As a U.S. veteran, your access to health care benefits through the U.S. Department of Veterans Affairs is largely influenced by where you fall within the VA’s system of priority enrollment groups.
This system allows the VA to provide tiered benefits to veterans based on which groups have the greatest and/or most immediate need. Keep reading for everything you need to know about which group you’re likely to be assigned to, along with how your placement affects your access to health care benefits.
- VA Priority Group 1
- VA Priority Group 2
- VA Priority Group 3
- VA Priority Group 4
- VA Priority Group 5
- VA Priority Group 6
- VA Priority Group 7
- VA Priority Group 8
One of the VA’s chief commitments to U.S. veterans is access to high quality and reliable health care once they leave service. In order to make sure that the veterans who need the most help can get it quickly, and ensure that all veterans have access to quality medical care, the VA has designed a system of assigning veterans to priority groups, based on their medical conditions, required care, and in some cases income. This helps ensure not only that veterans with the most acute needs get quick access to essential health care coverage, but also helps make sure the program can provide high quality care to all veterans enrolled in health care benefits through the VA.
All U.S. veterans who completed active military, naval, or air service, received any discharge other than dishonorable, and served at least 24 continuous months on active duty may qualify for VA health care benefits. However, the priority group to which a veteran is assigned may affect the type and level of benefits for which you’re eligible, along with how quickly the veteran is able to enroll in the VA benefits program.
The VA assigns enrollment priority to veterans based on the level of medical care they need and the costs associated with meeting those needs. The VA’s Group 1 is the highest priority, with the other groups following in descending order of priority. The enrollment group a veteran is assigned to may influence the level of co-payment the veteran is responsible for as part of their medical care.
In broad strokes, a veteran’s priority group is determined by their level of medical need and the costs the VA will need to cover to meet those needs. In cases where a veteran meets the qualifications for multiple groups, the VA will assign the veteran to the group with the highest priority level to make sure the veteran’s most pressing medical needs are met. Ultimately, the number of veterans within each priority group is driven by the amount of money the VA has the discretion to spend for that particular group.
The VA also will consider a veteran’s service history, disability rating, income level, whether they qualify for their state’s Medicaid program, and other benefits the veteran may currently receive (such as a VA pension). In short, the VA prioritizes most highly the veterans with the most severe service connected disabilities – and the lowest priority is given to veterans with high incomes and/or non-service related disabilities that don’t qualify for VA disability benefits.
Priority group assignments are not permanent – your priority group can change, for example, if you have a significant adjustment to income and/or if a service connected disability worsens to the point that the VA changes your disability rating.
The VA categorizes priority groups according to the categories listed below. Let’s take a closer look at each priority group for enrolling in VA health care coverage.
This group includes veterans who have disabilities rated by the VA as 50% or higher, plus veterans who have been deemed unemployable because of a service related condition, and veterans who are Medal of Honor recipients. This group is not required to pay for any medications and will typically not be asked to pay a copayment for medical services.
Priority Group 2 comprises veterans who have service connected disabilities that have been rated by the VA as between 30% and 40% disabling. It’s worth noting that priority groups 2 through 8 must pay for each 30-day or smaller supply of medication for treatment of any non-service connected medical condition, unless specifically exempted, and may be required to pay copayments for other medical services provided by a VA facility.
This group encompasses Purple Heart recipients and former prisoners of war, along with veterans who received a disability-related discharge and those with service connected disabilities that the VA has rated as between 10% and 30% disabling. In addition, Priority Group 3 includes veterans who have received special eligibility classification under Title 38, U.S.C., § 1151, which accounts for “benefits for individuals disabled by treatment or vocational rehabilitation.”
Veterans who are classified by the VA as catastrophically disabled and those who receive aid and attendance benefits or housebound benefits from the VA fall into Priority Group 4.
The VA’s Priority Group 5 comprises veterans who have a service connected disability rated 0%, those who have a non-service connected disability, or a service related disability deemed non-compensable. As an additional eligibility requirement for this group, veterans must have an annual income below the VA’s geographically adjusted income limit, which is determined by zip code. Veterans who are eligible for their state’s Medicaid program and veterans who receive VA pension benefits also fall into this priority group.
For the VA’s Priority Group 6, veterans must fall into one of the following categories:
- Veterans who were exposed to ionizing radiation during atmospheric testing or the occupation of Hiroshima and Nagasaki
- Veterans who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975
- Veterans who have a compensable 0% service related disability
- Veterans who participated in Project 112/SHAD
- Veterans who served during the Mexican border period
- Veterans of World War I
- Veterans who in the Persian Gulf War between August 2, 1990, and November 11, 1998
- Veterans who served on active duty at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987
Veterans who are currently enrolled, as well as new enrollees who served in combat operations after November 11, 1998, and were discharged from active duty on or after January 28, 2003, are eligible for an enhanced veterans benefits package for five years following their separation of service.
VA Priority Group 7 encompasses those who report a gross household income below the geographically adjusted VA income limit for their resident location and who agree to pay copayments as part of their health care coverage. For inpatient services, this group is responsible for a co-pay ranging from $155.60 to $311.20, along with a $2 per diem. Priority Group 7 also must pay copayments for medications and may be asked to be responsible for copayments related to outpatient services, including urgent care services.
Priority Group 8 includes veterans who report a gross household income higher than the VA’s predetermined income limits, plus the geographically adjusted income limits for their resident location. These veterans also agree to pay copayments as part of their health care coverage, ranging from $778 to $1,556, with a $10 per diem. Priority Group 8 also must pay copayments for medications and may be asked to be responsible for copayments related to outpatient services, including urgent care services.
One important point about Priority Group 8 is that it is further divided into six sub-groups. These sub-groups further prioritize veterans into the following categories:
- Sub-Group A: Veterans with non-compensable VA disabilities, rated at 0% who enrolled as of Jan. 16, 2003, and who have remained enrolled or have been placed in this sub-group because of a change in eligibility status.
- Sub-Group B: Veterans with non-compensable VA disabilities, rated at 0% who enrolled on or after June 15, 2009, whose income exceeds the current geographic or VA limit by a maximum of 10%.
- Sub-Group C: Veterans with non-service connected disabilities who have been enrolled since Jan. 16, 2003, and who have remained enrolled or have been placed in this sub-group because of a change in eligibility status.
- Sub-Group D: Veterans with non-service connected disabilities who have been enrolled since June 15, 2009, and whose income exceeds the current geographic or VA limit by a maximum of 10%.
- Sub-Group E: Veterans with non-compensable VA disabilities, who are eligible only for the care of their service connected condition.
- Sub-Group F: Veterans with non-service connected disabilities.
The VA’s overall health care benefits philosophy centers on making sure it can provide free health care to veterans who have service connected disabilities, those who are catastrophically disabled, and veterans who cannot otherwise afford to pay for health care. Those who fall outside of this priority group may be asked to share in the costs of their medical services.
Depending on your specific situation, you may be required by the VA to pay a fixed amount for some types of care, tests, and even medications you receive from a VA health care provider or an approved community health care provider to treat conditions that are unrelated to your time of military service. This amount is your copayment.
Whether you have to pay a copayment depends on several factors – including your VA disability rating, your military service record, your priority group, your income level, and your priority group. In some cases, the VA may ask for income verification so that it can make an accurate determination of whether and how much you’ll need to be responsible for as a copayment.
VA Health Care
Health care coverage is one of the most valuable benefits the VA offers to U.S. veterans after their terms of service. It’s important to understand how your specific situation falls within the guidelines the VA has established for categorizing veterans’ needs by priority groups.
The VA provides many medical services to U.S. veterans completely free of charge, including mental health care and care associated with military sexual trauma. If you haven’t yet checked your eligibility for VA health care benefits, you owe it to yourself to make sure you’re doing everything you can to claim the benefits you’ve earned.