Va Medical Care Copayment
The new tiered copayment structure will decrease the costs of outpatient medications for most Veterans, aligning with VA’s goals to reduce out-of-pocket costs, encourage greater adherence to prescribed outpatient medications and reduce the risk of fragmented care that results when multiple pharmacies are used to fill Veteran prescriptions. 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.
Copayments
Medical Debt Relief
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
VA is extending debt relief for Veterans through September 30, 2021, due to the COVID-19 pandemic. VA will suspend collection of all Veteran benefit overpayments incurred between April 6, 2020, and September 30, 2021. No adverse actions or collection attempts will occur during this suspension period. Additionally, all copayments for medical care and pharmacy services incurred from April 6, 2020, through September 30, 2021, will be cancelled, along with any fees or interest. Any payments for this time period will be refunded.
VA is committed to keeping Veterans informed about their debt and the expansive relief options available.
Does The Va Have Copays
What will happen next
With regard to benefit overpayments, Veterans will receive a letter from the VA Debt Management Center (DMC) showing current debt amount as well as available options. Subsequent letters will be sent showing updates to Veterans’ accounts.
What Veterans can do now
For benefit overpayments, no action is required through September 30, 2021. That said, if Veterans would like to resolve debts sooner, there are options they can exercise now. VA can work with Veterans to determine what option is best. Options include:
Pay My Va Prescription Bill
- Making a payment
- Establishing a repayment plan
- Submitting a compromise offer
- Disputing the debt
- Requesting a waiver
For benefit debt, information is available online at https://www.va.gov/manage-va-debt/, or by calling the DMC at 800-827-0648, or via IRIS at https://iris.custhelp.va.gov/app/ask/.
Your VA health care continues
There will be no change in the quality and availability of VA health care during this time. You can schedule appointments and communicate with your providers in the same manner you have been.
Va Medical Care Copayment
If you are concerned about copayments you owe for health care and pharmacy provided prior to April 6, 2020, you an apply for a debt relief program. For more information on financial relief, Veterans can visit https://www.va.gov/COMMUNITYCARE/revenue_ops/Financial_Hardship.asp or call the Health Resource Center at 866-400-1238, Monday through Friday from 8 a.m. to 8 p.m. ET.
Charges for medical care and prescriptions incurred from April 6, 2020, through September 30, 2021, will be cancelled. VA will refund payments that Veterans have already made.
For medical care copayment questions, please review the information found on the following website: https://www.va.gov/COMMUNITYCARE/revenue_ops/Financial_Hardship.asp#Relief or call the Health Resource Center (866-400-1238).
VA will work with all Veterans who apply for debt relief to determine the best possible solution.
Contact information
- For questions about VA benefit debt, including information on how to make voluntary repayment arrangements, or for information about how to request a waiver, how to dispute a debt, or how to submit a compromise offer, call the DMC (800-827-0648) from 6:30 a.m. to 6 p.m. CT Monday through Friday. Visit https://iris.custhelp.va.gov/app/ask/ to submit your request online.
- For medical care copayment questions, please contact the Health Resource Center at (866-400-1238) from 7:00 a.m. to 7 p.m. CT Monday through Friday.
- If a Veteran’s debt was referred to the U.S. Department of the Treasury (Treasury), the debt is suspended through September 30, 2021. For questions on debts referred to Treasury, contact the Treasury Cross-Servicing Program (888-826-3127) or the Treasury Offset Program (800-304-3107).
Va Medical Care Copayment Link
VA is here to help Veterans during the COVID-19 pandemic. Please follow national and local guidelines to stay healthy and safe.
*This post was updated 3/25/21 with additional medical care and pharmacy services information.
The VA Debt Management Center (DMC) provides Veterans and beneficiaries with compassionate counseling on their VA benefit debts. DMC manages the debt collection process and provides assistance with debt resolution options, such as payment plans and waivers.
Va Medical Care Copayments
The VHA Office of Community Care – Revenue Operations contributed to VHA medical and pharmacy services information.