The VA Health Care system can be difficult to navigate, which is probably why recent statistics show that only a small percentage of veterans are actually using their VA health care benefits. It can be hard to figure out if you’re eligible, sign up, and access those benefits regularly because there are a lot of steps.
Getting Your Benefits
There are many regulations governing the VA and they can be very difficult to understand. Even establishing eligibility can be complicated sometimes.
Are you eligible for VA health care benefits?
The first thing you need to establish is if you are eligible for VA health care benefits. There are many eligibility requirements and not all veterans are eligible for these services.
You may be eligible for VA health care benefits if you served on active duty in any military branch and did not receive a dishonorable discharge. However, there may be additional requirements depending on when and where you served.
For example, there are special rules for veterans who enlisted after September 7, 1981 or entered active duty after October 16, 1981. If that describes you, then you also must have served 24 continuous months OR the full period for which you were called to active duty. That rule does not apply to you if you you were discharged due to a disability, a hardship or early out, or if you served prior to September 7, 1981.
Reserves and National Guard members only qualify for VA health care if they were called to active duty by a federal order and completed the entire period they were ordered.
Veterans who served in certain locations or time periods during the Vietnam War are automatically eligible for VA health care.
How do I apply for VA health care?
Applying for VA health care doesn’t have to be complicated. You just need to fill out VA Form 10-10EZ. There are several ways that you can do this.
- You can apply online at the official VA website.
- You can call the toll-free VA number at 877-222-VETS. That’s 877-222-8387 if you’d rather not worry about the letters.
- You can also apply in person at a VA medical center. They have Application for Health Benefits paperwork on hand and there’s often someone who can assist you with completing that paperwork if necessary.
You will need to have your Social Security number, military discharge information, insurance card, and income information in order to complete your application. The VA estimates that the application process takes about 30 minutes.
Once you submit your application, it usually takes about a week to get approved. If you haven’t heard a response within the week, you’re encouraged to call the VA’s toll-free hotline for more information.
What happens when I’m approved?
Once your application is processed and your benefits are approved, you’ll be enrolled in the VA Health Care System. You do not have to reapply, although you will need to keep your contact information and financial information up-to-date.
When you’re enrolled, you should receive a phone call. During this call, a trained VA staff member will answer your questions and set up your first appointment.
You’ll also receive a printed copy of the Veterans Health Benefits Handbook in the mail. Your copy should include a letter that explains your specific benefits, including your Priority Group. This is important information because it will dictate how your receive your health care benefits.
What does my VA Priority Group mean?
Not everyone who is eligible will receive the same quality of service from the VA. That’s because the Department of Veterans Affairs categorizes veterans into different priority groups. Veterans who are sorted into higher-level priority groups can sign up faster, get care right away and will pay less for their VA-provided health care.
Your priority group will depend on your service record, disability rating, income level, Medicaid eligibility, and other benefits. It’s a very complex system. Veterans are automatically assigned to the highest priority group that they qualify for.
- Priority Group 1 is for veterans who have received a Medal of Honor (MOH), or who receive Individual Unemployability or have a service-connected disability rated at 50% or more.
- Priority Group 2 is for veterans who have a service-connected disability rating of 30-40%.
- Priority Group 3 is for veterans who have been a former Prisoner of War (POW), who received a Purple Heart medal, those who have a service-connected disability rating of 10-20%, those who were discharged due to a disability that was caused by or worsened during service, and those who are awarded special classification under Title 38 U.S.C § 1151.
- Priority Group 4 is for veterans who receive Aid and Attendance benefits or have been determined to be “catastrophically disabled.”
- Priority Group 5 is for veterans who are receiving VA pension benefits or Medicaid. Low income veterans who do not have a service connected disability (or at least don’t have a disability rated higher than 0%) are also placed in this group.
- Priority Group 6 is for veterans who have service connected disability rated at 0%, or meet certain specific service criteria. For example, veterans who served on active duty at Camp Lejeune for at least 30 days between August 1, 1953 and December 31, 1987 are eligible for this group. Certain WWII, Vietnam, and Persian Gulf War veterans are also eligible, as are newly returning combat Veterans.
- Priority Group 7 is for veterans who have a low income and agree to copays.
- Priority Group 8 is for veterans who agree to copays and aren’t eligible for a higher priority group. Within Priority Group 8, there are six separate sub-priority groups with different eligibility criteria.
Using Your VA Health Care Benefits
Although the VA is a great resource for veterans who need health care, it can be difficult to use. There are some things you need to know about using your health care benefits.
You will be assigned a PACT.
PACT stands for Patient Aligned Care Team. Your PACT will include a primary care provider, assistant, licensed practical nurse, registered nurse care manager and a clinical pharmacist. This team works together to provide your primary care services.
