VA Medical Services and Medication Copayments
Some Veterans are required to make copayments (copays) to receive VA health care and/or medications.
Inpatient Care Copay:
Priority Group 7 (and certain other veterans) are responsible for paying 20 percent of VA's inpatient copay or $252.00 for the first 90 days of inpatient hospital care during any 365-day period. For each additional 90 days, the charge is $126.00. In addition, there is a $2 per diem charge.
Priority Group 8 (and certain other Veterans) are responsible for VA's inpatient copay of $1,260 for the first 90 days of care during any 365-day period. For each additional 90 days, the charge is $630. In addition, there is a $10 per diem charge.
Extended Care Copay:
Long term care copays are based on three levels of care:
- Inpatient: Up to $97 per day (Community Living (Nursing home), Respite, Geriatric Evaluation)
- Outpatient: $15 per day (Adult Day Health Care,Respite, Geriatric Evaluation)
- Domiciliary: $5 per day
**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.
Outpatient Care Copay:
While many Veterans qualify for free healthcare services based on a VA compensable service-connected condition or other qualifying factor, most Veterans are asked to complete an annual financial assessment, to determine if they qualify for free services. Veterans whose income exceeds the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA healthcare services.
- Primary Care Services: $15
- Specialty Care Services: $50
NOTE: Copay amount is limited to a single charge per visit regardless of the number of health care providers seen in a single day. The copay amount is based on the highest level of service received.
Outpatient Visits Not Requiring Copays:
Certain services are not charged a copay:
- 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 examinations.
- Care that is part of a VA research project
- Care related to a VA-rated service-connected disability
- Readjustment counseling and related mental health services
- Care for cancer of head or neck caused by nose or throat radium treatments received while in the military
- Individual or Group Smoking Cessation or Weight Reduction services
- Publicly announced VA public health initiatives, for example, health fairs
- Care potentially related to combat service for Veterans that served in a theater of combat operations after November 11, 1998.
- Laboratory and electrocardiograms
- Hospice care
The only time a veteran is required to make a copay for medications prescribed by the VA is if the medicine is for a non-service connected issue. For example, if you have a service connected disability for a back injury but go the VA and are prescribed cholesterol medication, you will probably have to pay the VA a small payment called a "copay" when you get your medicine.
Veterans receiving medications for non-service connected conditions must pay a monthly copay based on the type of medication they receive. Generic drugs, which are the most commonly prescribed, have the lowest copay amount. The annual copay limit a veteran must pay is $700. Veterans who pay more than the annual copay limit will continue to receive their medications but will not have to pay anything for them.
While many Veterans are exempt for medication copays, nonservice-connected Veterans in any Priority Group other than Priority Group 1 may have to pay a copay for prescribed medications
The VA medication copays are as follows:
|Medication Tier||Copay Amount|
1 - 30 day supply
31 - 60 day supply
61 - 90 day supply
|Tier 1 (Preferred Generic)||
|Tier 2 (Non-Preferred Generic & Some Over-the-Counter Drugs)||
|Tier 3 (Brand Name)||
Veterans in Priority Group 1 will have no copay for any VA dispensed medications. Priority Group 1 includes veterans with a disability rating of 50% or more, or who are considered unemployable due to service-connected disability.
If your income is below certain limits the VA will not charge you any copay for your medications. The income limits are very complicated, they differ by location and by the size of your household. See the VA's website for more information. If you have private insurance, the VA will bill your insurance company for the cost of drugs prescribed to treat non-service connected conditions. If you cannot pay, the VA will not withhold your medications, you can work out a payment plan or apply for a waiver.
|VA Medical Benefits|