The VA has its own language, its own rules, and its own appeals process. This guide covers your priority group, what the MISSION Act actually means for your care, and how to fight a decision you disagree with.
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Enrollment and priority · Just enrolled
Five things to do this week
Welcome to VA health care. Your enrollment letter contains the most important piece of information about how the system works for you: your priority group. Here is the order most veterans should take to get set up.
1
Find your priority group on your enrollment letter
Priority groups are numbered 1 through 8. Group 1 is highest priority (typically 50%+ service-connected disability or POW/Medal of Honor); Group 8 is lowest. Your group affects what care is free, what costs apply, and even your wait times.
2
Note the location of your assigned VA medical center
You are typically assigned to the VA medical center nearest your address. You can also use Community-Based Outpatient Clinics (CBOCs) for primary care, which are smaller and often closer.
3
Set up MyHealtheVet
The VA online portal at myhealth.va.gov lets you message your care team, refill prescriptions, view records, and schedule some appointments. Get a Premium account (in-person verification required once) to access full features.
4
Schedule your first primary care appointment
Call 1-877-222-VETS or use MyHealtheVet to schedule. New patient appointments establish your VA care team. The wait may be longer than future appointments, do not be alarmed.
5
Connect with a Veterans Service Organization (VSO)
Free, accredited representatives at organizations like the American Legion, VFW, DAV, and others help with anything VA-related at no charge. Find one at va.gov/vso.
Keep your enrollment letter
It documents your priority group, effective date, and your assigned facility. You will reference this often.
The VA uses a system of 8 priority groups, with 1 being the highest priority. Your assigned group determines almost everything: what care is free, whether you owe copays, even what services you are eligible to receive. Knowing yours is essential.
Group 1
Highest priority. Veterans with service-connected disabilities rated 50% or more, those determined unemployable due to service-connected conditions, or recipients of the Medal of Honor. No copays for any care.
Group 2
Service-connected disabilities rated 30% or 40%. No copays for service-connected conditions; small copays may apply for non-service-connected care.
Group 3
Service-connected 10% or 20%, former POWs, Purple Heart recipients, veterans discharged for a disability incurred or aggravated in the line of duty, certain other special groups. No copays for service-connected conditions.
Group 4
Veterans receiving aid and attendance or housebound benefits, or those VA has determined to be catastrophically disabled. No copays.
Group 5
Non-service-connected veterans whose income falls below VA national income thresholds, or who receive VA pension or are eligible for Medicaid. This is the most common group for low-income non-disabled veterans.
Group 6
Veterans exposed to specific substances (e.g., Agent Orange, Camp Lejeune water, Gulf War, post-9/11 combat, ionizing radiation, PACT Act conditions). May have $0 copays for related conditions.
Group 7
Veterans with income above VA national income thresholds but below the geographic income threshold for their area. Required to pay copays at reduced rates for non-service-connected care.
Group 8
Veterans with income above both national and geographic thresholds. Highest copays. Some Group 8 veterans (those who enrolled before 2003) are grandfathered with continued enrollment.
Your priority group can change
If your service-connected disability rating changes, your income changes significantly, or you become eligible for special programs, your group may be reassigned. Report changes promptly.
Enrollment and priority · Your card
The Veteran Health Identification Card (VHIC)
Your VHIC is the credential you use at every VA appointment, pharmacy pickup, and many community care visits. It contains your member ID and proves your VA enrollment.
What it shows
Your name, photo, member ID number, and certain branch and service indicators (e.g., Purple Heart, POW status).
How to get it
After enrollment, call 1-877-222-VETS or visit any VA medical center to be photographed and processed. The card arrives by mail in 7 to 10 business days.
What to do if lost or stolen
Call the same number above to request a replacement. You can use the VA app or print a temporary ID from MyHealtheVet while you wait.
Mobile version
The VA Health Chat and VA: Health and Benefits app both display a digital version of your card on your phone. Many providers will accept it.
Combined Veteran ID Card
Some veterans have a Veteran ID Card (VIC) used for civilian discounts. This is different from your VHIC. The VIC is not used for VA medical purposes.
Enrollment and priority · Online access
Setting up MyHealtheVet
MyHealtheVet (myhealth.va.gov) is the online front door to your VA health care. With a Premium account, you can message your care team, refill prescriptions, view your medical records, schedule appointments, and more.
1
Register at myhealth.va.gov
Click "Register" and follow the prompts. You will need your Social Security number and a current email address.
