coverage, enrolled veterans should carefully consider 

the risks.

• There is no guarantee that in subsequent years Congress will appropriate sufficient funds 

for VA to provide care for all enrollment priority groups.

• Non-veteran spouses and other family members generally do not qualify for VA health care.

• If participation in Medicare Part B is cancelled, it cannot be reinstated until January of the 

next year and there may be a penalty for the reinstatement.

Reporting Health Insurance Information

By law, VA is obligated to bill health insurance carriers for services 

provided to treat nonservice-connected conditions. To ensure that 

current insurance information is on file—including coverage through 

employment or the veteran’s spouse—VA staff is required to ensure 

that veterans’ health insurance information is updated during each 

visit. Identification of insurance information is 

essential to VA since collections received from 

insurance companies help supplement the funding 

available to provide services to veterans. Veterans 

are asked to cooperate by disclosing all relevant 

health insurance information. 

Geographically-Based Means Testing

Recognizing that the cost of living can vary significantly from one geographic area to another, 

Congress added income thresholds based upon geographic locations to the existing VA national 

income thresholds for financial assessment purposes. This change assists lower-income 

veterans who live in high-cost areas by providing an enhanced enrollment priority and reducing 

the amount of their required inpatient copayment. 

Please note that the geographically-based copayment 

reductions apply ONLY to INPATIENT SERVICESoutpatient services, long-term care, as well as 

medication copayments are NOT affected by this change.

Insurance 

Collections

Since the start of insurance collections in 

1986, veterans’ health care services have 

been supplemented by over $9.3 billion 

allowing us to provide services to 

numerous additional veterans. 
6

Must I reapply in subsequent years and will I receive an enrollment 

confirmation?

If you have previously enrolled, your enrollment will be reviewed annually without any 

action necessary on your part. Veterans who are required to update their financial 

information are still required to provide their income information on an annual basis 

using the form VA 10-10EZR. Depending on your priority group and the availability 

of funds for VA to provide medical benefits to all enrollees, your enrollment will be 

automatically renewed without any action on your part. Should there be any change 

to your enrollment status, you will be notified in writing.

If enrolled, must I use the VA as my exclusive health care provider?

While there is no requirement that VA become your exclusive provider of care, please 

be aware that our authority to pay for non-VA care is extremely limited (see page 

15). You may, however, elect to use your private health insurance benefits as a 

supplement for your VA health care benefits.

What income is counted for the Means Test and is family size considered?

VA considers your previous year’s total household income (both earned and 

unearned income) for you as well as your spouse and dependent children. Earned 

income is usually wages you receive from working. Unearned income can be interest 

earned, dividends received, money from retirement funds, Social Security payments, 

annuities or earnings from other assets. The number of persons in your family will be 

factored into the calculation to determine the applicable income threshold—both the 

VA national income threshold and the income threshold for your geographic region.

What is a Geographic Threshold?

By regulation, VA is required to identify veterans who agree to make VA medical 

care copayments and whose family incomes are below the “low-income” limits for 

the geographical area set annually by the U.S. Department of Housing and Urban 

Development (HUD) for public housing benefits. Those veterans whose incomes 

and assets fall between the VA means test limits and the HUD low-income limits will 

have their inpatient medical care copayments reduced by 80% starting October 1, 

2002. The remaining higher income veterans will continue to pay the full inpatient 

medical care copayments and will be assigned the means test status “MT Copayment 

Required”. This regulation has no affect on outpatient and medication copayments.

For those veterans who have more than one residence, which address is used for 

means testing under the geographically-based income thresholds?

The address used to determine your geographically-based income threshold is your 

permanent address. Typically, it is the location in which you declare residency for voting 

and tax purposes.

How frequently are the thresholds updated?

