Copayments
- On April 6, VA stopped sending monthly copay billing statements. The suspension applied only to Veterans who had copayments for medical care or prescriptions. It will run until Dec. Unless otherwise directed, VA will resume sending out monthly copay patient statements beginning in.
- The statements will include copayments for medical care and prescriptions received since patient statements were suspended, in addition to unpaid copayment charges prior to April 2020. In November 2020, Veterans with a balance on their accounts will receive an information-only letter that will state that balance and will contain information on.
Medical Debt Relief
The new feature is for Veterans who receive care at a VA health care facility for non service-connected conditions and who therefore may owe a VA copayment (Veterans are not billed for service-connected care.). To access the patient statement online, Veterans can go to AccessVA and click on Veteran Patient Statement. We're canceling and refunding copayments for the following benefits: All medical care received through VA between April 6, 2020, and September 30, 2021 All prescription medications received through VA between April 6, 2020, and September 30, 2021 Learn more about what this means for your copayments.
American Rescue Plan: Copayment Cancellations and Refunds
Due to the passage of the American Rescue Plan in March 2021, copayments for medical care and prescriptions provided by the Veterans Health Administration (VHA) during the period of April 6, 2020 through September 30, 2021 will be canceled. All copayments paid to VA for medical care and prescriptions during the period of April 6, 2020 to present will be refunded.
Please review the COVID-19 Medical Debt Relief page for answers to some common questions.
COVID-19 Medical Debt Relief FAQs
Enrolled Veterans will be assessed copayments for care or services (including urgent care) based on their eligibility and/or income on file in the VA health care system. For care or services furnished through the Veterans Community Care Program, the same copayment requirements will apply. Copayment rates are listed below.
For information on how to pay your bill or copayment, visit our Billing and Payments page.
Billing and Payments
Veteran Copayments— Published October 6, 2017
You can explore your eligibility for VA health care benefits using the online Health Benefits Explorer or by contacting the VA Call Center.
VA Call Center: 877-222-VETS (8387)
Monday through Friday, 8:00 a.m. – 8:00 p.m. ET
Urgent Care (Community Care)
Veterans may be charged a copayment for urgent care that is different from other VA medical copayments.
- Copayments depend on the Veteran's assigned priority group and the number of times an urgent care provider is visited in a calendar year.
- Copayment charges are billed separately by VA as part of VA's billing process. There is no limit to the number of times a Veteran can go to an urgent care provider. For more information, visit the OCC Urgent Care page.
OCC Urgent Care page
Veteran Priority Groups | Copayment Amount |
---|---|
1-5 |
|
6 | If related to a condition covered by a special authority:
If not related to a condition covered by a special authority: $30 per visit |
7-8 | $30 per visit |
1-8 | $0 copay for visit consisting of only a flu shot |
Outpatient Care
Outpatient care is defined as primary or specialty care that does not require an overnight stay. Copayments for outpatient care are listed in the table.
NOTE: Veterans who have a service-connected rating of 10% or higher are not required to pay a copayment for outpatient medical care.
Examples of Outpatient Care | Copay |
---|---|
Primary Care Services | $15 per visit |
Specialty Care Services: Services such as outpatient surgery, dermatology, audiology, optometry, cardiology and specialty tests like MRI or CAT scan. | $50 per visit |
Inpatient Care
Inpatient care occurs when a patient's condition requires admission to a hospital. There are two inpatient copayment rates: the full rate and the reduced rate. Veterans living in high cost areas may qualify for a reduced inpatient copayment rate. Copayment rates for an inpatient hospital stay are listed in the table below.
NOTE: Veterans who have a service-connected disability rating of 10% or higher are not required to pay a copayment for inpatient medical care.
Veteran Priority Groups | Copay (2021) | Period of Service/Care |
---|---|---|
Priority Group 7 Veterans Veterans with gross household incomes below the geographically-adjusted VA income limits for their resident location and who agree to pay copayments. | $296.80 | First 90 days of care during a 365-day period |
$148.40 | Each additional 90 days of care during a 365-day period | |
$2 | Per day charge | |
Priority Group 8 Veterans Veterans with gross household incomes above the geographically-adjusted VA income limits for their resident location, who agree to pay copayments, and meet other specific enrollment and service-connected eligibility criteria. | $1,484 | First 90 days of care during a 365-day period |
$742 | Each additional 90 days of care during a 365-day period | |
$10 | Per day charge |
Medications
Medication copayments are required for each prescription, including each 30-day (or less) supply of maintenance medications prescribed on an outpatient basis for nonservice-connected conditions. This copayment may change annually.
