Today’s veterans have a comprehensive medical 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.

Veterans Choose the VA Facility

As part of the enrollment process, a veteran may select any VA health care facility or Community 

Based Outpatient Clinic (CBOC) 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.

Notice of Privacy Practices

Veterans who are enrolled for VA health care benefits are afforded various privacy rights under 

Federal law and regulations including the right to a notice of privacy practices. The Veterans Health 

Overview



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 copays, 

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

description, we have 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/healtheligibility

• Veterans Health Benefits Service Center 

1-877-222-VETS (8387)
Administration (VHA) issued the VA Notice of Privacy Practices, IB 10-163, in April 2003. All veterans 

enrolled for health care benefits have a right to a copy of the VA Notice of Privacy Practices, IB 10-163. 

The VA Notice of Privacy Practices provides enrolled veterans with information on how VHA may use 

and disclose your personal health information. The Notice also advises enrolled veterans of their rights 

to know when and to whom their health information may have been disclosed; request access to or 

receive a copy of their health information on file with VHA; request an amendment to correct inaccurate 

information on file; and file a privacy complaint. A copy of the VA Notice of Privacy Practices, IB 10-163, 

may be obtained through the Internet at http://www1.va.gov/health_benefits or through the mail by 

writing the VHA Privacy Office (19F2), 810 Vermont Avenue NW, Washington, DC 20420.

Do I have to enroll to receive VA health care?

While most veterans must be enrolled to receive VA health care, some veterans 

are not required to enroll 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 are not required to enroll?

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 who are not required 

to enroll, 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).

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.

Enrollment Restriction

Effective January 17, 2003, VA suspended NEW enrollment of veterans assigned to Priority 

Group 8 (VA’s lowest priority group consisting of higher income veterans). These veterans 

will not be eligible for enrollment at this time. Placement in Priority Group 8 is based on the 

following:

• The veteran does not have any special qualifying 

eligibilities such as a service connected disability 

• The veteran’s household income exceeds the current year VA income 

threshold and the geographic income threshold for the veteran’s residence

• Veterans who decline to provide their financial information

Veterans enrolled in Priority Group 8 on or before January 16, 2003, will remain 

enrolled and continue to be eligible for the full-range of VA health care benefits. 

Changes in VA’s available resources may affect the number of priority groups VA can enroll in a 

given year. If that occurs, VA will publicize the enrollment changes and notify affected enrollees. 

Recently Discharged Combat Veterans

If you have served in a combat location or in combat against a hostile force after November 11, 

1998, you are eligible for free health care and nursing home care services for conditions potentially 

related to that service for two years following your separation from active duty. These combat 

veterans will be enrolled into Enrollment Priority Group 6 if not otherwise qualified for a higher 

enrollment priority group assignment. VA provides full access to the Medical Benefits Package by 

virtue of this enrollment status. Also, veterans who enroll with VA under this authority will retain 

enrollment eligibility even after their two-year post discharge period ends under current enrollment 

policies.

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 paying copays (see 

Copays on pages 10 and 11). Veterans who choose not to complete the financial 

assessment must agree to pay the required copays 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, who 

agree to pay copays and who do not have any other special eligibility qualifying factors 

will not be accepted for enrollment. 
Updating Your Information

Enrolled veterans should use VA Form 10-10EZR, which is a shorter version of the 

application form, to update their previously reported information. This form can 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.

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 

copay. 

Please note that the geographically-based copay reductions apply ONLY to 

INPATIENT SERVICES. Outpatient services, long-term care, as well as medication 

copays are NOT affected by this change.

Private Health Insurance

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.

By law, VA is obligated to bill health insurance carriers for services provided to treat nonserviceconnected conditions. To ensure that current insurance information is on file—including coverage 

through employment of 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. Eligible veterans are not responsible for payment of VA medical 

services billed to their health insurance company that are not paid by their insurance carrier.

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.