Income thresholds, used for the national Means Test as well as for geographic adjustments 

for high cost-of-living areas, are updated annually. Frequently Asked Questions (FAQs)
VA HEALTH CARE ENROLLMENT 

PRIORITY GROUPS

Upon receipt of a completed application (must 

include signature and date), the veteran’s eligibility 

will be verified. Based on his/her specific eligibility 

status, he/she will be assigned to one of the 

following priority groups. The groups range from 1 

through 8 with Priority Group 1 being the highest 

priority and Priority Group 8 the lowest.

Priority Group 1

• Veterans with service-connected 

disabilities rated 50% or more disabling

Priority Group 2

• Veterans with service-connected 

disabilities rated 30% or 40% disabling

Priority Group 3

• Veterans who are former POWs

• Veterans awarded the Purple Heart

• Veterans whose discharge was for a disability that was incurred or aggravated in the 

line of duty

• Veterans with service-connected disabilities rated 10% or 20% disabling

• Veterans awarded special eligibility classification under Title 38, U.S.C., Section 

1151, “benefits for individuals disabled by treatment or vocational rehabilitation”

Priority Group 4

• Veterans who are receiving aid and attendance or housebound benefits

• Veterans who have been determined by VA to be catastrophically disabled

Priority Group 5

• Nonservice-connected veterans and noncompensable service-connected 

veterans rated 0% disabled whose annual income and net worth are 

below the established VA Means Test thresholds

• Veterans receiving VA pension benefits

• Veterans eligible for Medicaid benefits

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8

Priority Group 6

• Compensable 0% service-connected veterans

• World War I veterans

• Mexican Border War veterans

• Veterans seeking care solely for disorders associated with:

- exposure to herbicides while serving in Vietnam; or 

- exposure to ionizing radiation during atmospheric testing or during the occupation 

of Hiroshima and Nagasaki; or

- for disorders associated with service in the Gulf War; or

- for any illness associated with service in a theater of combat operations during a period 

of war after the Gulf War or during a period of hostility after November 11, 1998; or

- for illness possibly related to participation in Project 112/Project SHAD.

Priority Group 7

Veterans who agree to pay specified copayments with income and/or net worth ABOVE the VA 

Means Test threshold and income BELOW the geographically based threshold 

for their locality

• Subpriority a: Noncompensable 0% service-connected veterans who were enrolled in the 

VA health care system on a specified date and who have remained enrolled since that 

date

• Subpriority c: Nonservice-connected veterans who were enrolled in the VA health care 

system on a specified date and who have remained enrolled since that date

• Subpriority e: Noncompensable 0% service-connected veterans not included 

Subpriority a above

• Subpriority g: Nonservice-connected veterans not included in Subpriority c above

Priority Group 8

Veterans who agree to pay specified copayments with income and/or net worth ABOVE the VA 

Means Test threshold and income ABOVE the geographically-based threshold 

for their locality

• Subpriority a: Noncompensable 0% service-connected veterans enrolled as 

of January 16, 2003 and who have remained enrolled since that date

• Subpriority c: Nonservice-connected veterans enrolled as of January 16, 2003 

and who have remained enrolled since that date

• Subpriority e: Noncompensable 0% service-connected veterans applying for enrollment 

after January 16, 2003

• Subpriority g: Nonservice-connected veterans applying for enrollment after 

January 16, 2003
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How has the application of the geographically-based income thresholds 

changed the financial assessment process and the enrollment priority groups?

While the financial assessment procedures have not been changed, application of 

the geographically based income thresholds has resulted in a division of the original 

Priority Group 7 into two separate priority groups. Priority Group 7 is now limited 

to nonservice-connected veterans and 0% noncompensable service-connected 

veterans whose combined income and net worth exceed VA’s annually established 

national means test threshold BUT whose income is below the geographicallyadjusted threshold established by HUD. Priority Group 8 includes all other nonserviceconnected veterans and 0% noncompensable service-connected veterans whose 

income and net worth exceed VA’s national means threshold AND whose income 

exceeds the threshold for their geographic location. In addition, Priority Group 8 also 

includes veterans who have declined to provide financial information and who, as a 

condition of their eligibility, have agreed to make required copayments if they applied 

before January 16, 2003.

