Health Insurance

What Are VA Health Benefits?

People who served in the U.S. military may be eligible for VA health benefits. If so, you could receive coverage for inpatient and outpatient care, prescription drugs, long-term care, and more. Learn if you and your family could benefit.

What Are VA Health Benefits

VA health care benefits are offered by the Department of Veterans Affairs (VA) to eligible former members of the U.S. military. These benefits cover many of your healthcare-related expenses, such as health exams, surgeries, acute care, and more. To use these benefits, however, you have to receive care from a VA medical facility or physician.

The Department of Veterans Affairs is an organization committed to assisting veterans. In addition to healthcare, it offers assistance with education, life insurance, home loans, and more. Currently, the Veterans Health Administration provides care to over 9 million veterans at 1,298 VA healthcare facilities across the country.

Do Veterans Need Health Insurance?

The federal penalty for not having health insurance was effectively removed in 2018, so veterans are not required to have health insurance unless they live in a state that still requires health coverage. That said, it’s still crucial for veterans to have some kind of health coverage for the following reasons:

What Are VA Healthcare Benefits?

If you have a health condition related to your time in military service, the VA may provide you with free healthcare. It also offers healthcare to veterans with catastrophic disabilities and disability ratings of at least 50%. Finally, if you cannot afford healthcare, the VA may also step in to help.

With your VA coverage, you can receive benefits such as:

  • Preventative care services, like health exams, health education, and immunizations
  • Inpatient and outpatient care, like kidney dialysis, medical treatments, and acute care
  • Surgeries, such as organ transplants or orthopedic surgery
  • Emergency care, like an ER visit or urgent care facility visit
  • Mental health services to treat conditions like post-traumatic stress disorder (PTSD), depression, or substance use disorder
  • Assisted living and home health care, such as skilled nursing or physical therapy visits
  • Prescription drug coverage, provided the prescription is written by a VA physician

Some veterans may also be eligible for additional services, such as dental care. However, this depends on your priority group, your pre-existing medical conditions, and the advice of your doctor.

How Do VA Benefits Work?

To use your VA health benefits, you usually have to receive care from a VA-approved medical provider or facility. Currently, the VA has more than 1,200 care locations across the country. You may receive care from the following places:

  • VA medical centers, which offer hospital-based services like surgery or oncology care
  • VA community-based outpatient clinics, which offer outpatient services like routine exams
  • Vet Centers, which offer community-based care, such as counseling and outreach
  • VA community living centers, which offer assisted living care for those who need help with daily tasks

In some cases, you may be able to get care in your own home. Additionally, if you live far from the nearest VA location, you may be eligible to receive VA-covered care from a local community healthcare provider.

Who Is Eligible for VA Healthcare Benefits?

To have VA medical benefits eligibility, you must have served for at least 24 continuous months if you enlisted after September 7, 1980 or entered active duty after October 16, 1981. Those who received a dishonorable discharge are not eligible for VA benefits.

However, the minimum duty requirement can be waived for those who suffered a disability from active-duty service, were discharged for a hardship, or served before September 7, 1980.

Current and former members of the Reserves or National Guard are also eligible for VA health benefits as long as they have been called to active duty by a federal order and then completed serving the required period. Those on active-duty status just for training may not be eligible for VA benefits.

Though VA benefits can include things like dental and vision care, only some veterans are eligible for those additional benefits. Benefits coverage varies depending on your priority group, the advice of your primary care provider, and the medical standards for treating your health conditions.

What Are VA Priority Groups?

VA priority groups work to prioritize veterans that need care right away, determining how quickly you receive your benefits and how much you would pay. Priority groups are based on your military service history, disability rating, income level, Medicaid eligibility, and any other benefits you receive in addition to those provided by the VA.