Primary care providers help you with the majority of your health care needs. They do not offer emergency services. They do provide preventative care and diagnostic care. They also manage your medication refills and referrals to outside specialty providers.
Your PACT will be your primary health care team at the VA. Generally, in order to see a specialist, you will need to see your PACT first so that you can get a referral.
What does the VA health care cover?
VA health care covers regular doctor’s visits and specialty care visits within the VA health care system. They have a wide range of specialty providers, including cardiologists, gynecologists, and mental health providers. They even have home health, prosthetics, and pharmacy departments. The vision department can provide routine eye exams as well.
In the event you need a specialist that is not involved in the VA health care system, you may be able to receive help from an outside provider through their Community Care system.
The VA does not cover cosmetic surgery, gender-affirming surgeries, health club or spa memberships, or medications that are not approved by the FDA.
Your medications will be delivered by mail.
One of the most convenient aspects of VA health care is that they will mail your prescriptions to you at home at no cost. It’s a free and easy way to get your medications.
However, if you prefer to pick your prescriptions up, you can pick them up directly from the VA medical facility. You do need to let the pharmacy know your preference in advance.
Community Care is available.
Sometimes, the VA will pay for veterans to be seen by other providers in the community. This usually happens because the veteran lives too far from a VA facility, or the VA facility doesn’t have any open appointments, or the VA determines it’s in the veteran’s best interest to see a different provider.
The VA always has to approve community care in advance. You will need to work with the VA to get approval and find a provider. If you don’t get the VA’s approval first, they will not pay for the appointment.
VA Health Care Secrets
Because the VA is such a tangled mess of regulations, it can be hard to understand how to use your benefits. There are many loopholes and tricks that people don’t know about. That’s why we’re here to research and report on them!
You can use your VA health care benefits when you travel.
If you are travelling or even temporarily residing in a different area, you can still use your VA health care benefits. You can always reach out to the Travelling Veteran Coordinator at your local VA facility for assistance.
If you know in advance that you will be away, the VA recommends talking to your PACT or Specialty Providers 4-6 weeks prior to travel. This is especially helpful for veterans who live in one region in the summer and somewhere else in the winter.
You can go to a non-VA emergency room.
If you are experiencing an emergency and cannot safely travel to your nearest VA emergency room, then the VA will pay for emergency treatment at your local medical facility. However, the veteran must believe that his or her life or health is in danger in order for this to be covered, so you can’t go to the local ER for just anything.
If you do visit a non-VA emergency room, you will need to notify the VA within 72 hours of the visit. If you don’t, they may not pay for that visit. You can report online, over the phone (844-724-7842) or in-person at your local VA health care facility.
As of January 17, 2023, the VA has expanded their emergency services coverage for veterans who are experiencing a suicidal crisis. The VA will now pay for (or reimburse veterans for) costs related to emergency care due to a suicide crisis. They’ll even cover the ambulance transpiration costs and any follow-up inpatient care for 30 days! Outpatient care, including social work, will be covered for up to 90 days.
You can have non-VA medications filled by the VA.
If you have a regular provider outside the VA, you may still be able to get your medications filled for free through the VA system. In order to do this, you need to make sure that you are enrolled in VA health care, have an assigned VA provider, and send your VA provider the medical records from the non-VA provider. The VA provider will have to agree with the prescription in order to fill it through the VA system.
Some veterans are eligible for dental care.
Not all veterans can get dental care through the VA. However, you may be able to get dental care through the VA if you meet any of the following criteria:
- You have a service-connected dental disability rated 10% or higher.
- You are rated 100% disabled.
- You receive Individual Unemployability.
- You are a former prisoner of war.
There are some additional circumstances that could help you receive limited dental services through the VA. These include:
- You served on active duty for at least 90 days during the Persian Gulf War.
- You have a service-connected dental disability rated 0%.
- A VA dental provider has determined that your dental condition is aggravating a service-connected health condition.
- You are participating in the Chapter 31 Veteran Readiness and Employment Program.
- You are enrolled in the Homeless Veterans Dental Program.
You can be reimbursed for your travel expenses.
The VA has a travel pay reimbursement program. Certain veterans and caregivers can get paid for their mileage and travel expenses when they have to travel to medical appointments.
In order to be eligible for travel reimbursement, you must meet be travelling for VA-approved care (either at a VA facility or a community provider) and at least ONE of the following must also be true:
- You have a 30% or higher VA disability rating
- You are travelling because the appointment has to do with a service-connected disability
- You receive a VA pension.
- You meet income limits.
- You are travelling to a VA Comp & Pension exam, to get a service dog or for a VA-approved transplant.
You can file your claim for VA travel reimbursement on their website.