What is a VA service-connected rating and how do I establish one?

A service-connected rating is an official ruling by VA that your illness/condition 

is directly related to your active military service. Service-connected ratings are 

established by VA Regional Offices located throughout the country. In addition 

to compensation and pension ratings, VA Regional Offices are also responsible 

for administering educational benefits, vocational rehabilitation, and other benefit 

programs including home loans. To obtain more information or to apply for any of 

these benefits, contact your nearest VA Regional Office at 1-800-827-1000 or 

visit us online at www.va.gov.

Who does the VA consider to be “catastrophically” disabled?

To be considered catastrophically disabled, you must have a severely disabling 

injury, disorder, or disease which permanently compromises your ability to carry 

out the activities of daily living. The disability must be of such a degree that you 

require personal or mechanical assistance to leave home or bed, or requires 

constant supervision to avoid physical harm to yourself or others. To request an 

evaluation, contact the Enrollment Coordinator at your local VA health care facility. 

If it is determined by a VA health care provider that you are catastrophically disabled, 

your priority will be upgraded to Priority Group 4. If, however, you were previously 

required to make copayments, that requirement will continue until your financial 

situation qualifies you for 

cost-free services.

Priority Groups 7 and 8 both have subpriority groups—a, c, e, and g. Are there 

subpriority groups b, d, and f?

Although the subpriority group designations (a, c, e, and g) are in descending order based 

on highest priority to lowest, they deliberately were not put in consecutive order. Since 

these designations are used exclusively for internal tracking purposes, we reserved b, d, 

and f for future use in the event of additional changes to the priority groups. Frequently Asked Questions (FAQs)
10

While many veterans qualify for cost-free health care 

services based on a compensable service-connected 

condition or other qualifying factor, most veterans are 

required to complete an annual financial assessment 

or Means Test to determine if they qualify for cost-free 

services. Veterans whose income and net worth exceed 

the established Means Test threshold as well as those who 

choose not to complete the financial assessment must 

agree to pay required copayments to become eligible for 

VA health care services. Note that new veterans who apply 

for enrollment after January 16, 2003 and who decline to provide income information are not 

eligible for enrollment. Along with their enrollment confirmation and priority group assignment, 

enrollees will receive information regarding their copayment requirements, if applicable.

Types of Copayments

Outpatient Copayments*—based on the highest of two levels of service on any individual 

day.

• Primary Care Services—services provided by a primary care clinician (lower level 

of service).

• Specialty Care Services—services provided by a clinical specialist such as 

surgeon, radiologist, audiologist, optometrist, cardiologist, and specialty tests 

such as magnetic resonance imagery (MRI), computerized axial tomography 

(CAT) scan, and nuclear medicine studies (highest level of service).

*There is no copayment requirement for preventive care services such as screenings, 

immunizations, and other services that do not require the immediate presence of a physician.

Medication Copayments*—applicable to each prescription including each 30-day supply or less of 

maintenance medications.

*Includes an annual cap for some enrollment priority groups.

Inpatient Copayments—in addition to a standard copayment charge for each 90 days of care within 

a 365-day period regardless of the level of service (such as intensive care, surgical care, or general 

medical care), a per diem charge will be assessed for each day of hospitalization.

Long-Term Care Copayments*—based on three levels of care (see Long-Term Care Benefits on 

page 18 for definitions).

• Nursing Home Care/Inpatient Respite Care/Geriatric Evaluation

• Adult Day Health Care/Outpatient Geriatric Evaluation/Outpatient Respite Care

• Domiciliary Care

*Copayments for Long-Term Care services start on the 22nd day of care during any 12-month period—

there is no copayment requirement for the first 21 days. Actual copayment charges will vary from 

veteran to veteran depending upon financial information submitted on VA Form 10-10EC.

