Veterans' Eligibility for VA Health Care
Most veterans who served on active duty are eligible for VA health care, but priority for benefits depends on disability and other factors.
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The Veterans Health Administration (VHA) provides health care for veterans at VA hospitals and clinics throughout the country. The purpose of this article is to explain who is eligible for VA health care benefits, how to apply, how the VA decides which veterans receive care, and what groups of veterans are eligible for specialized services.
Eligibility for VA Health Care Benefits
If you had active duty in the military and were discharged under conditions other than dishonorable, you may be eligible for VA health care benefits. If you enlisted after September 7, 1980 or entered active duty after October 16, 1981, you must have served for 24 uninterrupted months to be eligible for health care. This minimum service time may not apply if you were discharged due to a service-connected disability or for hardship.
If you are a member of the National Guard or a Reservist, you may qualify if you had active duty by federal order and served for the full period you were called for.
Veterans who served prior to September 7, 1980 do not have to meet a minimum service requirement to be eligible for VA health care.
Enrollment in VA Health Care
In most cases, you need to apply for health care, but in some cases, enrollment is automatic.
In some cases, you will be provided with health care without applying if you:
- have a service-connected disability rated 50% or higher
- need care for a disability that VA has decided was linked to your service, but for which the VA hasn’t yet given you a rating (this will apply only during the first year after your discharge), or
- are getting care just for a service-connected disability.
How to Apply
If you are completing the application yourself and need help, call 877-222-VETS (8387) or use the VAs Online Web Chat.
Unfortunately, the Veterans Health Administration does not have enough resources to provide care to all veterans who need it. To address this issue, the VA has created eight priority groups for enrollment.
When you apply, the VA will assign you to a priority group. In some cases, you may be asked to agree to pay co-pays in order to be placed in a priority group. If you are eligible for more than one priority group, you’ll be put in the group that has higher priority.
How Priority is Determined
To determine which group you may belong to, see the VA's description of priority groups. If you have a service-connected injury or illness' your priority group will be determined by your disability rating. Former POWs and recipients of certain military honors are also given special priority. In addition, VA groups grants priority based on other factors, including financial need.
If you are not receiving disability compensation or pension, you will probably have to provide financial information to the VA to show that your income does not exceed the VA annual income threshold. Use the VA financial calculator to see if you qualify.
As resources increases, members of more priority groups are enrolled, and as resources decrease, members of fewer groups are enrolled. It all depends on the annual funding provided by Congress.
Special Priority for Recently Discharged Combat Veterans
Combat veterans who were discharged recently have five years of special enrollment status for health care after discharge under the enhanced health care eligibility program. If you are a combat veteran and you were recently discharged, it is a good idea to enroll even if you do not need VA health care. That way your right to receive VA health care is preserved for a later date in case you need it.
Health Care Benefits
All veterans, regardless of priority group, are generally entitled to the same medical services after enrollment. Visit the VA website for a comprehensive description of the medical benefits provided, including doctors' visits, mental health care, emergency care, in-patient hospital services, and more.
Military Sexual Trauma
The VA increasingly has recognized the need for services for veterans subjected to sexual trauma during service. Even if you are ineligible for VA health care, you can still receive counseling for military sexual trauma and health care for any related physical injuries or illnesses. To be eligible, the trauma must have occurred while you were on active duty, or, if you served in the National Guard or Reserves, active duty for training.
For more information, see the VA web page that describes services offered for survivors of military sexual trauma.
Spinal Cord Injuries and Disorders
The VA has established special treatment centers to meet the needs of veterans with spinal cord injuries and disorders. For more information or to locate a treatment center near you, go to the VA webpage on Spinal Cord Injury and Disorders.
What Happens After I Apply?
The VA will process your application and notify you about whether you are eligible, whether you were enrolled, and, if so, what priority group you were assigned to and whether you will be responsible for co-pays.
This notification will also explain how to appeal if you disagree with the decision. If you were denied benefits and you think you are eligible, contact a disability lawyer certified by the VA.