Medication copayments are also charged for all over-the-counter (OTC) medications (like aspirin, cough syrup, and vitamins) that are dispensed from a VA pharmacy. You may want to consider purchasing over-the-counter medications on your own.
NOTE: There is an annual medication copayment cap of $700 for Veterans in Priority Groups 2 through 8. The medication copayment cap goes by calendar year (January 1 – December 31).
Veterans who have a service-connected rating of 40% or less, and whose income is at or below the applicable national income thresholds may wish to complete a medication copayment exemption test.
VA National Income LimitsVA Financial Assessment information
Veteran Priority Groups | Copay | ||
---|---|---|---|
Priority Group 1 Veterans Veterans with VA-rated service-connected disabilities 50% or more disabling or Veterans determined by VA to be unemployable due to service-connected conditions or Medal of Honor recipients. | No copayment | ||
Priority Group 2-8 Veterans Required to pay for each 30-day or less supply of medication for treatment of nonservice-connected condition (unless otherwise exempt). Limited to $700 annual cap. IMPORTANT: Some Veterans may qualify for reduced or no-cost prescriptions based on special eligibility factors. | Prescription Drug Tier | Days of Supply | |
1‑30 | 31‑60 | 61‑90 | |
Tier 1: Preferred generics | $5 | $10 | $15 |
Tier 2: Non-preferred generics and some OTC medications | $8 | $16 | $24 |
Tier 3: Brand-name | $11 | $22 | $33 |
Additional information on tiered medication copays can be found on the VA Pharmacy Benefits Management Services website.
Geriatrics and Extended Care
Copayments for health care for older Veterans are based on three levels of care—inpatient, outpatient, and domiciliary (see below). Copayment rates will vary from Veteran to Veteran depending upon financial information submitted on VA Form 10-10EC, Application for Extended Care Services.
NOTE: Copayments for long-term care services start on the 22nd day of care during any 12-month period. There is no copayment requirement for the first 21 days.
Inpatient Care | Copay |
---|---|
Community Living Centers (formerly known as nursing homes) VA Community Living Centers are long-term care services provided to Veterans who need a skilled environment for short-term and long-term stays. | Up to $97/day |
Respite Care Respite Care is a service that pays for someone to come to a Veteran's home or for a Veteran to go to a program while your family caregiver takes a break. Respite Care services may be available up to 30 days each calendar year. | Up to $97/day |
Geriatric Evaluation A multidisciplinary team consisting of a doctor, nurse, and several other health providers conduct an evaluation to promote, preserve, or restore a Veteran's health. The information gained from the Geriatric Evaluation helps you and your family decide what type of services and support would best meet your needs and preferences. | Up to $97/day |
Outpatient Senior Care | Copay |
Adult Day Health Care Adult Day Health Care is a program Veterans can go to during the day for social activities, peer support, companionship, and recreation. Adult Day Health Care is for Veterans who need skilled services, case management, and assistance with activities of daily living (e.g., bathing and getting dressed); instrumental activities of daily living (e.g., fixing meals and taking medicines); and/or are isolated or your caregiver is experiencing burden. Adult Day Health Care can provide respite care for your family caregiver and can also help you and your caregiver gain skills to manage your care at home. | Up to $15/day |
Respite Care Respite Care is a service that pays for someone to come to a Veteran's home or for a Veteran to go to a program while your family caregiver takes a break. Respite Care services may be available up to 30 days each calendar year. | Up to $15/day |
Geriatric Evaluation A multidisciplinary team consisting of a doctor, nurse, and several other health providers conduct an evaluation to promote, preserve, or restore a Veteran's health. The information gained from the Geriatric Evaluation helps you and your family decide what type of services and support would best meet your needs and preferences. | Up to $15/day |
Domiciliary Care for Homeless Veterans | Copay |
Short-Term Rehabilitation and Long-Term Health Maintenance Care VA offers two types of Domiciliary Care: short-term rehabilitation and long-term health maintenance care. This program provides clinically appropriate levels of care for homeless Veterans whose health care needs are not severe enough to require more intensive levels of treatment. | Up to $5/day |
Resources
877-222-VETS (8387)
Monday – Friday
8 a.m. – 8 p.m. EST
VA Geriatrics and Extended Care Resources
• VA Geriatrics and Extended Care
• VA Community Living Centers
• Respite Care
• Adult Day Health Care
• Domiciliary Care for Homeless Veterans Program
Billing & Insurance
As per VA guidelines, copayments are due upon check-out at the Agent Cashier and may be charged for the following services:
- inpatient care
- outpatient care
- outpatient prescriptions
- long-term care
Typical Copayments:
Copayments
- On April 6, VA stopped sending monthly copay billing statements. The suspension applied only to Veterans who had copayments for medical care or prescriptions. It will run until Dec. Unless otherwise directed, VA will resume sending out monthly copay patient statements beginning in.
