Call VA Health Benefits toll-free help line at 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. ET. Information is also available at www.va.gov/healthbenefits.
Once your enrollment is confirmed, you will receive a Veterans Health Benefits Handbook from us notifying you of the status of your enrollment. You may also call us toll free to verify your enrollment at 1-877-222- VETS (8387) Monday – Friday between 8 a.m. and 8 p.m. ET.
There is no requirement that VA become your exclusive provider of care. If you are a Veteran who is receiving care from both VA and a local provider, it is important for your health and safety that your care is coordinated, resulting in one treatment plan (co-managed care).
If you want to transfer your care from one VA health care facility to another, contact your PACT. Your PACT will work with the Traveling Veteran Coordinator for assistance in transferring your care and establishing an appointment at the new facility.
When you apply for enrollment, you will be asked to choose a preferred VA facility. This will be the VA facility where you will receive your primary care. You may select any VA facility that is convenient for you.
If the facility you choose cannot provide the health care that you need, VA will make other arrangements for your care based on administrative eligibility and medical necessity. If you do not choose a preferred facility, VA will choose the facility that is closest to your home. You may change your preferred facility at any time.
You may request to dis-enroll from VA health care, commonly referred to as cancel/decline, at any time. To request to be dis-enrolled, you must submit a signed and dated document requesting to be dis-enrolled from VA health care to a VA Medical Center or you may mail the request to:
Health Eligibility Center
Enrollment & Eligibility Division
PO Box 5207
Janesville, WI 53547-5207
Cancelling your VA health care coverage may impact your health care coverage requirements under the Affordable Care Act if you do not have other qualifying health care.
You may reapply for enrollment at any time by completing a new VA Form 10-10EZ, “Application for Health Benefits,” online at www.vets.gov, by calling toll free 1-877-222-VETS (8387) or by visiting your local VA health care facility. Please note that you will be considered a new applicant and eligibility for enrollment will be based upon eligibility requirements in place at that time.
Because VA income limits may change each year, they are not published in this booklet; however, the income limit for the previous year can be viewed online at 2021 VA National and Priority Group 8 Relaxation Income Thresholds
Recognizing the cost of living can vary significantly from one geographic area to another, Congress added income limits based on geographic locations to the existing VA income limits for financial assessment purposes. Veterans whose income falls between the VA income limit and the geographic income limit for the Veteran’s locale will have their inpatient medical care copayments reduced by 80%.
Your copay status will be changed from copay exempt to copay required, which may result in disenrollment due to enrollment restrictions for Veterans whose income exceeds the income limits. VA facilities involved in your care will be notified of your change in status and to initiate billing for services provided during that income year. Your enrollment priority status may be changed if your financial status is adjusted by the income verification process. If your enrollment status is changed, you will be notified by mail.
No, VA does not have access to your tax return. The IRS and the SSA share earned and unearned income data reported by employers and financial institutions.
Veterans who qualify under this special eligibility are not subject to copays for conditions potentially related to their combat service; however, unless otherwise excused, combat Veterans may be subject to appropriate copay rates for care or services VA determines are unrelated to their military service.
A service-connected rating is an official ruling by VA that your illness or condition is directly related to your active military service. To obtain more information or to apply for any of these benefits, contact your nearest VA Regional Office at 1-800-827-1000, or visit us online at www.ebenefits.va.gov or www.va.gov.
If you are unable to pay your bill, you should discuss the matter with the Patient Billing Office at the VA health care facility where you received your care. See “ VA Has Options That Can Help Veterans Pay Copayments” on pages 15 and 16.
The Affordable Care Act, also known as the health care law, was created to expand access to affordable health care coverage to all Americans, lower costs and improve quality and care coordination. For more information, see “Coverage Under The Affordable Care Act”on page 12 or visit www.va.gov/health/aca/.
Yes. If you are enrolled in any of VA’s programs below, you have coverage under the standards of the health care law:
U.S. taxpayers need to declare their health coverage on their federal tax forms.
In 2015, VA began sending the IRS, Veterans and eligible beneficiaries forms that provide details of the health coverage provided by VA. These forms are used for the income tax process.
VA annually sent IRS Form 1095-B to Veterans who were enrolled in the VA health care system at any time the previous calendar year. If you did not receive a Form 1095-B from VA explaining your health care coverage for each year you are or have been enrolled, call 1-877-222-VETS (8387) Monday through Friday from 8 a.m. until 8 p.m. ET. This form is for your records only and should not be sent to the IRS or returned to VA.
A Patient Aligned Care Team (PACT) includes the Veteran, his or her family or caregivers and a group of health care professionals who work together to plan that individual’s whole-person care and life-long health and wellness. It focuses on:
A PACT uses a team-based approach. You are the center of the care team that also includes your family members, caregivers and health care professionals – primary care provider, nurse care manager, clinical associate and administrative clerk. When other services are needed to meet your goals and needs, another care team may be called in. For more information, visit www.patientcare.va.gov/primarycare/PACT.asp.
VA is authorized to provide extensive dental care, while in other cases, treatment may be limited. The chart below describes dental eligibility criteria and contains information to assist Veterans in understanding their eligibility for VA dental care. The eligibility for outpatient dental care is not the same as for most other VA medical benefits and is categorized into classes. For instance, if you are eligible for VA dental care under Class I, IIC or IV, you are eligible for any necessary dental care to maintain or restore oral health and masticatory function, including repeat care. Other classes have time and/or service limitations.
Dental care to the extent necessary as determined by a VA dental professional to:
*Note: Outpatient emergency dental care may be provided as a humanitarian service to individuals who do not have established dental eligibility. Dental treatment is limited to that necessary to address acute pain or a dental condition which is determined to be endangering life or health.
*Note: Public Law 83, enacted June 16, 1955, amended Veterans’ eligibility for outpatient dental services. As a result, any Veteran who received a dental award letter from the Veteran Benefits Administration (VBA) dated before 1955, in which VBA determined the dental conditions to be non-compensable, is no longer eligible for Class II outpatient dental treatment.
Veterans receiving hospital, nursing home or domiciliary care will be provided dental services that are professionally determined by a VA dentist, in consultation with the referring physician, to be essential to the management of the patient’s medical condition under active treatment.
For more information about eligibility for VA medical and dental benefits, call toll-free 1-877-222-VETS (8387) or visit https://www.va.gov/health-care/.
VA provides health care for Veterans from providers in your local community outside of VA. Veterans may be eligible to receive care from a community provider when VA cannot provide the care needed. This care is provided on behalf of and paid for by VA.
Community care is available to Veterans based on certain conditions and eligibility requirements, and in consideration of a Veteran’s specific needs and circumstances. Community care must be first authorized by VA before a Veteran can receive care from a community provider.
To qualify for routine health care at community facilities at VA’s expense, you must first be given a written referral. Included among the factors in determining whether such care will be authorized is your medical condition and the availability of VA services within your geographic area. VA copayments may be applicable.
Claims must be timely filed for community emergency care not authorized by VA in advance of services being furnished. Because timely filing requirements differ by type of claim, you should contact the nearest VA medical facility as soon as possible to avoid payment denial for an untimely filed claim. (See “Emergency Care” on page 29 for specific rules.)
Payment may not be approved for any period beyond the point of stability, except when VA cannot accommodate transfer of the Veteran to a VA or other federal facility. An emergency is deemed to have ended at the point of stability when a VA physician has determined that, based on sound medical judgment, a Veteran who received emergency hospital care could have been transferred from the community facility to a VA medical center for continuation of treatment.