2
Verify your identity in person (one-time)
To upgrade from Basic to Premium, you must verify your identity once. Go to any VA medical center and ask for "MyHealtheVet authentication." Brings 5 minutes; bring your VHIC and a government photo ID.
3
Enable Secure Messaging
Once Premium, you can message your VA care team about non-urgent matters. Faster than calling, and the message becomes part of your record.
4
Set up prescription refills
Add your active medications and request refills any time. Refills typically arrive by mail in 7 to 10 days.
5
Download your records
Use Blue Button to download your VA health records as a PDF or text file. Useful for sharing with non-VA doctors or your own personal records.
The VA Health and Benefits app does most of this on your phone
Available in the App Store and Google Play. Same login as MyHealtheVet.
Enrollment and priority · Before you go
Before your first VA visit
A few minutes of preparation makes the first appointment go smoothly and ensures your records and prescriptions transfer correctly from any prior care.
1
Bring your VHIC and a government photo ID
Both are needed at check-in. If your VHIC has not arrived yet, bring your enrollment letter and any photo ID.
2
Bring a current medication list
Names, doses, frequencies. Include over-the-counter medications, supplements, and any prescriptions from non-VA providers.
3
Bring records from outside doctors if you have them
The VA will not have records from before your enrollment. Hand-carry copies of recent labs, imaging reports, specialist notes, and discharge summaries.
4
List your service history if anything is service-related
Where you served, when, and what conditions you believe may be service-connected. This helps the VA understand context and may affect how care is billed and prioritized.
5
Arrive 30 minutes early
New patient registration takes time. Bring a book.
Care at VA · Finding your facility
Finding your VA
The VA operates a tiered system of facilities. Knowing which type of facility offers what helps you choose where to go and what to expect.
VA Medical Centers (VAMCs)
Full-service hospitals offering inpatient, outpatient, and specialty care. Generally one per metropolitan area. About 170 nationwide.
Community-Based Outpatient Clinics (CBOCs)
Smaller clinics offering primary care, mental health, and basic specialty care. About 1,100 nationwide. Often much closer to home than the nearest VAMC.
Vet Centers
For combat veterans and their families. Counseling for readjustment, PTSD, sexual trauma. No copays. About 300 nationwide. Find one at vetcenter.va.gov.
Mobile clinics
For rural veterans. Schedule varies by region. Ask your VA about mobile clinic visits to your area.
Tribal health and Indian Health Service
For American Indian and Alaska Native veterans. VA has agreements with IHS and tribal facilities. Care is typically covered.
Find any VA facility at va.gov/find-locations
Search by zip code. Filter by services offered. Includes addresses, phone numbers, and facility hours.
Care at VA · Community care
Community care eligibility
Under the MISSION Act, you can receive care from a non-VA provider at VA expense in certain circumstances. The 2026 Senator Elizabeth Dole Act streamlined the process by eliminating a previously required second-opinion review.
Wait time eligibility
If the VA cannot offer an appointment within 20 days for primary care or mental health, or 28 days for specialty care, you are eligible for community care.
Drive time eligibility
If the nearest VA facility offering the service you need is more than 30 minutes away (primary or mental health) or 60 minutes (specialty care), you qualify.
Service unavailable
If the VA does not provide a specific service you need (such as maternity delivery), you are eligible to receive that service from a community provider.
Best medical interest
If your VA primary care provider determines that community care is in your best medical interest, you can receive it. As of 2026, this no longer requires a second-opinion review.
No full-service VA in your state
Veterans living in states or territories without a full-service VA medical facility (e.g., Alaska, Hawaii, several territories) qualify for community care.
Grandfathered eligibility
If you were eligible under the old Veterans Choice Program based on distance, you remain eligible under the MISSION Act.
Care at VA · MISSION Act
How the MISSION Act works
The MISSION Act (2018) replaced the older Veterans Choice Program with the Veterans Community Care Program. The 2026 Dole Act streamlined the approval process. Here is the practical workflow when you need community care.
1
Talk to your VA primary care provider
Mention that you need a service the VA cannot provide quickly, or that drive time is a barrier. Your VA provider initiates the community care process.
2
Confirm your eligibility
Your VA team verifies which of the six MISSION Act criteria apply. As of 2026, no second-opinion review is required when your VA clinician agrees community care is appropriate.
3
VA submits a referral to a community provider
The VA contracts with two third-party administrators to manage community care networks: Optum handles eastern regions; TriWest handles western regions. They contact community providers for you.
4
You schedule the appointment
Optum or TriWest sends you a list of approved providers in your area. You call and schedule.