Copayment Requirements
11

Who it applies to:

Priority Groups 7 & 8 with the exception of 

noncompensable 0% service-connected 

veterans whose treatment is for their serviceconnected condition.

Most veterans with the exception of the 

following.

• Veterans with a service-connected 

rating of 50% or greater

• Veterans requiring medications 

for the treatment of a serviceconnected condition

• Veterans requiring medications for 

the treatment of disorders related 

to ionizing radiation, service in 

a theater of combat operations 

or hostilities after 11/11/98, 

participation in Project 112/SHAD 

testing or Military Sexual Trauma.

• Veterans whose income does 

not exceed the maximum VA 

annual rate of pension

• Former Prisoners of War

Annual Changes To Copayment Rates

Because of the annual changes to copayment 

rates—including the annual cap on medication 

copayments—they are published separately. 

Current year rates can be obtained at any VA 

health care facility or on the eligibility page on 

our web site www.va.gov/elig.

Copayments
12

I am a recently discharged combat veteran. Must I pay 

VA copayments?

If the services are provided for the treatment of a condition 

that may be related to your military service in a theater 

of combat operations, you will not be charged any 

copayments. This benefit is limited to a two-year period 

following military discharge. You will, however, be subject 

to means testing (and copayments, if applicable) for care 

of any condition clearly not related to your military service 

such as a broken limb or a problem that existed prior to 

entering service.

How many copayment charges may be assessed during a single day?

For outpatient services, you will be charged only one copayment, regardless of 

the number of health care providers you see in a single day. The amount of the 

outpatient copayment will be based on the highest level of service you received 

that day. For example, if you have a specialty care visit and a primary care visit 

on the same day, you will be charged only for the specialty care visit since it 

is a higher level of care. The number of medication copayments charged as a 

result of your outpatient visit depends on the number of each 30-day supply of 

medication filled. Inpatient copayments are based on both a standard charge for 

each 90 days of care within a 365-day period as well as a per diem (daily) charge. 

Together, the inpatient copay charges cover all services including medications. 

With the exception of medication copayments for outpatients, long-term care 

copayments are a single, all-inclusive charge.

Who qualifies for the annual cap on medication copayments?

The annual cap on medication copayments applies to Priority Groups 2 through 

6 (Priority Group 1 is exempt from ALL copayments). Because of their higher 

financial status, veterans in Priority Groups 7 and 8 do NOT qualify for the 

medication copayment annual cap. For those that qualify, once the annual limit is 

reached, all subsequent prescriptions filled during the calendar year will be free of 

the copayment requirement.

What if I am Unable to Pay the Copayments?

If there has been a significant decrease in your earned income from the previous year, 

your current projected income may be used on a case-by-case basis (VA calls this 

the Hardship Determination process. To apply for a Hardship Determination, consult 

your Enrollment Coordinator at your local VA medical facility.

I obtain medications from VA’s mail-out pharmacy program. What is the 

copayment for a 90-day supply?

Even though the prescription is written for 90-days, each 30-day or less supply is 

subject to that year’s applicable medication copayment rate. In your case, your 90-

day supply would cost you 3 times the medication copayment rate. Frequently Asked Questions (FAQs)
13

VA HEALTH CARE COVERED SERVICES 

ACUTE CARE BENEFITS

Standard Benefits

The following acute care services 

are available to all enrolled 

veterans.

