While many veterans qualify for cost-free health care services based on a compensable service-connected condition or other qualifying factor, most veterans are required to complete an annual financial assessment or Means test to determine if they qualify for cost-free services. Veterans whose gross household income and net worth exceed the established threshold as well as those who choose not to complete the financial assessment must agree to pay the required copays to become eligible for VA health care services. Note that new veterans who apply for enrollment after January 16, 2003 and who decline to provide income information are not eligible for enrollment. Along with their enrollment confirmation and priority group assignment, enrollees will receive information regarding their copay requirements, if applicable.
Who is subject to provide a financial assessment (Means Test)?
Certain nonservice-connected veterans and 0% noncompensable service-connected veterans are asked to report gross household income and net worth from the previous calendar year.
In determining your VA Health Care benefit it is generally to your advantage to provide your income information if your gross household income (less allowable deductions) is equal to or less than the amount listed below. From the amounts you report on the Financial Worksheet VA will calculate and inform you of your income-based benefits.
Current year income and net worth can be considered when there is a hardship .
Note: If you decline to give your financial information, VA will—
Place you in Priority Group 8 AND
Require you to agree to pay the copay fees for Group 8 before treatment can be given
Important Information: Please note that veterans who are applying for enrollment on or after January 17, 2003 who are assigned to Priority Group 8 are not eligible for enrollment or care of their nonservice-connected conditions.
The financial information we gather from your Financial Assessment (means test) will determine —
Your enrollment priority group assignment AND
If you will or will not be required to pay copays
VA determines your priority group and copay requirements based on set income and net worth limits. We refer to these limits as the VA National Income Thresholds for VA Health Care Benefits.
Will I be charged copays?
Many veterans qualify for cost-free health care and/or medications based on
Receiving a Purple Heart Medal, or
Former Prisoner of War Status, or
Compensable service-connected disabilities, or
Low income, or
Other qualifying factors including treatment related to their military service experience.
Reduce or Eliminate VA Medical Care Copays
If you are now receiving VA compensation for a service-connected disability or VA pension benefits, your VA medical care and/or prescription copays may be reduced or eliminated. You may also be eligible for a refund of copay charges you have previously paid based on this decision. For further information, please call our Health Benefits Service Center at 1-877-222-VETS (8387) or contact the Enrollment Coordinator at your local VA medical center.
If I have private health insurance, will VA bill my insurance company?
VA is required to bill private health insurance providers for medical care, supplies and prescriptions provided for care veterans receive for their non-service connected conditions. Generally, VA cannot bill Medicare, but can bill Medicare supplemental health insurance for covered services.
All veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Veterans are not responsible for paying any remaining balance of VA's insurance claim not paid or covered by their health insurance, and any payment received by VA may be used to offset "dollar for dollar" a veteran's VA copay responsibility.
Some of the Services Exempt from Inpatient and Outpatient Copays
Special registry examinations offered by VA to evaluate possible health risks associated with military service
Counseling and care for military sexual trauma
Compensation and pension examination requested by VBA
Care that is part of a VA approved research project
Care related to a VA-rated service connected disability
Readjustment counseling and related mental health services for PTSD
Emergency Treatment at other than VA facilities
Care for cancer of head or neck caused from nose or throat radium treatments given while in the military
Publicly announced VA public health initiatives (i.e., health fairs)
Care related to service for veterans who served in combat or against a hostile force during a period of hostilities after November 11, 1998
Laboratory services such as flat film radiology services and electrocardiograms
Immunizations (such as influenza and pneumococcal)
Hospice care provided in any setting
What should I do if I can't afford to pay copays?
There are three options if a veteran is unable to pay the assessed copay charges:
Request a Waiver of Debt for past debts you owe. A Waiver of Debt can be granted when there has been a significant change in income and the veteran has experienced significant expenses for medical care for the veteran or other family members, funeral arrangements or veteran educational expenses. A Waiver of Debt excuses all existing bills, but does not prevent future charges.
A waiver must be requested in writing and by completing VA Form 5655, Financial Status Report. The request must specify each copay for which a waiver is being requested. There is no limit on the amount that the veteran can request to be waived. The veteran must request a waiver in writing within 180 days from the date on the bill. To request a waiver, and for more information, contact the Revenue Coordinator at the VA health care facility where the veteran receives care.
Request a Hardship Determination to prevent future billing. A Hardship Determination is an exemption from copay for a determined period of time. If a veteran’s current year income is substantially reduced from the prior year, a veteran may request a Hardship Determination.
Hardship Determination must be requested in writing. To request a Hardship Determination, contact the Enrollment Coordinator at the VA Medical Center where the veteran receives care.
Request an Offer in Compromise. An Offer in Compromise is an offer for past debts only and acceptance of a partial payment in settlement and full satisfaction of the debt at the time the offer is made. VA will consider both the current and anticipated future income in making these determinations. Most Offers in Compromise that are accepted must be for a lump sum payment payable in full 30 days from the date of acceptance of the offer.
Offers in Compromise must be requested in writing and by completing VA Form 5655, Financial Status Report. There is no limit on the amount that the veteran can request for the Offer in Compromise. To request an Offer in Compromise, contact the Revenue Office at the VA Medical Center where the veteran receives their care.
Income Verification
VA is required to verify the gross household income (spouse and dependents, if any) of most nonservice-connected or noncompensable 0% service-connected veterans to confirm the accuracy of their
Eligibility for VA health care
Copay status, and
Enrollment priority group assignment.
VA verifies your gross household income (spouse and dependents, if any) by matching the financial data you provided with financial records maintained by IRS and SSA. If the matching process reveals that your gross household income is higher than the threshold, you will be provided an opportunity to review the IRS and SSA data and provide additional information regarding the difference. Veterans subject to this process are individually notified by mail and provided with all related information. Click here for Income Verification Fact Sheet.
At the end of the income verification process, if it is determined that your gross household income is higher than the threshold,
Your priority group assignment will be changed
You will be required to pay copay
The facilities that provided you care will be notified to bill you for services provided during the period covered by your income assessment, and
You will be provided with your due process/appeal rights.