- The statements will include copayments for medical care and prescriptions received since patient statements were suspended, in addition to unpaid copayment charges prior to April 2020. In November 2020, Veterans with a balance on their accounts will receive an information-only letter that will state that balance and will contain information on.
Medical Debt Relief
The new feature is for Veterans who receive care at a VA health care facility for non service-connected conditions and who therefore may owe a VA copayment (Veterans are not billed for service-connected care.). To access the patient statement online, Veterans can go to AccessVA and click on Veteran Patient Statement. We're canceling and refunding copayments for the following benefits: All medical care received through VA between April 6, 2020, and September 30, 2021 All prescription medications received through VA between April 6, 2020, and September 30, 2021 Learn more about what this means for your copayments.
American Rescue Plan: Copayment Cancellations and Refunds
Due to the passage of the American Rescue Plan in March 2021, copayments for medical care and prescriptions provided by the Veterans Health Administration (VHA) during the period of April 6, 2020 through September 30, 2021 will be canceled. All copayments paid to VA for medical care and prescriptions during the period of April 6, 2020 to present will be refunded.
Please review the COVID-19 Medical Debt Relief page for answers to some common questions.
COVID-19 Medical Debt Relief FAQs
Enrolled Veterans will be assessed copayments for care or services (including urgent care) based on their eligibility and/or income on file in the VA health care system. For care or services furnished through the Veterans Community Care Program, the same copayment requirements will apply. Copayment rates are listed below.
For information on how to pay your bill or copayment, visit our Billing and Payments page.
Billing and Payments
Veteran Copayments— Published October 6, 2017
You can explore your eligibility for VA health care benefits using the online Health Benefits Explorer or by contacting the VA Call Center.
VA Call Center: 877-222-VETS (8387)
Monday through Friday, 8:00 a.m. – 8:00 p.m. ET
Urgent Care (Community Care)
Veterans may be charged a copayment for urgent care that is different from other VA medical copayments.
- Copayments depend on the Veteran's assigned priority group and the number of times an urgent care provider is visited in a calendar year.
- Copayment charges are billed separately by VA as part of VA's billing process. There is no limit to the number of times a Veteran can go to an urgent care provider. For more information, visit the OCC Urgent Care page.
OCC Urgent Care page
Veteran Priority Groups | Copayment Amount |
---|---|
1-5 |
|
6 | If related to a condition covered by a special authority:
If not related to a condition covered by a special authority: $30 per visit |
7-8 | $30 per visit |
1-8 | $0 copay for visit consisting of only a flu shot |
Outpatient Care
Outpatient care is defined as primary or specialty care that does not require an overnight stay. Copayments for outpatient care are listed in the table.
NOTE: Veterans who have a service-connected rating of 10% or higher are not required to pay a copayment for outpatient medical care.
Examples of Outpatient Care | Copay |
---|---|
Primary Care Services | $15 per visit |
Specialty Care Services: Services such as outpatient surgery, dermatology, audiology, optometry, cardiology and specialty tests like MRI or CAT scan. | $50 per visit |
Inpatient Care
Inpatient care occurs when a patient's condition requires admission to a hospital. There are two inpatient copayment rates: the full rate and the reduced rate. Veterans living in high cost areas may qualify for a reduced inpatient copayment rate. Copayment rates for an inpatient hospital stay are listed in the table below.
NOTE: Veterans who have a service-connected disability rating of 10% or higher are not required to pay a copayment for inpatient medical care.