Preventive Care Services

• Immunizations

• Physical Examinations (including 

eye and hearing examinations)

• Health Care Assessments

• Screening Tests

• Health Education Programs

Ambulatory (Outpatient) Diagnostic and Treatment Services

• Medical

• Surgical (including reconstructive/plastic surgery 

as a result of disease or trauma)

• Mental Health

• Substance Abuse

Hospital (Inpatient) Diagnostic and Treatment Services

• Medical

• Surgical (including reconstructive/plastic surgery 

as a result of disease or trauma)

• Mental Health

• Substance Abuse

Prescription Drugs (when prescribed by a VA physician)
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Limited Benefits

The following acute care services (partial listing) have limitations and may have special 

eligibility criteria:

• Ambulance Services

• Dental Care

• Durable Medical Equipment

• Eyeglasses

• Hearing Aids

• Home Health Care

• Homeless Programs

• Maternity and Parturition Services—usually provided in non-VA 

contracted hospitals at VA expense, care is limited to the mother 

(costs associated with the care of newborn are not covered)

• Non-VA Health Care Services

• Orthopedic, Prosthetic, and Rehabilitative Devices

• Rehabilitative Services

• Readjustment Counseling

• Sexual Trauma Counseling

General Exclusions (partial listing)

• Abortions and abortion counseling

• Cosmetic surgery except where determined by VA to be medically necessary for 

reconstructive or psychiatric care 

• Gender alteration

• Health club or spa membership, even for rehabilitation

• In-vitro fertilization 

• Drugs, biological, and medical devices not approved by the Food and Drug 

Administration unless part of formal clinical trial under an approved research 

program or when prescribed under a compassionate use exemption.

• Medical care for a veteran who is either a patient or inmate in an institution of another 

government agency if that agency has a duty to provide the care or services.

• Services not ordered and provided by licensed/accredited professional staff

• Special private duty nursing
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Frequently Asked Questions (FAQs)

Hearing aids and eyeglasses are listed as “limited” benefits. Under what 

circumstances do I qualify?

To qualify for hearing aids and eyeglasses you must have a VA service-connected 

disability rating of 10% or more. You may also qualify if you are a former prisoner 

of war, Purple Heart recipient, require this benefit for treatment of a 0% serviceconnected condition or are receiving increased pension based on your need for 

regular aid and attendance or being permanently housebound.

Am I eligible for dental care?

You are eligible for dental services if your dental care is for either a 

compensable service-connected condition, a dental condition resulting from 

service-connected trauma, or if you have a service-connected rating of 100 

percent. You also qualify if you are a former prisoner of war, a participant in a 

VA vocational rehabilitation program, or if your dental condition is aggravating 

a medical problem under VA treatment. In addition, you may also qualify for 

one-time dental treatment if you have been 

recently discharged from military service, had 

a documented dental condition while in service, 

and your discharge certificate does not include 

certification that all appropriate treatment had 

been rendered prior to being released.

Am I limited to a specific number of 

inpatient days or outpatient visits during a 

given period of time?

For acute care services (inpatient days of care 

and outpatient visits) there are no limits. 

Do I qualify for routine health care at nonVA facilities at VA expense?

To qualify for routine care at non-VA facilities 

at VA expense (otherwise known as fee-basis 

care), you must first be given specific authorization by your VA provider. 

Included among the factors in determining whether such care will be 

authorized is your medical condition and availability of VA services within your 

geographic area.

Am I eligible for emergency care at non-VA facilities?

You are eligible if the non-VA emergency care is for a service-connected 

condition or, if enrolled, you have been provided care by a VA clinician or 

provider within the past 24 months and have no other health care coverage or 

ability to pay for the services. Also, it must be determined that VA health care 

facilities were not feasibly available; that a delay in medical attention would 

have endangered your life or health, and that you are personally liable for the 

cost of the services.

15
16

Is VA approval needed before I obtain nonVA emergency services?

While approval is not required, notification 

to the nearest VA health care facility must 

be made within 48 hours if hospitalization 

is required. Since VA payment is limited 

up to the point your condition is stable 

for transportation to a VA facility, transfer 

arrangements should be made as soon as 

possible.

Does the VA offer compensation for travel 

expenses to and from a VA facility?

If you meet specific criteria (see next 

question), you are eligible for travel benefits. 

