VA Co-Payment Requirements 2017

VA Disability


Basic Business Rule
No extended care copayment when income is below pension single rate threshold.
*Copayment Free Care and Medication for treatment of Service-Connected (SC) disabilities, SC 50% or more, former POWs, Catastrophically Disabled Veterans, VA pensioners, and those under Special Authorities (e.g. PG 6, military sexual trauma, nasopharyngeal radium irradiation).
**Copayment for extended care services for former POWs when care provided is for a NSC condition.
***Veterans determined by VA to be Catastrophically Disabled (CD) are exempted from inpatient, outpatient and prescription copayments. CD Veterans are also exempt
from copayments applicable to the receipt of non-institutional respite care, non-institutional geriatric evaluation, non-institutional adult day health care, Homemaker/Home Health Aide, Purchased Skilled Home Care, Home based Primary Care, and any other non-institutional alternative extended care services. Co-payment for other extended care services (ex. Nursing Home Care) not mentioned still apply.
***A&A and HB – For Veterans who are not in receipt of a VA Pension, but requires the aid and attendance (A&A) of another person or is permanently housebound (HB), the income limits for determining the exemption from outpatient medication copayment requirements and the eligibility for bene ciary travel bene ts will be based on the maximum annual rate of pension as Identi ed in VHA Fact Sheet IB10-497.
****Exposure Treatment Authorities: Care authorized under 38 U.S.C. 1710(e) for Vietnam-era herbicide exposed Veterans, radiation-exposed Veterans, Gulf War Veterans, post-Gulf War combat exposed Veterans or Camp Lejeune Veterans.
OEF/OIF/OND Combat Veterans Enhanced Eligibility for Health Care Bene ts
Combat Veterans discharged from active duty on or after January 28, 2003, are eligible for enrollment in Priority Group (PG) 6 for 5 years following discharge unless eligible for a higher enrollment priority (PG 1-5). After the special eligibility period ends, these Veterans will be reassigned to appropriate PG and subject to copayments, if applicable.
Copayments only applicable for PG 6 Combat Veteran enrollees for care related to a condition that is congenital or developmental e.g., scoliosis existed before military service (unless aggravated by combat service) or has a speci c ailment that began after military service, such as a common cold, etc.
Comprehensive Medical Bene ts Package
All enrolled Veterans have a comprehensive medical bene ts package, which VA administers through an annual patient enrollment system. The enrollment system is based on priority groups to ensure health care bene ts are readily available to all enrolled Veterans. Enrollment in the VA health care system provides Veterans with the assurance that comprehensive health care services will be available when and where they are needed during that enrollment period.


Author: WPTangerine


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