VA Healthcare: Priority Groups

Doctor greets a patient with a handshake.

The number of Veterans who can be enrolled in the health care program is determined by the amount of money Congress gives VA each year. Since funds are limited, VA set up Priority Groups to make sure that certain groups of Veterans are able to be enrolled before others.

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 range from 1-8 with 1 being the highest priority for enrollment. Based on eligibility and income, some Veterans may have to agree to pay copay to be placed in certain Priority Groups and some Veterans may not be eligible for enrollment.

You may be eligible for more than one Enrollment Priority Group. In that case, VA will always place you in the highest Priority Group that you are eligible for. Under the Medical Benefits Package, the same services are generally available to all enrolled Veterans.VA determines your eligibility for VA’s comprehensive medical benefits package through our patient enrollment system, which is based on Priority Groups from 1 through 8.

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

 

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.

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 who are Former Prisoners of War (POWs)
  • Veterans awarded a Purple Heart medal
  • Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty
  • Veterans with VA-rated service-connected disabilities 10% or 20% disabling
  • Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”
  • Veterans awarded the Medal Of Honor (MOH)

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

  • Nonservice-connected Veterans and noncompensable service-connected Veterans rated 0% disabled by VA with annual income below the VA’s and geographically (based on your resident zip code) adjusted income limits.
  • Veterans receiving VA pension benefits
  • Veterans eligible for Medicaid programs

Priority Group 6

  • Compensable 0% service-connected Veterans
  • Veterans exposed to Ionizing Radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki
  • Project 112/SHAD participants
  • Veterans who served in the Republic of Vietnam between January 9,1962 and May 7,1975
  • Veterans of the Persian Gulf War who served between August 2, 1990 and November 11, 1998
  • *Veterans who served on active duty at Camp Lejeune for not fewer than 30 days beginning August 1, 1953 and ending December 31, 1987
  • Veterans who served in a theater of combat operations after November 11, 1998 as follows:
    • Currently enrolled Veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for 5 years post discharge.
    • Combat Veterans who were discharged between January 2009 and January 2011, and did not enroll in the VA health care during their 5 year period of eligibility have an additional one year to enroll and receive care.  The additional one-year eligibility period began February 12, 2015 with the signing of the Clay Hunt Suicide Prevention for America Veterans Act.

Note: At the end of this enhanced enrollment priority group placement time period Veterans will be assigned to the highest Priority Group their unique eligibility status at that time qualifies for.

*Note: While eligible for Priority Group (PG) 6; until system changes are implemented you would be assigned to PG 7 or 8 depending on your income.

Priority Group 7

  • Veterans with gross household income below the geographically-adjusted income limits (GMT) for their resident location and who agree to pay copays

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Priority Group 8

  • Veterans with gross household income above the VA and the geographically-adjusted income limits for their resident location and who agrees to pay copays

Veterans eligible for enrollment:

Noncompensable 0% service-connected:

  • Subpriority a:  Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility status
  • Subpriority b:  Enrolled on or after June 15, 2009 whose income exceeds the current VA or geographic income limits by 10% or less

Nonservice-connected and:

  • Subpriority c:  Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility status
  • Subpriority d:  Enrolled on or after June 15, 2009 whose income exceeds the current VA or geographic income limits by 10% or less

Veterans not eligible for enrollment:

Veterans not meeting the criteria above:

  • Subpriority e: Noncompensable 0% service-connected (eligible for care of their SC condition only)
  • Subpriority g: Nonservice-connected

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 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.

Related Topics

Veteran Health Care VA Medical Benefits

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