In most cases, travel benefits are subject to 

a deductible. Exceptions to the deductible 

requirement are: 1) travel for a compensation 

and pension examination; and 2) travel by 

an ambulance or a specially equipped van. 

Because travel benefits are subject to annual 

mileage rate and deductible changes, we 

publish a separate document each year. You 

can obtain a copy at any VA health care facility.

Do I qualify for travel benefits?

You may qualify for beneficiary travel payments if you fall into one of 

the following categories.

• you have a service-connected rating of 30 percent or more

• you are traveling for treatment of a service-connected condition

• you receive a VA pension

• you are traveling for a scheduled compensation or pension 

examination

• your income does not exceed the maximum annual VA 

pension rate

• your medical condition requires an ambulance or a specially 

equipped van, you are unable to defray the cost, and the 

travel is pre-authorized (authorization is not required for 

emergencies if a delay would endanger your life or health)
Standard 

Benefits

The following long-term care services are available 

to all enrolled veterans.

Geriatric Evaluation

Geriatric evaluation is the comprehensive 

assessment of a veteran’s ability to care for 

him/herself, his/her physical health, and social 

environment, which leads to a plan of care. The 

plan could include treatment, rehabilitation, health 

promotion, and social services. These evaluations 

are performed by inpatient Geriatric Evaluation and 

Management (GEM) Units, GEM clinics, geriatric 

primary care clinics, and other outpatient settings.

Adult Day Health Care

The adult day health care (ADHC) program is a therapeutic day care program, providing 

medical and rehabilitation services to disabled veterans in a combined setting.

Respite Care

Respite care provides supportive care to veterans on a short-term basis to give the caregiver 

a planned period of relief from the physical and emotional demands associated with providing 

care. Respite care can be provided in the home or other noninstitutional settings.

Home Care

Skilled home care is provided by VA and contract agencies to veterans that are homebound 

with chronic diseases and includes nursing, physical/occupational therapy, and social services.

Hospice/Palliative Care

Hospice/palliative care programs offer pain management, symptom control, and other medical 

services to terminally ill veterans or veterans in the late stages of the chronic disease process. 

Services also include respite care as well as bereavement counseling to family members.

Long-Term Care Benefits

17

Financial Assessment for Long-Term Care Services

For veterans who are not automatically exempt from making copayments for longterm care services (see Copayment Requirements on page 10), a separate financial 

assessment (VA Form 10-10EC, APPLICATION FOR EXTENDED CARE SERVICES) 

must be completed to determine whether they qualify for cost-free services or to what 

extent they are required to make long term care copayments. For those veterans who 

do not qualify for cost-free services, the financial assessment for long term care services 

is used to determine the copayment requirement. Unlike copayments for other VA health 

care services, which are based on fixed changes for all, long-term care copayment 

charges are individually adjusted based on each veteran’s financial status.
18

I already provided financial information on my initial VA application, why is it 

necessary to complete a separate financial assessment for long-term care?

Unlike the information collected from the Means Test, which is based on your previous 

year’s income, the 10-10EC is designed to assess your current financial status, including 

current expenses. This in-depth analysis provides the necessary monthly income/expense 

information to determine whether you qualify for cost-free long-term care or a significant 

reduction from the maximum copayment charge.

Once I submit a completed VA Form 10-10EC, who notifies me of my long-term care 

copayment requirements?

The social worker or case manager involved in your long-term care placement will provide 

you with an annual projection of your monthly copayment charges.

Assuming I qualify for nursing home care, how is it determined whether the care will 

be provided in a VA facility or a private nursing home at VA expense?

Generally, if you qualify for indefinite nursing home care, that care will be furnished in 

a VA facility. Care may be provided in a private facility under VA contract when there is 

compelling medical or social need. If you do not qualify for indefinite care, you may be 

placed in a community nursing home—generally not to exceed six months—following an 

episode of VA care. The purpose of this short-term placement is to provide assistance to 

you and your families while alternative, long-term arrangements are explored.