There are currently 8 priority groups:

  • Priority group 1: Service-connected disability rated 50% or greater, or prevents you from working; or Medal of Honor recipient
  • Priority group 2: Service-connected disability of 30% to 40%
  • Priority group 3: Service-connected disability of 10% to 20%; former prisoner of war; Purple Heart medal recipient; discharged for a disability; or you’re eligible under Title 38, U.S.C § 1151
  • Priority group 4: Receiving VA aid; or you’re catastrophically disabled
  • Priority group 5: No service-connected disability (or a non-compensable disability rated at 0%) and an income below adjusted income limits; you’re receiving VA pension benefits; or you’re eligible for Medicaid
  • Priority group 6: Compensable service-connected disability rated as 0%; exposed to radiation in Hiroshima or Nagasaki; participated in Project 112/SHAD; served in Vietnam, the Persian Gulf War, or Camp Lejeune
  • Priority group 7: Gross household income is less than the adjusted income limits; and you agree to pay copays
  • Priority group 8: Gross household income is more than the adjusted income limits; and you agree to pay copays

Your priority group could change if you have a change in income or your disability worsens over time.

What Do VA Health Benefits Cover?

VA health benefits provide the full spectrum of care for eligible veterans. You may receive basic health care coverage, dental and vision benefits, long-term care, and prescription drug coverage.

VA Basic Health Care Coverage

The VA offers a wide range of basic health care coverages, including preventative care services. These can help you stay healthy to reduce your risk of future health problems. These services include:

  • Health and wellness visits, such as your annual checkup
  • Educational visits, such as a meeting with a nutritionist
  • Immunizations, like the flu shot
  • Genetic counseling, especially if you have a disease that runs in your family

If you require inpatient, surgical, or specialty care, your VA benefits can cover a wide range of care services. Some examples include:

  • Anesthesiology
  • Cardiology
  • Gynecology
  • Neurology
  • Oncology
  • Podiatry
  • Pulmonary
  • Transplant surgery
  • Vascular surgery

Emergency care is also covered by your VA benefits. This means if you have to go to an emergency room and you choose a VA facility, your bill may be covered. You can also visit walk-in health clinics or urgent care facilities that are VA-approved.

VA Dental and Vision Benefits

For dental care, eligible veterans are placed into a benefits class that determines exactly what the VA pays. Classes I, IIC, and IV can get any needed dental care, such as routine cleanings, fillings, root canals, and more. Class II may be eligible for one-time dental care, while Class IIA can receive any dental needed to make sure you have a working set of teeth, such as bridges or dentures.

Classes III and VI might be eligible for dental care to treat oral conditions that are worsening your service-connected health condition. If you’re in Class V or IIB, you can get dental care to help you stay in the employment program or get a job. This might include treating severe gingival and periodontal conditions that can lead to bone and tooth loss if left untreated.

Fortunately, vision benefits are less complex. The VA covers routine eye exams and preventive vision testing for veterans with VA healthcare benefits. It can also cover the cost of eyeglasses if you have a service-connected disability, a health condition for which you’re receiving treatment, or vision problems caused by an injury.

VA Long-Term Care Coverage

The VA offers robust long-term care services for veterans. It might cover services such as:

  • Round-the-clock medical or nursing care
  • Ongoing physical therapy and rehabilitation
  • Home health aide assistance for completing daily tasks like cooking and bathing
  • Pain management
  • Caregiver support so they can have a break from their duties

VA beneficiaries can receive long-term care in a nursing home, assisted-living center, or VA-approved community health facility. In some cases, private home care could also be covered for those needing full-time or occasional care.

VA Prescription Coverage

Your VA health benefits cover prescriptions written or approved by a VA doctor. However, the VA may also provide coverage for a prescription written by a community provider as long as your VA primary care provider agrees with the prescription order after reviewing your medical records from the community provider.

To make sure your drugs are covered, have them filled at a VA pharmacy. However, short-term prescription medications for 14 days or less may be filled at a non-VA pharmacy.

What Is Not Covered by VA Health Benefits?

