VA Healthcare Enrollment Guide

The Veterans Health Administration (VHA) is one of the largest integrated healthcare systems in the United States, operating over 1,300 facilities including 171 VA medical centers, more than 1,100 outpatient clinics, and hundreds of community-based programs. It serves over 9 million enrolled veterans each year.

Eligible veterans can receive comprehensive medical care including preventive services, primary care, specialty care, mental health treatment, prescription medications, and more. Many veterans qualify for free or low-cost healthcare depending on their service history, disability status, and income level.

Most veterans who served on active duty and were discharged under conditions other than dishonorable are eligible for VA healthcare. The basic requirements are:

• Character of discharge: Honorable or General (Under Honorable Conditions). Other-than-honorable discharges may still qualify — the VA makes case-by-case determinations.
• Minimum service: Veterans who enlisted after September 7, 1980, or entered active duty after October 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty. Exceptions apply for combat veterans, those discharged for hardship or early out, and those discharged for a service-connected disability.
• National Guard and Reserves: Eligible if called to active duty by federal order and completed the full period of service.

Enhanced eligibility applies to certain groups who receive higher priority and often no-cost care:

• Veterans with service-connected disabilities
• Former Prisoners of War (POWs)
• Purple Heart recipients
• Veterans who are catastrophically disabled
• Veterans exposed to toxic substances (Agent Orange, burn pits, radiation)
• Veterans with Medal of Honor
• Veterans receiving VA pension benefits
• Recently discharged combat veterans (5 years of enhanced eligibility under the PACT Act)

When you enroll in VA healthcare, you are assigned to a priority group based on your military service history, disability rating, income, and other factors. Your priority group determines your access to care and your copay obligations. Group 1 is the highest priority.

Enrollment requires completing VA Form 10-10EZ (Application for Health Benefits). There are four ways to submit it:

• Online: Apply at VA.gov/health-care/apply-for-health-care-form-10-10ez. This is the fastest method. You will need your Social Security number, military service information, and financial information (including previous year's gross household income).
• By phone: Call 1-877-222-8387 (1-877-222-VETS), Monday through Friday, 8:00 a.m. to 8:00 p.m. ET. A representative can walk you through the application over the phone.
• In person: Visit your nearest VA medical center or clinic. Bring a photo ID, DD-214, and any VA disability rating letters. An enrollment coordinator will help you complete the form.
• By mail: Download VA Form 10-10EZ from VA.gov, fill it out, and mail it to: Health Eligibility Center, 2957 Clairmont Rd., Suite 200, Atlanta, GA 30329.

What to have ready: DD-214 or other discharge documentation, Social Security number, financial information (income, deductible expenses), insurance card(s) if applicable, and your VA disability rating letter if you have one.

VA healthcare covers a wide range of services. Once enrolled, you may be eligible for:

• Preventive care: Immunizations, health screenings, annual physicals
• Primary care: Routine appointments with an assigned primary care team
• Specialty care: Cardiology, orthopedics, dermatology, neurology, and more
• Mental health: Individual and group therapy, PTSD treatment, substance use disorder programs, crisis intervention
• Prescription medications: Filled at VA pharmacies or by mail through the VA Mail Order Pharmacy (CMOP)
• Emergency care: At VA facilities, and in some cases at non-VA emergency rooms
• Surgical services: Inpatient and outpatient procedures
• Prosthetics and orthotics: Artificial limbs, braces, hearing aids, and assistive devices
• Home health and geriatric care: For veterans who need assistance with daily living
• Women's health: Gynecological care, maternity care, and specialized women's health clinics
• Hearing care: Hearing exams and hearing aids
• Vision care: Routine eye exams (for certain eligible veterans — see Dental & Vision section below)

Whether you owe copays depends on your priority group and the type of care. Key rules:

• Service-connected conditions are always free. If you have a VA disability rating, treatment for those rated conditions costs nothing regardless of your priority group.
• Priority Groups 1–6 generally pay no copays or reduced copays for most services.
• Priority Groups 7–8 pay copays for non-service-connected care. Copays are still significantly lower than typical civilian costs.