5
VA pays the provider directly
You do not pay the provider out of pocket. The VA bills you afterward only if a copay applies for your priority group.
6
Records flow back to the VA
Community providers are required to send records back to your VA team. This is critical for continuity of care.
Always get VA approval first
If you see a non-VA provider without prior VA approval, the VA generally will NOT pay. Exception: emergencies (call your VA within 72 hours (1-877-222-VETS / 1-877-222-8387)).
Care at VA · Urgent care
VA urgent care
Through the MISSION Act, enrolled veterans can use community urgent care clinics without a referral. This is one of the most useful and underused VA benefits.
Eligibility
You must be enrolled in VA health care AND have received care from the VA within the past 24 months.
Where to go
Any urgent care clinic in the VA Community Care Network. Find one at va.gov/find-locations and filter by "Urgent Care."
What is covered
Most non-emergency illnesses and minor injuries: flu, ear infections, cuts requiring stitches, sprains, allergic reactions, urinary tract infections, etc.
What is NOT covered
True emergencies (chest pain, stroke symptoms, major trauma), go to the nearest ER. Specialty care that requires a referral.
Copay structure (2026)
Priority groups 1-5: $0 for first 3 visits per calendar year, then $30 each. Priority group 6: $0 for special-authority conditions (e.g., combat-era), $30 otherwise. Priority groups 7-8: $30 every visit.
Prescriptions
Up to a 14-day supply at the urgent care visit. For longer-term medications, the prescription must be filled through VA pharmacy.
Care at VA · Telehealth
VA telehealth
The VA was a national leader in telehealth long before the COVID era. You can connect with VA providers by video, phone, or secure messaging from home.
Video visits
Connect from home using the VA Video Connect app on your phone, tablet, or computer. Schedule through your VA team or MyHealtheVet.
Phone appointments
For follow-ups and check-ins where video is not needed. Often easier to schedule than in-person.
Secure messaging
Through MyHealtheVet, send non-urgent questions to your care team. Responses typically within 1 to 3 business days.
Mental health telehealth
Particularly well-developed at the VA. Therapy, psychiatry, medication management can all be done by video. No copay for any priority group.
Home equipment loans
For some specialties, the VA loans equipment (blood pressure cuffs, scales, glucose monitors) and connects to your care team automatically. Ask your provider about Home Telehealth.
No internet at home?
The VA can provide tablets with internet to qualifying veterans. Ask your social worker or care coordinator about the Connected Care iPad program.
Care at VA · Coordinating care
Coordinating community care
Once you are using community care alongside VA care, three things matter most: records, prescriptions, and follow-up. Getting these right keeps you safe and prevents billing problems.
Records flow
Community providers are required to send their notes back to the VA. If they do not, your VA team is operating with incomplete information. Ask the community provider directly to send records to your VA primary care provider.
Prescriptions
Short-term (14-day or less): can be filled at any pharmacy. Long-term: must be filled through VA pharmacy. Have community providers send long-term prescriptions to the VA pharmacy directly.
Follow-up appointments
Coordinate with your VA primary care team. Some specialties send their own follow-up reminders; others assume your VA team will track. Ask explicitly.
Lab work
Whenever possible, get labs done at the VA so results flow into your VA chart automatically. If a community provider orders labs at an outside lab, request a copy.
Bills and copays
You may receive a copay bill from the VA after community care visits if applicable to your priority group. Do not pay community providers directly unless explicitly told to.
Watch for community provider direct bills
Some community providers may bill you directly by mistake. Forward any bill to your VA Community Care office before paying.
Coverage and benefits · The full picture
What VA health care covers
VA health care is comprehensive when you are eligible. Most enrolled veterans can access primary care, specialty care, mental health, prescriptions, and hospitalization at little or no cost. Specific coverage depends on your priority group and whether the condition is service-connected.
Primary care
Annual exams, preventive screenings, chronic disease management, immunizations. The foundation of VA care.
Specialty care
Cardiology, orthopedics, oncology, gastroenterology, neurology, dermatology, and dozens of other specialties. Available at most VAMCs; community care available when wait times are long.
Mental health
Therapy, psychiatry, medication, group treatment, intensive outpatient programs. $0 copay for any priority group.
Hospital and inpatient care
Surgical and medical admissions, intensive care, rehabilitation. Free for service-connected conditions or for priority groups 1 through 6.
Pharmacy
A robust formulary covering most needed medications. Refills by mail or in person. Copays apply for some priority groups; service-connected medications are free.