Some medical benefits are not covered by the current VA medical benefits package. These include:

  • Cosmetic surgery to improve or alter your appearance. The VA does have an exception if you need cosmetic surgery to prevent a condition, illness, injury, or to treat symptoms.
  • Gender-affirming surgical interventions, including top surgery or vaginal or penile construction.
  • Memberships to gyms, health clubs, or spas.
  • Care you receive in a non-VA government agency institution, as many of these agencies must legally provide care or services to you regardless.
  • Non-FDA-approved medicines and medical devices.

If you want to receive any of the above benefits, you will likely need to pay for them out of pocket. However, there are some exceptions for non-FDA-approved drugs and treatments. For example, if you enroll in an approved clinical trial, your VA benefits could kick in and provide coverage. You may also be able to take advantage of newer treatments if you have a serious illness and there are no other comparable options available to you.

VA Health Benefits Costs

VA healthcare is free for any illness or injury you have that stems from your military service, otherwise known as “service connected” issues. It also offers a few other services for free, even if you’re not suffering from a service-connected health issue. These include:

  • Readjustment counseling and other mental health services to help with reintegration into non-military life.
  • Care for military sexual trauma, including therapy and outpatient counseling.
  • Registry health exam to check and see if you’re at risk for certain health issues due to your service, such as diseases stemming from Agent Orange during the Vietnam War.

When you use your VA healthcare, you may need to pay a copay if you’re seeking help for an injury or illness that’s not service-connected. What you pay depends on a few factors, like your disability rating and priority group. If you do need to pay a copay, these are the current rates for 2022:

  • Urgent care visit: $30
  • Outpatient primary care services: $15
  • Outpatient specialty care services: $50
  • Specialty tests: $50
  • Hospital stay: Up to $1,556 (plus a $10 charge per day)

How to Enroll in VA Healthcare

After verifying your eligibility for VA healthcare, the next step is to fill out an Application for Health Benefits (VA Form 10-10EZ). Have the following information on hand to expedite your enrollment:

  • Your Social Security number (along with those of your spouse and dependents, if applicable)
  • Your DD214, DD215, Report of Separation, or other release papers
  • Details on your current health insurance
  • Your gross household income for you, your spouse, and your dependents
  • Any deductible expenses you had last year

When you’re ready, you can apply using one of the following methods:

  • Online: Visit VA.gov to get started
  • Phone: Call the VA at 1-877-222-8387
  • Mail: Send your completed application to:

    Health Eligibility Center
    2957 Clairmont Rd.
    Suite 200
    Atlanta, GA 30329
  • In-person: Head to your nearest VA medical clinic or your state’s Department of Veterans Affairs office

How Do VA Benefits Work with Other Insurance?

You may utilize other health insurance options to supplement your VA health benefits. Whether your VA benefits acts as your primary insurance or secondary depends on where you seek care. For example, any time you seek care from a VA hospital, your VA benefits act as your primary insurance. If you go to a VA hospital for a non-service-connected issue, the VA bills your other health insurance. However, even if your other health insurance plan does not cover the entire bill, you do not have to pay the unpaid balance, though you may still need to pay a copay.

If you seek care at a non-VA facility, your other health insurance would become your primary and only health coverage. This applies even if you seek care for service-connected issues outside of a VA facility, unless you are eligible for coverage under specific circumstances.

However, VA benefits interacts differently with Medicare and Medicaid. Since VA benefits are only applicable at VA facilities and Medicare coverage is only applicable at Medicare-certified facilities, they tend to not overlap. This means your VA benefits acts as your sole insurer if you seek care at a VA facility and Medicare acts as your sole insurer if you seek care outside of a VA facility. Having both expands your coverage options for where you may receive healthcare.

Those with Medicaid will likely find that their Medicaid benefits offer more coverage than VA benefits without as many copays, though this may vary based on state regulations. However, you may still have both VA coverage and Medicaid coverage.