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Applying for VA Healthcare Benefits

Joe Wallace

The Department of Veterans Affairs offers education benefits and disability compensation for qualifying veterans. It also provides various healthcare treatment benefits and services for veterans and qualifying family members.

Healthcare is provided to all qualifying veterans, but some benefits, like dental care, have additional eligibility requirements. The full scope of VA benefits may depend on your assigned priority group, recommendations from a doctor, and needs based on the specific condition the patient is dealing with.

Enrolling in VA Healthcare

The U.S. Department of Veterans Affairs (VA) offers healthcare services to eligible veterans. According to the Department of Veterans Affairs, “Eligibility for most VA benefits is based on discharge from active military service under other than dishonorable conditions.“

Thanks to the passage of the PACT Act and other legislation, access to VA healthcare has been expanded in recent years to include those with so-called Don’t Ask, Don’t Tell discharges. If you applied for VA benefits in the past but were denied, it pays to apply again as many rules about VA benefits have changed.

VA.gov notes that the phrase “active service” means full-time service, other than active duty for training, “as a member of the Army, Navy, Air Force, Marine Corps, Coast Guard, Space Force or as a commissioned officer of the Public Health Service, Environmental Science Services Administration, or National Oceanic and Atmospheric Administration, or its predecessor, the Coast and Geodetic Survey. “

Dishonorable discharges and bad conduct discharges (by general court-martial) may be a barrier for some veterans. Still, it’s not safe to assume you do not qualify for VA benefits without having your circumstances reviewed by the Department of Veterans Affairs.

Determine Your Eligibility

Before you begin the enrollment process, it’s crucial to determine if you qualify for VA healthcare. The VA uses a priority group system to categorize veterans based on service-connected disabilities, income level, and special circumstances.

Factors Affecting Eligibility

• Service History: Generally, veterans who served in the active military, naval, or air service and were discharged or released under conditions other than dishonorable may be eligible for VA healthcare.
• Service-Connected Disability: Veterans with a service-connected disability, meaning a health condition incurred or aggravated during active duty, are generally eligible for VA healthcare.
• Income Level: Veterans with income below certain thresholds may qualify for enrollment in a specific priority group.
• Special Circumstances: Veterans who meet specific criteria, such as being a former prisoner of war, receiving a Purple Heart, or having a service-connected disability rating of 0%, may also be eligible for VA healthcare.

Priority Groups

The VA assigns veterans to priority groups based on their eligibility factors. These groups range from 1 to 8, with Group 1 having the highest priority for enrollment and healthcare services.

• Group 1: Veterans with service-connected disabilities rated 50% or more.
• Group 2: Veterans with service-connected disabilities rated 30% or 40%.
• Group 3: Veterans with service-connected disabilities rated 10% or 20%.
• Group 4: Veterans who are former prisoners of war (POWs) or recipients of the Purple Heart medal.
• Group 5: Veterans with a 0% service-connected disability rating and who meet specific criteria, such as being a combat veteran or receiving special wartime benefits.
• Group 6: Veterans with income below the VA’s income limits and who agree to pay copays for some services.
• Group 7: Veterans with income above the VA’s income limits but who agree to pay higher copays for most services.
• Group 8: Veterans who are eligible for enrollment based on specific circumstances, such as being a veteran of the Persian Gulf War or a Vietnam War veteran exposed to Agent Orange.

Gather Necessary Documents

To streamline the enrollment process, it’s essential to gather the necessary documents beforehand.

• Proof of Identity: A valid driver’s license, passport, or other government-issued photo identification.
• Social Security Number: Your Social Security card or a document displaying your Social Security number.
• Military Service Records: Your DD214 (Certificate of Release or Discharge from Active Duty) or other relevant military service documents.
• Income Information: If you’re applying based on income, you’ll need to provide proof of your current income, such as tax returns or pay stubs.
• Health Insurance Information: If you have other health insurance, you’ll need to provide information about your coverage.
• Direct Deposit Information: If you want to receive any VA benefits by direct deposit, you’ll need to provide your bank account information.

Choose an Enrollment Method

The VA offers several convenient ways to enroll in healthcare services:

• Online: Visit the VA’s website at www.va.gov/health-care/how-to-apply/ and complete the online application.
• By Mail: Download and print the VA Form 10-10EZ, “Application for Health Benefits,” fill it out completely, and mail it to the address provided on the form.
• In Person: Visit your local VA medical center or clinic and apply in person with the assistance of a VA representative.
• By Phone: Call the VA’s toll-free number at 1-877-222-VETS (8387) to apply over the phone.

Complete the Application

Regardless of the enrollment method you choose, you’ll need to provide accurate and complete information on the application.