Insurance Collections

Since the start of insurance collections in 1986, veterans’ health care services have 

been supplemented by funds collected from private health insurance companies. This 

supplement has allowed VA to provide services to numerous additional veterans.
Medicare Part D Prescription Drug Coverage

If you are eligible for Medicare Part D prescription drug coverage, you need to know that enrollment 

in the VA health care system is creditable coverage for Medicare Part D purposes. This means that 

VA prescription drug coverage is at least as good as the Medicare Part D coverage. For additional 

information visit VA: www.va.gov or Medicare: www.cms.hhs.gov. 

Must I reapply every year 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 

or when their income changes, using VA Form 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 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 Financial Assessment (Means Test) and is family size 

considered?

VA considers your previous calendar year’s total household income and net worth. This 

includes the earned and unearned income and net worth of your spouse and dependent. 

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 law, VA is required to identify veterans who agree to pay VA medical care copays 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 income falls between the VA means test limits and 

the HUD low-income limits will have their inpatient medical care copays reduced by 80%. 

The remaining higher income veterans will continue to pay the full inpatient medical care 

copays and will be assigned the means test status “MT Copay Required”. This law has no 

affect on outpatient and medication copays.

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 Financial Assessment as well as for geographic adjustments for 

high cost-of-living areas, are updated annually.
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 

• Veterans determined by VA to be unemployable 

due to service-connected conditions

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 VA 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
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

- service in the Gulf War; or

- 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

- illnesses possibly related to participation 

in Project 112/Project SHAD.

Priority Group 7

Veterans who agree to pay specified copays 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 copays 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
How does application of the geographically-based 

income thresholds change the financial assessment 

process and the enrollment priority groups?

While the financial assessment procedures do not 

change, application of the geographically based 

income thresholds results in a division of the original 

Priority Group 7 into two separate priority groups. 

Priority Group 7 is now limited to nonserviceconnected 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. 

What is a VA service-connected rating and 

how do I establish one?

A compensation and/or a service-connected 

rating is an official ruling by VA Regional Office 

that your illness or condition is directly related to 

your active military service. 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 copays, 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. 
Copays

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, also 

known as a means test, to determine if they qualify for 

cost-free services. Veterans whose income and net worth 

exceed the established income threshold as well as those 

who choose not to complete the financial assessment must 

agree to pay required copays to become eligible for VA 

health care services. Note that new veterans who apply for 

enrollment on or after January 17, 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 copay requirements, if applicable.

Types of Copays

Outpatient Copays*—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 copay requirement for preventive care 

services such as screenings, immunizations, and other 

services that do not require the immediate presence of a 

physician.

Medication Copays*—applicable to each prescription 

including each 30-day supply or less of maintenance 

medications.

* Includes an annual cap for enrollment priority groups 2 

through 6.

Inpatient Copays—in addition to a standard copay 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 Copays*—based on three levels of care (see Long-Term Care Benefits on page 18 

for definitions).

• Nursing Home Care/Inpatient Respite Care/Geriatric Evaluation
11

• Adult Day Health Care/Outpatient Geriatric 

Evaluation/Outpatient Respite Care

• Domiciliary Care

* Copays for Long-Term Care services start on the 22nd day of care during 

any 12-month period—there is no copay requirement for the first 21 days. 

Actual copay charges will vary from veteran to veteran depending upon 

financial information submitted on VA Form 10-10EC.

Annual Changes To Copay Rates

Because of the annual changes to the copay rates—including the annual cap 

on medication copays—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/healtheligibility.

Which Veterans Are Not Required to Make Copays?

Many veterans qualify for cost-free health care and/or medications based on 

• Receiving a Purple Heart Medal, or 

• Former Prisoner of War Status, or 

• Compensable service-connected disabilities, or 

• Low income, or 

• Other qualifying factors including treatment related to their military service experience. 

Some of the Services Exempt from Inpatient and Outpatient Copays

• Special registry examinations offered by VA to evaluate 

possible health risks associated with military service 

• Counseling and care for military sexual trauma 

• Compensation and pension examination requested by VBA 

• Care that is part of a VA approved research project 

• Care related to a VA-rated service connected disability 

• Readjustment counseling and related mental health services

• Emergency Treatment at other than VA facilities 

• Care for cancer of head or neck caused from nose or throat 

radium treatments given while in the military 

• Publicly announced VA public health initiatives i.e. health fairs 

• Care related to service for veterans who served in combat or against a 

hostile force during a period of hostilities after November 11, 1998. 

• Laboratory and other services such as flat film radiology services 

and electrocardiograms 
12

I am a recently discharged combat veteran. Must I pay VA copays?

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 copays. This benefit is limited to a 

two-year period following military discharge. Recently discharged 

combat veterans will be asked to complete the applicable financial 

assessments (means test or medication copay tests) to determine 

if they qualify for a higher enrollment priority assignment, whether 

they will be charged copays for care and medication provided 

for treatment of non-combat related conditions, as well as their 

potential eligibility for beneficiary travel.

How many copay charges may be assessed during 

a single day?

For outpatient services, you will be charged one copay, 

regardless of the number of health care providers you see in 

a single day. The amount of the outpatient copay 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 copays charged as 

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

medication filled. Inpatient copays 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 copays for outpatients, long-term care copays are a single, all-inclusive 

charge.

Who qualifies for the annual cap on medication copays?

The annual cap on medication copays applies to Priority Groups 2 through 6 (Priority 

Group 1 is exempt from ALL copays). Because of their higher financial status, veterans 

in Priority Groups 7 and 8 do NOT qualify for the medication copay 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 copay requirement.

What if I am Unable to Pay the Copays?

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. Hardship 

determinations apply only to future copay responsibility. For copay debt that 

has already been established, you may apply for a waiver by contacting the 

Enrollment Coordinator at the VA Medical Center where you received your 

care.

What is the copay for a 90-day supply of medication?

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

supply is subject to that year’s applicable medication copay rate. In your 

case, your 90-day supply would cost you 3 times the medication 

copay rate.
VA Health Care Covered Services 

Acute Care Benefits

13

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)

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
14

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% service connected 

condition, or are receiving a VA pension, housebound or aid and attendance benefits.

Am I eligible for dental care?

You are eligible for dental services if your dental care is for either a compensable serviceconnected 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, an enrolled homeless veteran 

participating in specific health care programs, or if your dental condition is aggravating a medical 

• 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
15

problem under VA treatment. In addition, recently discharged veterans who served on active duty 

90 days or more and who apply for VA dental care within 90 days of separation from active duty, 

may receive a one time treatment for dental conditions if the veteran’s certificate of discharge 

does not indicate that the veteran received necessary dental care within a 90-day period prior to 

discharge or release. 

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 non-VA 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.

Is VA approval needed before I obtain non-VA 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)
Long-Term Care Benefits

16

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.

Financial Assessment for Long-Term Care Services

For veterans who are not automatically exempt from making copays for longterm care services (see Copays 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 copays. For those 

veterans who do not qualify for cost-free services, the financial assessment 

for long term care services is used to determine the copay requirement. Unlike copays for other VA 

health care services, which are based on fixed changes for all, long-term care copay charges are 

individually adjusted based on each veteran’s financial status.

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 
17

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 financial assessment, 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 copay charge.

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

copay requirements?

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

you with an annual projection of your monthly copay 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.

service-connected rating of 70% or more. Other veterans—with priority given to those with serviceconnected 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.
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Additional VA Health Care

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.

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 two separate offices (as indicated below) depending on 

where the health care services are obtained.

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

All other countries

address

Foreign Medical Program

PO Box 65021

Denver CO 80206-9021

telephone

303.331.7590

e-mail 

hac.fmp@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 fax

CHAMPVA 303.331.7804

PO Box 65023

Denver CO 80206-9023

telephone 

web site

800.733.8387

www.va.gov/hac

e-mail

hac.inq@va.gov 
19

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

e-mail

cwvv.inq@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

Spina Bifida Health Care

PO Box 65025

Denver CO 80206-9025

telephone

888.820.1756

fax

303.331.7807

e-mail

spina.inq@va.gov

web site

www.va.gov/hac