Veteran Priority Groups | Copay (2021) | Period of Service/Care |
---|---|---|
Priority Group 7 Veterans Veterans with gross household incomes below the geographically-adjusted VA income limits for their resident location and who agree to pay copayments. | $296.80 | First 90 days of care during a 365-day period |
$148.40 | Each additional 90 days of care during a 365-day period | |
$2 | Per day charge | |
Priority Group 8 Veterans Veterans with gross household incomes above the geographically-adjusted VA income limits for their resident location, who agree to pay copayments, and meet other specific enrollment and service-connected eligibility criteria. | $1,484 | First 90 days of care during a 365-day period |
$742 | Each additional 90 days of care during a 365-day period | |
$10 | Per day charge |
Medications
Medication copayments are required for each prescription, including each 30-day (or less) supply of maintenance medications prescribed on an outpatient basis for nonservice-connected conditions. This copayment may change annually.
Medication copayments are also charged for all over-the-counter (OTC) medications (like aspirin, cough syrup, and vitamins) that are dispensed from a VA pharmacy. You may want to consider purchasing over-the-counter medications on your own.
NOTE: There is an annual medication copayment cap of $700 for Veterans in Priority Groups 2 through 8. The medication copayment cap goes by calendar year (January 1 – December 31).
Veterans who have a service-connected rating of 40% or less, and whose income is at or below the applicable national income thresholds may wish to complete a medication copayment exemption test.
VA National Income LimitsVA Financial Assessment information
Veteran Priority Groups | Copay | ||
---|---|---|---|
Priority Group 1 Veterans Veterans with VA-rated service-connected disabilities 50% or more disabling or Veterans determined by VA to be unemployable due to service-connected conditions or Medal of Honor recipients. | No copayment | ||
Priority Group 2-8 Veterans Required to pay for each 30-day or less supply of medication for treatment of nonservice-connected condition (unless otherwise exempt). Limited to $700 annual cap. IMPORTANT: Some Veterans may qualify for reduced or no-cost prescriptions based on special eligibility factors. | Prescription Drug Tier | Days of Supply | |
1‑30 | 31‑60 | 61‑90 | |
Tier 1: Preferred generics | $5 | $10 | $15 |
Tier 2: Non-preferred generics and some OTC medications | $8 | $16 | $24 |
Tier 3: Brand-name | $11 | $22 | $33 |
Additional information on tiered medication copays can be found on the VA Pharmacy Benefits Management Services website.
Geriatrics and Extended Care
Copayments for health care for older Veterans are based on three levels of care—inpatient, outpatient, and domiciliary (see below). Copayment rates will vary from Veteran to Veteran depending upon financial information submitted on VA Form 10-10EC, Application for Extended Care Services.
NOTE: Copayments for long-term care services start on the 22nd day of care during any 12-month period. There is no copayment requirement for the first 21 days.
Inpatient Care | Copay |
---|---|
Community Living Centers (formerly known as nursing homes) VA Community Living Centers are long-term care services provided to Veterans who need a skilled environment for short-term and long-term stays. | Up to $97/day |
Respite Care Respite Care is a service that pays for someone to come to a Veteran's home or for a Veteran to go to a program while your family caregiver takes a break. Respite Care services may be available up to 30 days each calendar year. | Up to $97/day |
Geriatric Evaluation A multidisciplinary team consisting of a doctor, nurse, and several other health providers conduct an evaluation to promote, preserve, or restore a Veteran's health. The information gained from the Geriatric Evaluation helps you and your family decide what type of services and support would best meet your needs and preferences. | Up to $97/day |
Outpatient Senior Care | Copay |
Adult Day Health Care Adult Day Health Care is a program Veterans can go to during the day for social activities, peer support, companionship, and recreation. Adult Day Health Care is for Veterans who need skilled services, case management, and assistance with activities of daily living (e.g., bathing and getting dressed); instrumental activities of daily living (e.g., fixing meals and taking medicines); and/or are isolated or your caregiver is experiencing burden. Adult Day Health Care can provide respite care for your family caregiver and can also help you and your caregiver gain skills to manage your care at home. | Up to $15/day |
Respite Care Respite Care is a service that pays for someone to come to a Veteran's home or for a Veteran to go to a program while your family caregiver takes a break. Respite Care services may be available up to 30 days each calendar year. | Up to $15/day |
Geriatric Evaluation A multidisciplinary team consisting of a doctor, nurse, and several other health providers conduct an evaluation to promote, preserve, or restore a Veteran's health. The information gained from the Geriatric Evaluation helps you and your family decide what type of services and support would best meet your needs and preferences. | Up to $15/day |
Domiciliary Care for Homeless Veterans | Copay |
Short-Term Rehabilitation and Long-Term Health Maintenance Care VA offers two types of Domiciliary Care: short-term rehabilitation and long-term health maintenance care. This program provides clinically appropriate levels of care for homeless Veterans whose health care needs are not severe enough to require more intensive levels of treatment. | Up to $5/day |
Resources
877-222-VETS (8387)
Monday – Friday
8 a.m. – 8 p.m. EST
VA Geriatrics and Extended Care Resources
• VA Geriatrics and Extended Care
• VA Community Living Centers
• Respite Care
• Adult Day Health Care
• Domiciliary Care for Homeless Veterans Program
Billing & Insurance
As per VA guidelines, copayments are due upon check-out at the Agent Cashier and may be charged for the following services:
- inpatient care
- outpatient care
- outpatient prescriptions
- long-term care
Typical Copayments:
- $15 for visit to Primary Care Clinic
- $50 for visit to Specialty Clinic (Radiation, Orthopedics, Podiatry, etc.)