Medication copay tiers (for non-SC conditions):

• Tier 1 (preferred generics): $5 for a 30-day supply
• Tier 2 (non-preferred generics and some brands): $8 for a 30-day supply
• Tier 3 (brand-name drugs): $11 for a 30-day supply

There is an annual copay cap. Once your medication copays reach the cap in a calendar year, you pay nothing more for prescriptions for the rest of that year. Veterans in Priority Groups 1–6 generally do not pay medication copays.

The VA MISSION Act (2018) expanded veterans' ability to receive care from non-VA providers in the community when certain conditions are met. You may be eligible for community care if:

• Drive time: You live more than 30 minutes from a VA facility for primary care or mental health, or more than 60 minutes for specialty care.
• Wait time: The VA cannot schedule an appointment within 20 days for primary care or mental health, or within 28 days for specialty care.
• Service not available: The specific service you need is not offered at any nearby VA facility.
• Best medical interest: Your VA provider determines it is in your best medical interest to receive care in the community.
• VA service standards not met: The VA facility does not meet certain quality standards for the care you need.

How to get a community care referral:

• Talk to your VA primary care provider about a referral.
• The VA will determine if you meet community care eligibility criteria.
• If approved, the VA will help you find a community provider in your area.
• The VA pays the community provider directly — you should not receive a bill (except applicable copays).
• Always get VA approval before seeking community care, except in emergencies.

CHAMPVA provides healthcare coverage for the spouse, surviving spouse, and dependents of certain veterans. It is not the same as TRICARE. You may be eligible for CHAMPVA if you are the spouse or child of:

• A veteran rated permanently and totally disabled due to a service-connected condition
• A veteran who died from a service-connected condition
• A veteran who was rated permanently and totally disabled at time of death

CHAMPVA covers most medically necessary services including doctor visits, hospital care, prescriptions, mental health, and durable medical equipment. There is an annual deductible and a cost share (the beneficiary pays 25% of the allowable amount after the deductible is met). There is also an annual out-of-pocket maximum, called the catastrophic cap.

To apply, complete VA Form 10-10d and submit it along with supporting documents (marriage certificate, birth certificates, DD-214, VA rating decision). Mail to: VHA Office of Integrated Veteran Care, CHAMPVA Eligibility, PO Box 469028, Denver, CO 80246-9028.

Dental care through the VA is much more limited than medical care. Full dental benefits are only available to:

• Veterans with a 100% service-connected disability rating (or rated totally disabled due to individual unemployability)
• Former POWs
• Veterans with a service-connected dental condition or disability
• Veterans with dental conditions aggravating a service-connected medical condition
• Veterans participating in a VA vocational rehabilitation program
• Veterans receiving care under the homeless veteran dental program
• Recently separated veterans may receive a one-time dental treatment if they apply within 180 days of discharge and had a dental condition noted at separation that existed at enlistment

Veterans who do not qualify for VA dental can enroll in the VA Dental Insurance Program (VADIP), which offers discounted private dental insurance through Delta Dental or MetLife. Learn more about VADIP.

Vision care is generally available to enrolled veterans as part of their medical benefits. This includes:

• Routine eye exams for veterans with certain conditions (diabetes, glaucoma risk, etc.)
• Eye exams and prescription eyeglasses for veterans with a service-connected eye condition or a compensable SC disability rating
• Eyeglasses for former POWs
• Veterans in Priority Groups 1–4 are generally eligible for routine eye exams and eyeglasses
• All veterans receiving VA healthcare can get eye care for medical conditions affecting the eyes

If you have a medical emergency and cannot get to a VA facility, the VA may cover your care at a non-VA emergency room. This is one of the most commonly misunderstood benefits — many veterans get stuck with surprise ER bills because they do not know the rules.