• Personal Information: Your full name, address, contact information, Social Security number, and date of birth.
• Military Service History: Your branch of service, dates of service, and discharge status.
• Health Information: Your current health conditions, medications, and allergies.
• Insurance Information: Details about any other health insurance coverage you have.
• Financial Information: If you’re applying based on income, you’ll need to provide details about your household income and expenses.

Submit Your Application

Once you’ve completed the application, submit it through your chosen method. If you’re applying online or by phone, your application will be processed immediately. If you’re applying by mail, your application may take several weeks to be processed.

Receive Your Enrollment Decision

After the VA processes your application, you’ll receive a decision letter in the mail. This letter will inform you whether you’ve been approved for VA healthcare and your assigned priority group. If you’re approved, the letter will also include information about how to schedule your first appointment and access VA healthcare services.

Schedule Your First Appointment

Once you’re enrolled in VA healthcare, you can schedule your first appointment with a primary care provider. You can do this by contacting your local VA medical center or clinic or by using the VA’s online scheduling tool.

>> Frustrated with your VA disability rating?  Get help with increasing your rating to get the compensation you deserve.

Additional Information

• Copays: Depending on your priority group and the type of service, you may be responsible for copays for some VA healthcare services.
• Travel Reimbursement: The VA may reimburse you for travel expenses to and from VA medical facilities for certain appointments.
• Mental Health Services: The VA offers a wide range of mental health services, including counseling, therapy, and medication management.
• Women’s Health Services: The VA provides comprehensive healthcare services for women veterans, including primary care, reproductive health services, and maternity care.
• Caregiver Support: The VA offers support services for caregivers of veterans, including respite care, training, and financial assistance.

Read next: Where to Apply for VA Disability Benefits

Features of VA Health Care

VA healthcare options include preventive care:

• Routine health exams,
• Gender-specific exams
• Health education
• Nutrition counseling
• Immunizations
• Genetic counseling

VA healthcare also features inpatient care for:

• Surgeries
• Medical treatments
• Kidney dialysis
• Short-term acute care
• Post-surgery recovery
• Specialized care, including organ transplants, intensive care, and trauma care
• Surgical specialty services

VA healthcare options for urgent care and emergency medical treatment include:

• Urgent or emergency care at VA health facilities
• Urgent care for non-life-threatening illnesses or injuries at VA-approved walk-in clinics or urgent care facilities. This is open to those enrolled in VA health care who have received care within the past 24 months.
• Emergency care in non-VA hospitals or clinics may be covered under specific conditions, particularly for service-connected conditions.

Other options include mental health services, prescriptions, assisted living, home health care, and caregiver support.

Excluded Medical Services

Some VA healthcare services are generally not offered:

• Cosmetic surgery, unless medically necessary
• Health clubs
• Spa memberships
• Non-FDA-approved medicines and devices 
• Care provided by non-VA government agencies

Prescription Coverage

The VA can fill prescriptions from non-VA community providers if the patient meets VA requirements, including being enrolled in VA health care, having a VA primary care provider, and obtaining an agreement from their VA provider.

Read next: Where to Apply for VA Disability Benefits

Costs and Financial Assessments

Out-of-pocket costs for VA health care depend on income level, disability rating, and service history. 

Most vets take a financial assessment during enrollment to determine eligibility for free care. VA.gov reminds applicants, “Some Veterans are eligible for free care for non-service-connected conditions based on their VA disability rating, pension payments, or other factors (like receiving the Medal of Honor).”

However, for veterans who are not eligible for free care based on the factors above, income and financial need may be a qualifying factor. 

VA.gov benefit applications ask you “for information about your household’s income as part of the enrollment process.” The VA also requests “to keep your income information up to date after you enroll.”

Why?” Because in cases where your household income “falls below our current income limits for where you live, you may be eligible for free or reduced-cost care” according to the official site.

What to Gather Before You Apply

• Social Security numbers for yourself and all dependents and spouse.
• Your military discharge papers 
• Military service history information
• Details about duty-related exposure to any toxins or other hazards.
• Insurance card information for all insurance companies you are covered by
• Gross household income from the previous calendar year for you, your spouse, and your dependents. 
• Your deductible expenses for the past year.

If you are transitioning out of the military, call the VA at 877-222-8387 to get started or fill out a benefits application at the VA official site.

VA Resources

• Questions: Contact the VA at 877-222-8387 
• Online Services: Manage healthcare and other benefits online, including prescription refills and secure messaging.
• Indian Health Service Facilities: VA.gov offers services to American Indian/Alaska Native veterans for medical care at these facilities “without preauthorization or copays.”

Read next: Where to Apply for VA Disability Benefits

 

>> Frustrated with your VA disability rating?  Get help with increasing your rating to get the compensation you deserve.