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
Medication Copay:While many Veterans are exempt for medication copays, nonservice-connected Veterans in Priority Groups 7 and 8 are charged $9 for each 30-day or less supply of medication provided on an outpatient basis for the treatment of a nonservice-connected condition. Veterans enrolled in Priority Groups 2 through 6 are charged $8 for each 30-day or less supply of medication; the maximum copay for medications per calendar year is $960 for nonservice-connected medications.
NOTE: Copays apply to prescription and over-the-counter medications, such as aspirin, cough syrup or vitamins, dispensed by a VA pharmacy. Copays are not charged for medical supplies, such as syringes or alcohol wipes. Copays do not apply to condoms.
Veterans Not Required To Make Copays
Some Veterans qualify for free healthcare and/or prescriptions based on special eligibility factors including but not limited to:
- Former Prisoner of War status
- 50% or more compensable VA service-connected disabilities (0-40% compensable service- connected may take copay test to determine prescription copay status)
- Veterans deemed catastrophically disabled by a VA provider
Health Insurance and VA Copays
VA is required to bill private health insurance providers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. Generally, VA cannot bill Medicare, but can bill Medicare supplemental health insurance for covered services.
All Veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Veterans are not responsible for paying any remaining balance of VA's insurance claim not paid or covered by their health insurance, and any payment received by VA may be used to offset "dollar for dollar" a Veteran's VA copay responsibility.
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