Prosthetics and durable medical equipment
Wheelchairs, prosthetic limbs, hearing aids, CPAP, oxygen, all free when medically necessary.
Long-term care
Nursing home, home-based primary care, hospice, geriatric evaluation. Free for some priority groups; copays for others (see Long-Term Care section).
Caregiver support
Through PCAFC (Program of Comprehensive Assistance for Family Caregivers), eligible veterans can have a family caregiver receive a stipend, training, respite, and health care.
Coverage and benefits · Dental
Dental coverage at the VA
Dental is one of the biggest gaps in VA coverage. Most veterans do not get free or low-cost VA dental care unless they meet specific criteria. Knowing whether you qualify saves frustration.
Who qualifies for free comprehensive VA dental
Veterans with a service-connected dental disability, a 100% service-connected disability rating, former POWs, certain veterans with discharges within the past 90 to 180 days, veterans with serious dental needs related to military service.
Who does NOT qualify for free VA dental
Most enrolled veterans. If your priority group is 1 through 8 but you do not meet the criteria above, you generally cannot get routine dental care at the VA.
VA Dental Insurance Program (VADIP)
A private dental insurance option open to all enrolled veterans. You pay a monthly premium for dental coverage through Delta Dental or MetLife. Not free, but cheaper than private dental insurance.
Dental discount programs
Some local dental schools and community health centers offer discounted dental care for veterans. Ask your local VSO for referrals.
How to apply for VA dental eligibility
Apply at va.gov/health-care/about-va-health-benefits/dental-care or at your local VA. The first step is a determination of eligibility.
Coverage and benefits · Vision and hearing
Vision and hearing
Unlike dental, vision and hearing are generally well-covered for enrolled veterans, particularly when service-connected. Routine eye exams and basic glasses are usually included.
Routine eye exams
Generally covered for enrolled veterans. Frequency varies by need and priority group.
Glasses
Available at no cost to veterans with service-connected vision conditions, those with priority group 1 through 4, or veterans receiving care for an issue related to vision. Frames and lenses are basic but functional.
Specialty vision services
Glaucoma management, diabetic retinopathy screening, low vision rehabilitation, and other specialty services available at VA Medical Centers with eye clinics.
Routine hearing exams
Available to enrolled veterans, particularly at VAMCs with audiology departments.
Hearing aids
Free for veterans with service-connected hearing loss, those receiving care for related conditions, or as medically necessary based on priority group. The VA dispenses some of the most advanced hearing aids available, including modern bluetooth-enabled models.
Vision and hearing exclusions
Cosmetic procedures, refractive surgery (LASIK), and over-the-counter glasses purchases are not covered.
Coverage and benefits · Mental health
Mental health and substance use
VA mental health care is comprehensive, free for any priority group, and one of the largest mental health systems in the country. The VA has invested heavily in this area, particularly for veterans with PTSD, substance use, and military sexual trauma.
Outpatient therapy
Individual and group therapy, including specialized programs for PTSD, depression, anxiety, and grief. $0 copay regardless of priority group.
Psychiatry and medication
Psychiatric evaluation, medication management, ongoing follow-up. Available in-person and via telehealth.
Inpatient psychiatric care
Voluntary and involuntary admission for mental health crises. Available at VAMCs with psychiatric units.
Substance use disorder treatment
Detoxification, residential treatment, medication-assisted treatment for opioid and alcohol use. Often co-located with mental health services.
Vet Centers
Separate from VA medical centers, focused on combat veterans and their families. Counseling for readjustment, PTSD, sexual trauma. Confidential and informal. Find one at vetcenter.va.gov.
Veterans Crisis Line
Available 24/7. Dial 988 then press 1, text 838255, or chat online. Confidential and free regardless of VA enrollment status.
Military Sexual Trauma (MST) services
Free, confidential treatment available regardless of priority group, gender, or whether the assault was reported. You do not need a service-connected disability rating to receive MST care.
You do not need a referral for mental health
Walk in or call your VA mental health intake line (1-877-222-VETS / 1-877-222-8387). New patients are typically seen within 24 hours for urgent needs.
Coverage and benefits · Pharmacy
VA pharmacy
The VA has its own pharmacy system, which is one of the most cost-effective ways to get prescriptions. The VA negotiates drug prices nationally and can deliver mail-order prescriptions to your door for a small copay.
Where to fill
On-site at any VA medical center pharmacy, by mail order through MyHealtheVet, or at any participating community pharmacy for short-term (14 day) supplies from urgent care.