For veterans who do not qualify for indefinite nursing home 

care at VA expense, what assistance is available for making 

alternative arrangements?

When the need for nursing home care extends beyond the 

veteran’s eligibility, our social workers will help family members 

identify possible sources for financial assistance. Our staff will 

review basic Medicare and Medicaid eligibility and direct the family 

to the appropriate sources for further assistance, including possible 

application for additional VA benefit programs.

Frequently Asked Questions (FAQs)

Limited Benefits

Nursing Home Care

While some veterans qualify for indefinite nursing home care services, other veterans may qualify 

for a limited period of time. Among those that automatically qualify for indefinite nursing home care 

are veterans whose service-connected condition is clinically determined to require nursing home 

care and veterans with a service-connected rating of 70% or more. Other veterans—with priority 

given to those with service-connected conditions—may be provided short-term nursing home care 

if space and resources are available.

Domiciliary Care

Domiciliary care provides rehabilitative and long-term, health maintenance care for veterans 

who require some medical care, but who do not require all the services provided in nursing 

homes. Domiciliary care emphasizes rehabilitation and return to the community. VA may provide 

domiciliary care to veterans whose annual income does not exceed the maximum annual rate of 

VA pension or to veterans who have no adequate means of support.
VA Foreign Medical Program —a health care benefits program for US 

veterans with VA-rated service-connected conditions who are living or 

traveling abroad. Foreign benefits are administered by three separate 

offices (as indicated below) depending on where 

the health care services are obtained.

19

Veterans in the Philippines

address

VA Outpatient Clinic (358/00)

2201 Roxas Blvd.

Pasay City 1300

Republic of the Philippines

e-mail

manlopc.inqry@vba.va.gov

fax

011-632-838-4566

in Canada

address

VAM&RO Center (136FC) 

North Hartland Road

White River Junction VT 05009-0001

e-mail 

vavbawrj/ro/vse@vba.va.gov

fax

303.331.7803

all other countries

address

Foreign Medical Program 

PO Box 65021

Denver CO 80206-9021

telephone

303.331.7590

e-mail 

hac.fmp@med.va.gov

fax

303.331.7803

web site

www.va.gov/hac

Dependents & Survivors

CHAMPVA—a health care benefits program for:

• dependents of veterans who have been rated by 

VA as having a total and permanent disability;

• survivors of veterans who died from VA-rated 

service-connected conditions, or who at the time 

of death, were rated permanently and totally 

disabled from a VA-rated service-connected 

condition; and

• survivors of persons who died in the line of duty 

and not due to misconduct and not otherwise 

entitled to benefits under DoD’s TRICARE 

program.

address

CHAMPVA

PO Box 65023

Denver CO 80206-9023

Telephone

800.733.8387

e-mail

hac.inq@med.va.gov

fax 

303.331.7804

web site

www.va.gov/hac

Children of Women 

Vietnam Veterans

Health Care Benefits—

a program designed 

for women Vietnam 

veterans’ birth children who are determined 

by a VA Regional Office to have one or more 

covered birth defects.

address

Children of Women Vietnam Veterans 

PO Box 469027

Denver CO 80246-9027

telephone

888.820.1756

email

cwvv.inq@med.va.gov

fax 

303.331.7807

web site

www.va.gov/hac

Spina Bifida Health Care Benefits—a program 

designed for Vietnam veterans’ birth children 

diagnosed with spina bifida and who are in receipt 

of a VA Regional Office award for spina bifida 

benefits.

address e-mail

Spina Bifida Health Care spina.inq@med.va.gov

PO Box 65025

Denver CO 80206-9025

telephone fax web site

888.820.1756 303.331.7807 www.va.gov/hac

Veterans

In addition to the VA health care 

system, which administers benefits to veterans residing within 

the United States, VA also provides benefits to service-connected 

veterans outside the country.

Additional VA health care