Eligibility for Military Health Benefits
Information about the Department of Veterans Affairs (VA) health benefits. Find out who is eligible, what the difference is between priority groups, and how to apply for VA health care.
What types of health care benefits are offered by the VA?
The VA system offers basic health care benefits, including annual examinations, health education, immunizations, counseling on genetic diseases, clinic visits to monitor ongoing conditions, and visits for episodic illnesses like colds, flu, etc. The VA also offers screening exams that are gender specific like mammograms, prostate exams, etc. The specific exams available at local VAs may vary from one VA facility to another.
The VA also offers inpatient services like surgeries, inpatient medical treatment, kidney dialysis, acute hospital care, and post-operative care. For those that need an organ transplant, intensive care for a mental illness, or specialized care for a traumatic injury, the VA may send the person to another facility if the local VA hospital does not provide that service.
Some VA facilities offer urgent care and emergency department services. There is usually a walk-in clinic for episodic illnesses, wound care, and minor injuries. The VA also offers prescription service through its pharmacies when a VA doctor writes a prescription. It may also fill prescriptions written by non-VA physicians if the following are true:
- They are enrolled in VA health care,
- They have an assigned VA physician,
- The VA doctor has the person's medical records from that outside physician, and
- The VA doctor approves the prescription written by the outside physician.
Who is eligible for VA Health Care Benefits?
Any individual who has served in the active military and is no longer in the service may be eligible for health benefits. Current and former members of the Army Reserve and National Guard who were called into duty by a federal order and completed their full period of service may also be eligible (training duty does not count).
Those who do not qualify are:
- Those that received a dishonorable, other than honorable, or bad conduct discharges.
- Reserves and National Guard members with active duty for training purposes do not meet requirements.
If enlisted after September 7, 1980 or entered active duty after October 16, 1981 must have served 24 consecutive months, unless:
- Discharged because of a disability that was caused or worsened by active duty service (see Disability Benefits), or
- Received an "early out" because of a hardship discharge, or
- Served before September 7, 1980.
There may be other exceptions to this rule, so the VA encourages all service members to apply.
What documents will I need to use to apply for health care?
The following paper work should be gathered to complete an application:
- Most recent tax returns for federal and state,
- Social security number and the social security numbers of qualified dependents, and
- Account numbers for any current health insurance coverage. It may be Medicare, privately purchased health coverage, health care benefit package that is part of a retirement plan, or group health insurance coverage through an employer.
How do I apply for VA health care benefits?
Once it is decided that they are eligible and gathered the required documents, there are multiple ways to apply for health care benefits.
Online on the VA website
Call (877) 222-8387 (8:00am to 8:00pm EST)
Visit the local VA office - Arizona Locations
Apply by mail by filling out Form 10-10EZ and mailing it to:
Health Eligibility Center
2957 Clairmont Rd., Suite 20
Atlanta, GA 30329
After applying, the applicant will be placed into a priority group to determine where they are in line for health care benefits.
What are VA "priority groups"?
When you apply for VA health benefits, the VA examines your application and assigns you to one of eight priority groups. This priority system is designed to make sure that the veterans who most urgently need care receive it without delay.
Your assigned priority group will decide:
- How soon you can be signed up and accepted for care, and
- What you will be charged, if anything, for the cost of care you receive.
How are priority groups assigned?
Priority groups are assigned based on the following factors:
- Service history, and
- Disability rating, and
- Income level, and
- Whether or not you qualify for Medicaid, and
- Other benefits you may be receiving. (Example: VA Pensions)
Veterans with a service-connected disability receive the highest priority for care and veterans with higher incomes, who do not have a service-connected disability receive lower priority. If a veteran qualifies for more than one priority group, the VA will use the higher of the two groups.
What are the eight priority groups?
Priority Group One- You have a service-connected disability rated as 50% or more disabling, OR
- You have a. service-connected disability that makes you unable to work and earn a living, OR
- You received the Medal of Honor for your service.
- You have a service-connected disability that has been rated as 30-40% disabling.
- You are a former prisoner of war, OR
- You received the Purple Heart, OR
- You were discharged for a disability that caused or was made worse by your active duty military service, OR
- You have a service-connected disability that has been rated at 10-20% disabling, OR
- You were awarded special eligibility classification under 38 USC § 1151.
- You are receiving VA aid and assistance or household benefits, OR
- You have a VA determination of catastrophically disabled (not connected to service).
- You have a disability that is not related to your service, OR
- You have a service-connected disability that has been rated as 0% disabling AND you have an annual income that is below the VA's adjusted income limits, OR
- You are receiving a VA pension, OR
- You are eligible for Medicaid.
- You have a service-connected disability rated as 0% disabling, OR
- You are exposed to ionizing radiation during atmospheric testing of the atomic bomb or were part of the U.S. military force occupying Hiroshima and Nagasaki after World War II, OR
- You participated in Project 112/SHAD (a chemical and biologic testing program that ran from 1962-1973), OR
- You served in Vietnam between January 9, 1962 - ay 7, 1975, OR
- You served in the Persian Gulf between August 2, 1990 - November 11, 1998, OR
- You served at Camp Lejeune for at least 30 days between August 1, 1953 - December 31, 1987.
You may also qualify for group six if all of the following are true:
- Currently or recently enrolled in VA Health Care, AND
- Served in a combat theater after November 1998 or were discharged from active duty after January 28, 2003, AND
- Were discharged within the past five years.
- Your income is below the VA adjusted income limits, AND
- You agree to pay copays for your care.
- Your income is above the VA adjusted income limits, AND
- You agree to pay copays for your care.
Can a priority group change?
Yes, if your service-connected disability becomes worse or if your income decreases, your priority group may change.
Enhanced EligibilitySome veterans may be offered enhanced eligibility status when applying:
- Prisoners of War
- Purple Heart Medal Recipients
- Medal of Honor Recipients
- Have a compensable VA awarded service connected disability of 10% or more
- Discharged due to disability, early out, or hardship
- Served in Theatre of Operation 5 years post discharge
- Served in Republic of Vietnam from January 9, 1962 to May 7, 1975
- Served in Persian Gulf from August 2, 1990 to November 11, 1998
- Stationed or resided at Camp Lejeune for 30 days or more between January 1, 1957 and December 31, 1987
- Found by VA to be Catastrophically Disabled
- Previous years’ household income is below VA’s National Income or Geographical-Adjusted Thresholds.
- Operates on an annual enrollment system
- Once Veteran’s application is reviewed and verified, they remain in the VA health care system and receive and maintain certain VA health benefits.
- Once the application is successfully processed, the veteran will be assigned into a Priority Group.