Refill methods
MyHealtheVet (online or mobile app), automated phone line, or in person. Mail order arrives in 7 to 10 days for most medications.
Copay structure (2026)
Priority groups 1-6 (service-connected): $0 for service-connected medications, varies for non-service-connected. Priority groups 7-8: Tier 1 (preferred generic) $5, Tier 2 (non-preferred generic and OTC) $8, Tier 3 (brand) $11. Annual maximum copay cap of $700 for priority groups 2-8.
Long-term medications
Best filled through VA pharmacy by mail. 90-day supplies are typical. Set up automatic refills through MyHealtheVet.
Specialty medications
High-cost medications (e.g., for hepatitis C, certain cancers, immunology) are dispensed through VA specialty pharmacy with care coordinator support.
Community care prescriptions
Short-term (14-day or less): any pharmacy. Long-term: must be filled through VA pharmacy. Have your community provider send the prescription to VA.
Do not let prescriptions run out
Mail-order delays happen. Order refills 10 to 14 days before you run out. The VA can express-ship if needed in an emergency.
Coverage and benefits · Long-term care
Long-term care
The VA offers a continuum of long-term care options, from home-based primary care to nursing homes. Coverage and copays vary by priority group and whether your need is service-connected.
Home-Based Primary Care
For veterans whose chronic conditions make office visits difficult. A VA team brings primary care to your home.
Homemaker and Home Health Aide
Help with daily activities (bathing, dressing, meal prep) at home. Available based on need.
Adult Day Health Care
Daytime care at a VA or community facility, providing socialization and supervision while a family caregiver works.
Nursing home care (Community Living Centers)
VA-operated nursing facilities. Free for service-connected conditions or priority groups 1 through 4. Copays apply for non-service-connected long-term care for groups 7 and 8.
Community nursing home placement
When VA cannot provide nursing home care directly, the VA contracts with community nursing homes.
Hospice
End-of-life care available at home, in nursing facilities, or at VA hospice units. Free for all enrolled veterans.
Geriatric evaluation
Comprehensive evaluation by a team to determine appropriate level of care. Recommended before major care decisions.
Long-term care copays (2026)
Vary by service and priority group. Up to $97/day for nursing home care for some priority groups. The 2026 community spouse resource allowance (CSRA) of $162,660 protects assets when one spouse needs care and the other does not.
Coverage and benefits · Caregivers
Caregiver support
The Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides significant support to family members caring for seriously injured or ill veterans. The 2026 expansion broadened eligibility to include caregivers of pre-9/11 veterans.
What PCAFC provides
Monthly stipend for the primary family caregiver, training, mental health counseling for caregivers, respite care, certain travel benefits, and access to caregiver health benefits.
Eligibility (veteran)
Must have a serious injury or illness from active military service. As of 2026, eligibility includes both post-9/11 and pre-9/11 veterans (the original program was post-9/11 only).
Eligibility (caregiver)
A family member at least 18 years old who provides personal care services. Spouses, parents, children, and other family members can qualify.
Stipend amount
Based on the level of care needed and the local hourly wage for home health aides. Tiered system, with primary caregivers receiving more for higher-need veterans.
Respite care
Up to 30 days per year of substitute care so the primary caregiver can take a break. In-home or facility-based.
Caregiver health benefits
CHAMPVA-like coverage for primary caregivers if they have no other health insurance.
How to apply
Apply at caregiver.va.gov or call the Caregiver Support Line at 1-855-260-3274. The application requires medical documentation from the veteran.
PCAFC eligibility was expanded in 2026
If you applied before and were denied because the veteran was pre-9/11, you may now qualify under expanded rules.
Bills and copays · A bill arrived
I got a bill, should I pay?
Most VA care is no-cost for most veterans. If you receive a bill, it usually means a copay applies for your priority group, but it may also mean a billing error. A few minutes of verification before paying is worth it.
1
Verify the bill is from the VA, not a community provider
Real VA bills come from "Department of Veterans Affairs" with the VA logo. They are mailed from the VA Medical Center Health Care System where you received care, or from a national billing center.
2
Check the service type and your priority group
Different services have different copay rules. Service-connected conditions are always free. Mental health is always free. Prescriptions and outpatient visits depend on your priority group.
3
If the bill is for a service that should be free, dispute it
Call your VA medical center billing office. Common errors: charging for a service-connected condition, charging mental health copays, charging when you are exempt due to disability rating.
