Outpatient Copays

• Primary Care Services: $15
• Specialty Care Services: $50
• Prescriptions: 
  • 30-day or less supply for certain Veterans: $8
  • 30-day or less supply for higher income Veterans: $9

Inpatient Copays

There are two inpatient copay rates, the full rate and the reduced rate.

Priority Group 7 and certain other Veterans are responsible for paying 20 percent of VA's inpatient copay rate.

• Inpatient Copay for the first 90 days of care during a 365-day period……………$236.80
• Inpatient Copay for each additional 90 days of care during a 365-day period……………$118.40
• Daily Charge……………$2/day

Priority Group 8 and certain other Veterans are responsible for VA's full inpatient copay rate.

• Inpatient Copay for the first 90 days of care during a 365-day period……………$1,184.00
• Inpatient Copay for each additional 90 days of care during a 365-day period……………$592
• Daily Charge……………$10/day

Veterans living in high cost areas may qualify for a reduced inpatient copay rate. For more information contact VA toll-free at 877-222-VETS (8387).

Geriatrics and Extended Care

Long term care copays are based on three levels of care:

• Inpatient: Up to $97 per day (Community Living (Nursing home), Respite, Geriatric Evaluation)
• Outpatient: $15 per day (Adult Day Health Care, Respite, Geriatric Evaluation)
• Domiciliary: $5 per day

**Copayments for Long-Term Care services start on the 22nd day of care during any 12-month period — there is no copayment requirement for the first 21 days. Actual copayment charges will vary from Veteran to Veteran depending upon financial information submitted on VA Form 10-10EC.

Veterans Not Required To Make Copays

Some Veterans qualify for free healthcare and/or prescriptions based on special eligibility factors including but not limited to:

• Former Prisoner of War status 
• 50% or more compensable VA service-connected disabilities (0-40% compensable service- connected may take copay test to determine prescription copay status)
• Veterans deemed catastrophically disabled by a VA provider

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 examinations.
• Care that is part of a VA research project
• Care related to a VA-rated service-connected disability
• Readjustment counseling and related mental health services
• Care for cancer of head or neck caused by nose or throat radium treatments received while in the military
• Individual or Group Smoking Cessation or Weight Reduction services
• Publicly announced VA public health initiatives, for example, health fairs
• Care potentially related to combat service for Veterans that served in a theater of combat operations after November 11, 1998. 
• Laboratory and electrocardiograms
• Hospice care

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