VA Health Care: Cost and Co-payments

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Most nonservice-connected veterans and noncompensable 0% service-connected veterans are required to complete an annual means test or to agree to pay VA the applicable copayment. The means test is based on their family's income and net worth. Some veterans are required to make copayments for their care and medications. The following is a summary of cost and co-payments for VA Health Care:

Veterans are requested to provide health insurance information. VA is required to submit claims to insurance carriers for treatment of all nonservice-connected conditions. Reimbursement received from insurance carriers are retained at the VA health care facility where treatment was received. These funds are used to provide additional health care services to all veterans.

Means Testing

Certain nonservice-connected and 0% noncompensable service-connected veterans are required to fill out the financial worksheet, which we refer to as the "Means Test." A means test is a gathering of financial information by which VA determines your priority group for enrollment, and whether or not you are required to make copayments for the service you receive. The means test is based on prior year income and net worth. However, you can apply for an exemption from paying those copayments to avoid a hardship if projections of your income for the current year will be substantially below the applicable income threshold.

Should you decline to complete the Financial Worksheet, you must agree to pay the applicable copayment unless you are otherwise eligible for VA care. We would be unable to determine your priority and therefore could not offer you enrollment. It is possible, if you do not want to complete the Financial Worksheet, to declare yourself as a Discretionary Veteran. This means that you would accept placement in priority group 8 for enrollment and if enrolled you would be accepting responsibility for making the required copayments.

Hardship Determination

A Hardship Determination is a process by which veterans enrolled in Priority Group 7 & 8 may request a change in their enrollment priority group if their projected income for the current year will be substantially lower than their income from the previous year. Circumstances that might warrant hardship determination would be the loss of employment, business bankruptcy, or out-of-pocket medical expenses.

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If you are being provided treatment, necessary prescriptions will be provided. For more information on the current copayment rates, visit the Department of Veterans Affairs website. Service-connected veterans rated 50% or more, service-connected veterans receiving medications for a service-connected condition, or nonservice-connected veterans who meet the low-income criteria are exempt from the prescription copayment. This income threshold changes annually.

Four Basic Types of Co-payments

  • Medication – Prescription copayment charges were established by Congress. The charge ranges from $5 to $11 for each 30 day or less supply of medications provided on an outpatient basis for nonservice-connected conditions.
  • Outpatient – The copayments will be based on primary care visits ($15) and specialty care visits ($50).
  • Inpatient – Congress determined the appropriate inpatient copayment should be the current inpatient Medicare Deductible Rate ($1,316 in 2017) for the first 90 days that you remain in the hospital plus a $10 per diem charge.
  • Long Term Care – VA charges for Long Term Care Services vary by type of service provided and the individual veterans ability to pay.

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Veteran Health Insurance

Whether or not you have insurance does not effect your eligibility for VA health care benefits.

If you are receiving care for a nonservice-connected condition and have health insurance, your insurance carrier will be billed. VA does not bill your health insurance carrier for VA-adjudicated service-connected disabilities. An adjudicated service-connected disability is one that VA has determined was incurred or aggravated in the line of active duty. The law requires VA to bill private health insurance companies for all nonservice-connected care a veteran receives. VA's budget and your future care could depend on the amount VA is able to collect from private health insurance carriers. By not giving us insurance information you may be limiting your future care and that of many other veterans. Additionally, if you are a veteran who is subject to a copayment and are receiving care for your non service connected disability, providing VA your insurance information enables VA to submit a claim to your health insurance company. Any payment received from your insurance will be applied to your outstanding copayment debt. This may satisfy all or part of your copayment responsibility.

You will NOT be responsible for any unpaid balance that the insurance carrier does not pay except for VA copayments. In addition, many insurance companies will apply VA health care charges toward the satisfaction of your annual deductible.

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