Coverage requirements (all must be met):

• Prudent Layperson Standard: A reasonable person with average medical knowledge would believe that a delay in seeking care could result in serious health risk, serious impairment of bodily functions, or serious dysfunction of any body part or organ
• VA facility not feasibly available: A VA facility was not reasonably accessible at the time of the emergency
• Enrolled in VA healthcare or have received VA care within the past 24 months
• For non-service-connected conditions: You must have no other health insurance that would cover the visit (if you have Medicare, TRICARE, or private insurance, those payers are responsible first)
• For service-connected conditions: Coverage applies regardless of other insurance

What to do after a non-VA ER visit:

• Notify the VA within 72 hours of admission (call your local VA medical center)
• The VA will determine if continued care should transfer to a VA facility or remain at the community hospital
• Do not pay the bill out of pocket — submit it to VA for review
• If you receive a bill, contact VA Health Administration at 1-877-222-8387

Important: Urgent care is different from emergency care. The VA has an urgent care benefit that allows enrolled veterans to visit participating in-network urgent care facilities for minor injuries and illnesses. You may owe a copay depending on your priority group and the number of visits in a calendar year. Check your eligibility and find in-network urgent care locations at VA.gov.

The VA reimburses eligible veterans for travel costs to and from approved healthcare appointments. Many veterans never file for this benefit and leave money on the table.

Who qualifies:

• Veterans with a service-connected disability rating of 30% or higher
• Veterans traveling for treatment of a service-connected condition (any rating)
• Veterans receiving VA pension
• Veterans whose income does not exceed the maximum annual VA pension rate
• Veterans traveling for a C&P exam

How it works:

• Mileage rate: $0.415 per mile (round trip)
• Deductible: $6.00 each way ($12.00 round trip) — deducted from reimbursement, not charged separately. Waived for some veterans (SC 30%+, C&P exams, VA-scheduled appointments)
• Special mode transport: If you need an ambulance, wheelchair van, or other special transport, the VA may cover the full cost if medically authorized in advance

How to file:

• Online: Through the Beneficiary Travel Self-Service System (BTSSS) at VA.gov
• In person: Use the kiosk at your VA facility to file when you check in or out
• By mail: Submit VA Form 10-3542
• Deadline: File within 30 days of your appointment for fastest processing

The VA is the largest provider of hearing aids in the United States. Eligible enrolled veterans receive hearing aids and audiology services at no cost, regardless of whether hearing loss is service-connected.

What's provided:

• Comprehensive hearing evaluation — audiometric testing and consultation
• Digital hearing aids — VA provides current-generation hearing aids from major manufacturers, fitted and programmed to your hearing loss
• Batteries — supplied by mail at no cost (reorder through VA Prosthetics or online)
• Repairs and maintenance — covered at no cost
• Replacement — typically every 5 years, or sooner if hearing changes significantly or the device cannot be repaired
• Cochlear implant evaluations — for veterans with severe hearing loss who may benefit from implants
• Assistive listening devices — amplified phones, alerting devices, TV amplifiers for qualifying veterans

To get started, ask your VA primary care provider for a referral to audiology, or contact your local VA medical center's audiology department directly. If you have a service-connected hearing loss or tinnitus rating, you have priority access.

If you are a veteran considering VA healthcare, here are practical first steps:

• Step 1: Gather your documents — DD-214, financial information (last year's gross income), insurance cards, and VA disability rating letter if applicable.
• Step 2: Apply for enrollment using one of the four methods above (online is fastest).
• Step 3: Once enrolled, you will receive a Veterans Health Identification Card (VHIC) and be assigned to your nearest VA medical center.
• Step 4: Schedule your first appointment. You will be assigned a primary care team (called a Patient Aligned Care Team, or PACT).
• Step 5: Bring your ID, insurance cards, a list of current medications, and any recent medical records to your first visit.

My HealtheVet is the VA's online patient portal. Once enrolled, register at myhealth.va.gov to:

• Send secure messages to your care team
• Refill prescriptions online
• View your VA medical records, lab results, and appointments
• Schedule and manage appointments
• Access your VA health summary and Blue Button report