Outpatient Health Care Copay
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VA charges some veterans a copay for outpatient care provided for their nonservice-connected conditions. These veterans have gross household income over the current VA Income Threshold. A three-tiered copay system is used for all outpatient services:
| Term |
Definition |
VA Charges |
| Basic Care Services |
Services by a primary care clinician. |
$15 per visit |
| Specialty Care Services |
Services provided by a clinical specialist such as a surgeon, radiologist, audiologist, optometrist, cardiologist, and specialty tests such as magnetic resonance imagery (MRI), computerized axial tomography (CAT) scan, and nuclear medicine studies. |
$50 per visit |
| Other Services |
Copays do not apply to publicly announced VA health fairs or outpatient visits solely for preventive screening and/or immunizations for influenza and pneumococcal, or screening for hypertension, hepatitis C, tobacco, alcohol, hyperlipidemia, breast cancer, cervical cancer, colorectal cancer by fecal occult blood testing, education about the risks and benefits of prostate cancer screening, smoking cessation counseling (individual and group), and weight management counseling (individual and group). Laboratory, flat film radiology, and electrocardiograms are also exempt from copays. Hospice care provided in any setting is exempt from copays. |
$0 |
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.
NOTE: Veterans enrolling under the “Combat Veteran” enhanced enrollment authority are assigned to Priority Group 6, unless eligible for a higher Priority Group, and will not be charged copays for medication and/or treatment of conditions that are potentially related to their combat service. Combat veterans are not required to disclose their income information, but may do so to determine their eligibility for a higher priority, beneficiary travel benefits and exemption of copays for care unrelated to their military service.
Veterans who enroll with VA under this enhanced enrollment authority will continue to be enrolled even after their enhanced eligibility period ends. At the end of their enhanced eligibility period, veterans enrolled in Priority Group 6 may be shifted to Priority Group 7 or 8, depending on their income level, and required to make applicable copays. For more information on your possible eligibility for “Combat Veteran” status, see the Combat Veterans page.
Federal Benefits for Veterans and Dependents
VA National Means Test Income Threshold |
GMT Income Threshold
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VA Health Care Eligibility & Enrollment Site Map
For questions about Health Care Eligibility, please visit the VA inquiry website.
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