To ensure health care benefits are readily available to all enrolled Veterans, VA determines eligibility for the comprehensive medical benefits package through a patient enrollment system, which is based on Priority Groups 1 through 8. Eligibility for VA health benefits is based on each Veteran’s unique eligibility factors. Most Veterans must be enrolled to receive VA health care. While some Veterans are not required to enroll due to their special eligibility status, all Veterans, including those who have special eligibility, are encouraged to apply for enrollment. Enrollment in the VA health care system provides Veterans with the assurance that their health care services will be available when and where they are needed during that enrollment period. In addition to the assurance that services will be available, enrolled Veterans welcome not having to repeat the application process, regardless of where they seek their care or how often.
If you served in the active military, naval or air service and are separated under any condition other than dishonorable, you may qualify for health care benefits. Also, current and former members of the Reserves or National Guard who were called to active duty (other than for training only) by a federal order and completed the full period for which they were called or ordered to active duty may be eligible for VA health care.
Minimum Duty Requirements
Most Veterans who enlisted after September 7, 1980, or entered active duty after October 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty to be eligible. This minimum duty requirement may not apply to Veterans who were discharged for a disability incurred or aggravated in the line of duty, were discharged for a hardship, received an “early out,” or those who served prior to September 7, 1980. Since there are a number of other exceptions to the minimum duty requirements, VA encourages all Veterans to apply so that we may determine their enrollment eligibility.
Enrollment Begins with the Application Process
The very first step in obtaining access to VA health care benefits is to apply:
You may complete an application on line at https://www.1010ez.med.va.gov/. At any point in the application process, you can click “Show Help” to display specific information for the block your curser is on or click “Show FAQ” for information on what information is needed.
You may complete an application in person at any VA medical facility where eligibility personnel are available to answer your questions.
You may call VA toll-free at 1-877-222-VETS (8387) to complete the application over the phone.
Once your application is successfully processed, VA will notify you of your enrollment priority group assignment and whether you are enrolled. If enrolled, we will send you a personalized Veterans Health Benefits Handbook, which will detail your assigned enrollment priority group, the VA health benefits you are eligible for, and will provide important information concerning your access to VA health care. You may be eligible for more than one enrollment priority group; in that case, VA will always place you in the highest priority group for which you are eligible. If you are not enrolled, you will receive a letter telling you so and providing you instructions on how to appeal the decision if you do not agree with it.
Catastrophically Disabled Veterans
Veterans may be determined to be catastrophically disabled by VA, which for VA purposes only is defined as having a permanent, severely disabling injury, disorder, or disease that:
Compromises the ability to carry out the activities of daily living to such a degree that one requires personal or mechanical assistance to leave home or bed; or
Requires constant supervision to avoid physical harm to oneself or others.
Veterans found to be catastrophically disabled are enrolled in Priority Group 4, unless eligible for a higher Priority Group and exempt from inpatient, outpatient and medication copays.
Veterans, including activated Reservists and members of the National Guard, who served on active duty in a theater of combat operations after November 11, 1998, and have been discharged under other than dishonorable conditions are defined as “Combat Veterans” by VA for enrollment purposes.
“Combat Veterans” are assigned to Priority Group 6, unless eligible for enrollment in a higher priority group, for a period of five years after discharge. During this time, VA provides cost-free (no VA copayments) health care services and nursing home care for conditions potentially related to service in the theater of operations.
Veterans will continue to be enrolled even after their “Combat Veteran” status has ended. At that time, VA will reassess the Veteran’s eligibility and make a new enrollment priority group determination.
Financial Assessment (Means Testing)
While many Veterans qualify for enrollment and cost-free (no VA copayments) health care services based on a compensable, Service-connected condition or other qualifying factor, most Veterans will be asked to complete a financial assessment as part of their enrollment application process. Otherwise known as the means test, this financial assessment is based on the Veteran’s previous year gross household income and is used to determine his or her eligibility for VA health care benefits and, in many cases, his or her priority group assignment.
VA is required by law to verify Veterans’ self-reported household income information. Income Verification (IV) is a process VA uses to match Veterans’ self-reported household income information with the Internal Revenue Service (IRS) and Social Security Administration (SSA) records. Veterans who receive free medical care and/or medications based on their self-reported income are subject to this process. If a Veteran’s self-reported income is below VA’s income thresholds but the income information received from IRS/SSA indicates income above VA’s income threshold, the Veteran and spouse, if applicable, will be notified by letter and given an opportunity to verify or dispute this information. The IV benefits case managers will assist the Veteran in reviewing all documents, including those that may further reduce the Veteran’s reported total gross household income using authorized deductions. If the submitted information does not reduce the Veteran’s self-reported income below VA’s income threshold, the copayment status may be changed and the Veteran may be required to pay applicable copayments.