Community Care

Financial Hardship

• Repayment Plan
• Copayment Exemption
• Debt Relief
• Debt Collection
• Contacts

Repayment Plan

You have the right to establish a monthly repayment plan at any time during your enrollment in VA health care if you cannot pay your debt in full. Typically, a repayment plan term does not extend beyond three years. VA will consider the size of your debt and your ability to pay within a reasonable time when determining your repayment plan.

Repayment plans do not include new charges incurred. You may request a new repayment plan to cover any new charges by submitting a new VA Form 1100, Agreement to Pay Indebtedness. If you are continuously receiving new charges, it is recommended that you contact the VA Health Resource Center every 90 days to request a new repayment plan.

Health Resource Center Billing Specialists: 866-400-1238, Monday–Friday, 8 a.m.–8 p.m. EST

How to Apply

1. Complete and sign VA Form 1100, Agreement to Pay Indebtedness.
2. Indicate your proposed monthly payment amount in paragraph 1A.
3. Send the completed form and/or other required documentation to the Facility Revenue Office at your local VA medical center. Use the Facility Locator to find the address of your local VA medical center.
4. Once you receive confirmation the repayment plan has been approved, you will be notified about where to send your first payment. If you received a coupon book with your approved repayment plan, please send payments to the address shown on the coupon. You can make a payment:
   
   

   In Person: Visit the Facility Revenue Office at your local VA medical center.

   By Mail: Send completed forms and/or other required documentation to the Facility Revenue Office at your local VA medical center.

   VA Form 1100, Agreement to Pay Indebtedness VA Facility Locator

Copayment Exemption

You may be eligible for a hardship copayment exemption if your gross household income has decreased. If you qualify and are granted an exemption, you would be placed into a higher priority group category and future copayment would be waived for the remainder of the calendar year.

A hardship copayment exemption does not apply to copayments for pharmacy medications.

How to Apply

1. Complete and sign the VA Form 10-10HS, Request for Hardship Determination.
2. Include a letter that describes the financial difficulties that limit you from paying your copayment.
3. Provide these materials to VA in person or by mail:
   
   

   In Person: Visit your local VA medical center’s Business Office or Health Administration Service Office.

   By Mail: Send completed forms and/or other required documentation to the Business Office/Health Administration Service Office at your local VA medical center. Use the Facility Locator to find the address of your local VAMC.

   VA Form 10-10HS, Request for Hardship Determination VA Facility Locator

Debt Relief

You have the right to request a waiver (request for debt relief), write-off (termination of debt owed by Veteran), or a compromise (negotiate a lesser payment amount) of part or all of your balance. If a request is granted in full or in part, you will not be required to pay the amount of the balance considered for debt relief.

You also have the right to a hearing when you request a debt waiver. VA will notify you of the date, time and place where the hearing will be held.

How to Apply

1. Complete and sign VA Form 5655, Financial Status Report, to request a compromise.
2. Provide a written request to explain why you are requesting debt relief.
3. Include any financial difficulties that limit you from paying your copayment.
4. Indicate a hearing request (if applicable).
5. Send the completed forms and/or other required documentation to the Facility Revenue Office at your local VA medical center. Use the Facility Locator to find the address of your local VA medical center.
   
   VA Form 5655, Financial Status Report VA Facility Locator

Debt Collection

You have the right to inspect and copy your balance records. You also have the right to establish a payment plan or to submit a compromise offer to pay the balance.

VA is required under federal law to refer delinquent balances to the VA Debt Management Center or the Department of Treasury. Collection from these agencies can result in a decrease in other federal payments you receive, like income tax refunds, social security benefits, and/or retirement benefits. It could also include garnishment of non-federal wages or reduction of current or future VA benefits.

The Department of Treasury may refer a delinquent account to a private collection agency, which will result in additional fees and interest being added to your account. Your delinquent account may also be reported to credit reporting agencies.

For more information, please visit the VA Debt Management Center website or the Department of Treasury’s Bureau of the Fiscal Services Cross-Servicing FAQs.

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