Some veterans are required to make copayments (copays) for VA health care and medications.
Usually these copays are determined by the Priority Group you are in. Explanation of VA Priority Groups.
Veterans in Priority Group 1 have no copay for any VA medical service. Those in Priority Groups 2 - 8 get treatment for any service-connected conditions for free. All other medical treatment probably has a copay, this is usually based on your income.
If you have private insurance, VA will bill your insurance company for the cost of drugs or treatment for non-service connected conditions. If you can't pay, the VA won't withhold treatment, you can work out a payment plan or apply for a waiver.
| Medication Tier | 1 - 30 day supply | 31 - 60 day supply | 61 - 90 day supply |
|---|---|---|---|
| Tier 1 (Preferred Generic) | $5 | $10 | $15 |
| Tier 2 ( Non-preferred Generic and some Over-the-Counter Drugs) | $8 | $16 | $24 |
| Tier 3 (Brand Name) | $11 | $22 | $33 |
Veterans in Priority Groups 2 - 8 may have a copay of $15 for a primary care doctor or $50 for a specialist visit for treatment of non-service connected conditions.
The copay amount is limited to a single charge per visit and is based on the highest level of service received.
Certain services are not charged a copay:
Inpatient care is free for most in Priority Groups 1 - 6 and for service-connected conditions.
Priority Group 7 (and certain other veterans) have to pay a 20 percent copay or $252.00 for the first 90 days of inpatient hospital care during any 365-day period. For each additional 90 days, the charge is $126.00. In addition, there is a $2 per diem charge.
Priority Group 8 (and certain other veterans) have to pay a of $1,260 for the first 90 days of care during any 365-day period. For each additional 90 days, the charge is $630. In addition, there is a $10 per diem charge.
Long term care copays are based on three levels of care:
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. Actual copayment charges will vary depending upon your financial situation.
Military benefits are always changing. Keep up with everything from pay to health care by subscribing to Military.com, and get access to up-to-date pay charts and more with all latest benefits delivered straight to your inbox.
Related Topics: Veteran BenefitsJim Absher is Military.com's former benefits editor and columnist. He joined the Navy to see the world and later realized the world is two-thirds water. He also worked for the Department of Veterans Affairs in field offices and Washington, D.C. before coming to Military.com in 2015. Read Full Bio
© Copyright 2024 Military.com. All rights reserved. This article may not be republished, rebroadcast, rewritten or otherwise distributed without written permission. To reprint or license this article or any content from Military.com, please submit your request here.