- $8 for each 30-day prescription
Copayment Issues:
- If you do not make your copayments upon check-out, you will receive a bill at your address of record within 30 days after your stay/appointment.
- Questions: Health Resource Center, 1-866-393-9132
- If you cannot make your copayment, you may request a repayment plan using VA Form 1100, Agreement to Pay Indebtedness. If approved, the plan will result in a more affordable monthly payment.
- If you set up a repayment plan and cannot make one of your monthly payments, notify the Health Resource Center immediately. If you miss a payment and do not notify us, you will not be able to use the repayment plan option again.
- Special circumstances such as job loss may qualify you for a one time cancellation of debt. You may request a waiver by submitting a written request and sufficient proof you cannot financially afford to make payment. Complete VA Form 5655, Financial Status Report and mail it to:
Dallas VA Medical Center
Attn: MCCF 04D
4500 S. Lancaster Rd.
Dallas, TX 75216
Va Medical Care Copayment
Medicare/Medicaid
Va Medical Care Copayment
The Department of Veterans Affairs does not bill Medicare or Medicaid.
Health Resource Center (HRC)
- The VA Health Resource Center is open Monday through Friday, 7 a.m. to 7 p.m. to answer questions about bills.
- Telephone: 1-866-393-9132
- Automated options include account balance and answers to Frequently Asked Questions.
- Have your account number located in the middle of your statement ready. If you do not have it, a trained representative will assist you.
- While the average wait time is usually less than one minute, you do have the option to leave a call back number and a time you are available.
Private Health Insurance
VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare supplemental plans. Generally, VA does not bill Medicare or Medicaid for reimbursement; however, VA does bill other types of health insurance including Medicare Supplemental plans for covered services.
Note: A Veteran's insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility.
Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under policies of their spouses. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. However, Veterans may be responsible for a VA copayment depending on their assigned Priority Group.
Importance of Providing Health Insurance Information
- Veterans are not responsible for any unpaid balance that the insurance carrier does not pay, except for VA copayments they may be required to pay, depending on their assigned Priority Group.
- Payments received from a Veteran's private health insurance carrier are credited towards any applicable VA copayments, reducing all or part of the Veterans out-of-pocket expenses.
- Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse.
- Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. The funds are used to provide the best care possible to our Veterans.
Va Health Care Copayments
Cancelling Private Health Insurance
Veterans who have private health insurance should consider a number of important factors before canceling their health insurance, such as:
- Impacts to Family Members. VA does not normally provide care for family members of Veterans enrolled in VA health care. If you cancel your private health insurance, they may have no health care coverage.
- Disenrollment in VA health care. There is no guarantee that in subsequent years Congress will appropriate sufficient funds for VA to provide care for all enrollment Priority Groups. This could happen if you are enrolled in one of the lower Priority Groups. This would leave a Veteran with no health care coverage.
- Medicare Parts A and B. VA does not require a Veteran to have Medicare Part A or B to be enrolled in VA health care. However, Veterans should always consider their current and future health care needs before changing any insurance coverage.
If you cancel your Medicare Part B Coverage, you need to know that you cannot be reinstated until January of the following year, and you may be penalized for reinstatement.
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Va Medical Payment Claims
In most cases, if you don't sign up for Part B when you are first eligible, you'll have to pay a late enrollment penalty. You will have to pay this penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Coverage will start July 1 of that year.
Pay My Va Prescription Bill
For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance.