Basic Eligibility
A person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable may qualify for VA health care benefits. Reservists and National Guard members may also qualify for VA health care benefits if they were called to active duty (other than for training only) by a Federal order and completed the full period for which they were called or ordered to active duty.
Minimum Duty Requirements: Veterans who enlisted after Sept. 7, 1980, or who entered active duty after Oct. 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible. This minimum duty requirement may not apply to Veterans discharged for hardship, early out or a disability incurred or aggravated in the line of duty.
Enrollment
For most Veterans, entry into the VA health care system begins by applying for enrollment. To apply, complete VA Form 10-10EZ, Application for Health Benefits, which may be obtained from any VA health care facility or regional benefits office, online or by calling 1-877-222-VETS (8387). Once enrolled, Veterans can receive health care at VA health care facilities anywhere in the country.
Veterans enrolled in the VA health care system are afforded privacy rights under federal law. VA’s Notice of Privacy Practices, which describes how VA may use and disclose Veterans’ medical information, is also available online.
The following four categories of Veterans are not required to enroll, but are urged to do so to permit better planning of health resources:
- Veterans with a service-connected disability of 50 percent or more.
- Veterans seeking care for a disability the military determined was incurred or aggravated in the line of duty, but which VA has not yet rated, within 12 months of discharge.
- Veterans seeking care for a service-connected disability only.
- Veterans seeking registry examinations (Ionizing Radiation, Agent Orange, Gulf War/Operation Iraqi Freedom and Depleted Uranium).
Priority Groups (as of June, 2010)
During enrollment, each Veteran is assigned to a priority group. VA uses priority groups to balance demand for VA health care enrollment with resources. Changes in available resources may reduce the number of priority groups VA can enroll. If this occurs, VA will publicize the changes and notify affected enrollees. A description of priority groups follows:
Group 1: Veterans with service-connected disabilities rated 50 percent or more and/or Veterans determined by VA to be unemployable due to service-connected conditions.
Group 2: Veterans with service-connected disabilities rated 30 or 40 percent.
Group 3: Veterans with service-connected disabilities rated 10 and 20 percent; Veterans who are former Prisoners of War (POW) or were awarded a Purple Heart medal; Veterans awarded special eligibility for disabilities incurred in treatment or participation in a VA Vocational Rehabilitation program; and Veterans whose discharge was for a disability incurred or aggravated in the line of duty.
Group 4: Veterans receiving aid and attendance or housebound benefits and/or Veterans determined by VA to be catastrophically disabled.
Group 5: Veterans receiving VA pension benefits or eligible for Medicaid programs, and non service-connected Veterans and non-compensable, zero percent service-connected Veterans whose gross annual household income and/or net worth are below the VA national income threshold and geographically-adjusted income threshold for their resident area.
Group 6: Veterans of World War I; Veterans seeking care solely for certain conditions associated with exposure to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki; for any illness associated with participation in tests conducted by the Department of Defense (DoD) as part of Project 112/Project SHAD; Veterans with zero percent service-connected disabilities who are receiving disability compensation benefits and Veterans who served in a theater of combat operations after Nov. 11, 1998 as follows:
- Veterans discharged from active duty on or after Jan. 28, 2003, who were enrolled as of Jan. 28, 2008 and Veterans who apply for enrollment after Jan. 28, 2008, for 5 years post discharge
- Veterans discharged from active duty before Jan. 28, 2003, who apply for enrollment after Jan. 28, 2008, until Jan. 27, 2011
Group 7: Veterans with gross household income below the geographically-adjusted income threshold (GMT) for their resident location and who agree to pay copays.
Group 8: Veterans with gross household income and/or net worth above the VA national income threshold and the geographic income threshold who agree to pay copays. Note: Due to income relaxation rules implemented on June 15, 2009 Veterans with household income above the VA national threshold or the GMT income threshold for their resident location by 10 percent or less, who agree to pay copays, are eligible for enrollment in Priority Group 8. The GMT thresholds can be located on the VA website.
Women Veterans
Women Veterans are eligible for the same VA benefits as male Veterans. Comprehensive health services are available to women Veterans including primary care, specialty care, mental health care and reproductive health care services.
VA Community Living Centers
Community Living Centers (CLC) provide a dynamic array of short stay (less than 90 days) and long stay (91 days or more) services. Short stay services include but are not limited to skilled nursing, respite care, rehabilitation, hospice, and maintenance care for Veterans awaiting placement in the community. Short stay services are available for Veterans who are enrolled in VA health care and require CLC services. Long stay services are available for enrolled Veterans who need nursing home care for life or for an extended period of time for a service-connected disability, and those rated 60 percent service-connected and unemployable; or Veterans or who have a 70 percent or greater service-connected disability. All others are based on available resources.
Non-Institutional Long-term Care Services: In addition to nursing home care, VA offers a variety of other long-term care services either directly or by contract with community-based agencies. Such services include adult day health care, respite care, geriatric evaluation and management, hospice and palliative care, home based skilled nursing, and home based primary care. Veterans receiving these services may be subject to a co-pay.
