Some veterans are required to make copayments (copays) for VA health care and medications.
Usually these copays are determined by the Priority Group you are in. Explanation of VA Priority Groups.
Veterans in Priority Group 1 have no copay for any VA medical service. Those in Priority Groups 2 - 8 get treatment for any service-connected conditions for free. All other medical treatment probably has a copay, this is usually based on your income.
If you have private insurance, VA will bill your insurance company for the cost of drugs or treatment for non-service connected conditions. If you can't pay, the VA won't withhold treatment, you can work out a payment plan or apply for a waiver.
|Medication Tier||1 - 30 day supply||31 - 60 day supply||61 - 90 day supply|
|Tier 1 (Preferred Generic)||$5||$10||$15|
|Tier 2 ( Non-preferred Generic and some Over-the-Counter Drugs)||$8||$16||$24|
|Tier 3 (Brand Name)||$11||$22||$33|
Outpatient Care Copay
Veterans in Priority Groups 2 - 8 may have a copay of $15 for a primary care doctor or $50 for a specialist visit for treatment of non-service connected conditions.
The copay amount is limited to a single charge per visit and is based on the highest level of service received.
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
- Smoking cessation or weight reduction services
- Publicly announced VA public health initiatives such as 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
Inpatient Care Copay
Inpatient care is free for most in Priority Groups 1 - 6 and for service-connected conditions.
Priority Group 7 (and certain other veterans) have to pay a 20 percent 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) have to pay a 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 care, etc.)
- Outpatient: $15 per day (Adult day health care, respite care, geriatric evaluation, etc.)
- 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 depending upon your financial situation.
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