VA Health Care Eligibility

Eligibility for VA health care is dependent upon a number of variables, which may influence the final determination of the services for which you qualify. These factors include the nature of a veteran's discharge from military service (e.g., honorable, other than honorable, dishonorable), length of service, VA adjudicated disabilities (commonly referred to as service-connected disabilities), income level, and available VA resources among others.

Regulations now allow VA to enroll certain Priority Group 8 veterans who applied for enrollment and who may have been previously denied enrollment in the VA health care system because their income exceeded VA's income thresholds. These Veterans would qualify if their household income does not exceed the current VA income thresholds by more than 10%. To see if you are eligible and to access a calculator to see how you stand against the income thresholds, visit www.va.gov/healthbenefits/cost/income_thresholds.asp. If you have any enrollment or eligibility questions, you may call 1-877-222-VETS (8387).

Generally, you must be enrolled in VA health care system to receive benefits offered in the Medical Benefits Package. To apply for VA health care benefits, including enrollment you must fill out an application. We use the application to determine:

• Whether you have qualifying service as a veteran
• What your veteran status is so that you can be placed into one of the priority groups

The following is a summary of veterans priority for VA Health Care:

• Priority Groups Explained
• Priority Groups
  • Priority Group 1
  • Priority Group 2
  • Priority Group 3
  • Priority Group 4
  • Priority Group 5
  • Priority Group 6
  • Priority Group 7
  • Priority Group 8

VA places a priority on improved veteran satisfaction and maintains that their goal is to ensure the quality of care and service that veterans receive is consistently excellent, in every location, in every program. Under the Medical Benefits Package, VA offers the veteran a comprehensive health care plan that provides the care you need.

What are the Priority Groups?

Once you apply for enrollment, your eligibility will be verified. Based on your specific eligibility status, you will be assigned a priority group.

The priority groups are as follows, ranging from 1-8 with 1 being the highest priority for enrollment. Under the Medical Benefits Package, the same services are generally available to all enrolled veterans.

As of January 2008, Combat Veteran Health Care eligibility has been extended.

To see if you are eligible and to access a calculator to see how you stand against the income thresholds, visit www.va.gov/healtheligibility. If you have any enrollment or eligibility questions, you may call 1-877-222-VETS (8387).

Be sure to visit the VA Health Care Eligibility website to get the most current information.

Priority Group 1

• Veterans with service-connected disabilities rated 50% or more disabling, or
• 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 with service-connected disabilities rated 10% or 20% disabling
• Veterans who are former POWs
• Veterans awarded the Purple Heart
• Veterans whose discharge was for a disability that began in the line of duty
• Veterans who are disabled because of VA treatment or participation in VA vocational rehabilitation program

Priority Group 4

• Veterans who are receiving aid and attendance or housebound benefits
• Veterans who have been determined by VA to be catastrophically disabled

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Priority Group 5

• Veterans receiving VA pension benefits
• Veterans who are eligible for Medicaid programs
• Veterans with income and assets below VA Means Test Thresholds

Priority Group 6

• Veterans with 0% service-connected conditions, but receiving VA compensation
• Veterans seeking care only for disorders relating to Ionizing Radiation and Project 112/SHAD
• Veterans seeking care for Agent Orange Exposure during service in Vietnam
• Veterans seeking care for Gulf War Illness or for conditions related to exposure to during service in the Persian Gulf
• Veterans of World War I or the Mexican Border War
• Veterans who served in combat in a war after the Gulf War or during a period of hostility after November 11, 1998 for 2 years following discharge or release from the military.

 Click here for more information about combat veteran eligibility

Priority Group 7

• Veterans who agree to pay specified copay with income and/or net worth above VA Income Threshold and income below the Geographic Means Test Threshold
  
  
  
  • Subpriority a: Noncompensable 0% service-connected veterans who were enrolled in 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 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 in Subpriority a above. VA is not currently using Subpriority e.
    
    
  • Subpriority g: Nonservice-connected veterans not included in Subpriority c above. VA is not currently using Subpriority g.

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Priority Group 8

New regulations now allow VA to enroll certain Priority Group 8 Veterans who have been previously denied enrollment in the VA health care system because their income exceeded VA's income thresholds. These Veterans may now qualify if their household income does not exceed the current VA income thresholds by more than 10 percent.

Veterans with income and/or net worth above the VA national income thresholds and the Geographic Means Test Threshold who agree to pay copays may be eligible to enroll under the following conditions:

Veterans eligible for enrollment: Noncompensable 0% service-connected and:

• Subpriority a: Enrolled as of January 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 means test or geographic means test by 10% or less

Veterans eligible for enrollment: Nonservice-connected and:

• Subpriority c: Enrolled as of January 16, 2003, and who have 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 means test or geographic means test by 10% or less

Veterans not eligible for enrollment: Veterans not meeting the criteria above

• Subpriority e: Noncompensable 0% service-connected
• Subpriority g: Nonservice-connected

To see if you are eligible and to access a calculator to see how you stand against the income thresholds, visit http://www4.va.gov/healtheligibility/eligibility/enrollment.asp. If you have any enrollment or eligibility questions, you may call 1-877-222-VETS (8387).

VA Travel Reimbursement

Reimbursement for mileage or public transportation may be paid to the following:

1. Veterans with service-connected disabilities rated at 30% or more;
2. Veterans traveling for treatment of a service-connected condition;
3. Veterans receiving a VA pension;
4. Veterans traveling for scheduled compensation or pension examinations;
5. Veterans whose income does not exceed the maximum VA pension rate;

Mileage reimbursement is made at the current rate of 41.5 cents per mile. The new deductibles are $3 for a one way trip, $6 for a round trip, with a maximum of $18 per calendar month. However, these deductibles can be waived if they cause a financial hardship to the veteran.

The deductible is also waived for veterans traveling for scheduled compensation or pension examinations.