4
If the bill is correct, you have payment options
Pay online at pay.va.gov, call 1-888-827-4817, or mail a check to the address on the bill. Set up a payment plan if needed; the VA generally works with veterans on hardship cases.
5
If you cannot afford the copay, request a hardship waiver
The VA has a financial hardship program. Submit VA Form 5655 with documentation of your situation. Approval can waive or reduce copays.
Bills and copays · 2026 rates
2026 copay rates
VA copays are tiered by service type and priority group. These rates are current for 2026 and verified against VA published rates.
Outpatient visit (primary care)
$15 for priority groups 7 and 8. $0 for groups 1-6. Some Group 6 veterans pay $15 for non-special-authority care.
Outpatient visit (specialty care)
$50 for priority groups 7 and 8. $0 for groups 1-6 (with above caveats).
Inpatient hospital stay (first 90 days)
Up to $1,672 for priority group 8 (full rate). Reduced rate ~$334 for priority group 7. $0 for groups 1-6 for service-connected.
Inpatient hospital stay (over 90 days)
$836 plus daily charges of $11 for priority group 7-8.
Urgent care (community)
$0 for first 3 visits/year for priority groups 1-5, then $30 each. $30 every visit for groups 7-8.
Prescription medications
Tier 1 (preferred generic) $5, Tier 2 (non-preferred generic) $8, Tier 3 (brand-name) $11 for priority groups 7-8. Annual cap $700 for groups 2-8.
Long-term care (nursing home)
Up to $97/day for some services. Up to $5/day for adult day health care. Geriatric evaluation copays vary.
Mental health, preventive care, lab tests
Always $0 copay regardless of priority group when ordered as part of covered care.
Copays change annually
These are 2026 rates. Always verify current rates at va.gov/health-care/copay-rates before relying on them for budgeting.
Bills and copays · Exemptions
Who is exempt from copays
Several factors can exempt you from VA copays entirely or reduce them significantly. Many veterans are eligible for exemptions they do not know about.
Service-connected disability rating of 50% or higher
No copays for any care, ever, including non-service-connected conditions.
Service-connected conditions at any rating
No copays for treatment of the specific service-connected condition (regardless of overall disability rating).
Former POW status
No copays for any care.
Purple Heart recipients
No copays for any care.
Medal of Honor recipients
No copays for any care.
Catastrophically disabled
Veterans the VA has determined to be catastrophically disabled (whether service-connected or not). No copays.
Income below VA threshold (Group 5)
Veterans with income below the national threshold or receiving VA pension/Medicaid. No copays.
Special authority (Group 6)
Combat veterans (within 5 years of discharge), Agent Orange exposure, Gulf War, ionizing radiation, Camp Lejeune, and PACT Act exposed veterans. No copays for related conditions.
Mental health and preventive care
Always free regardless of priority group or exemption status.
Update your VA enrollment if your status changes
New disability rating, retirement, divorce, etc. can affect your copay obligations. Keep your VA enrollment current.
Bills and copays · Service-connected
Service-connected conditions
A service-connected condition is one the VA has formally determined was caused or made worse by your military service. Care for any service-connected condition is always free, regardless of your priority group, income, or any other factor.
How a condition becomes service-connected
Through a VA disability claim. You apply, provide evidence, and the VA assigns a percentage rating (0% to 100%) based on severity. Even a 0% rating means service-connection is established.
Why this matters for health care
Care for service-connected conditions is always free. If your VA bill includes copays, verify whether the service was for a service-connected condition.
How to verify service-connection
Look at your VA Disability Awards letter or check va.gov in the disability section. Each award letter lists which conditions are service-connected and their ratings.
Adding new service-connected conditions
You can file claims for additional conditions any time after discharge. There is no time limit. PACT Act expanded service-connection for many toxic exposures.
Increasing existing ratings
If a service-connected condition has worsened, file for an increased rating. Higher ratings mean more compensation and may also affect priority group placement.
Free help filing
Veterans Service Organizations (VSOs) like American Legion, VFW, DAV, and others help with disability claims at no charge. They are accredited representatives.
Bills and copays · Errors
A bill looks wrong
VA billing errors happen. The most common are charging for service-connected care, charging exempt veterans, and confusion between VA bills and community provider bills.
A community provider billed you directly
Forward the bill to your VA Community Care office immediately. Do not pay. The VA usually pays community providers directly; if you receive a bill, the provider may have failed to bill the VA properly.
You were charged for a service-connected condition
Call your VA billing office (1-888-827-4817 for VA billing). Provide your service-connected condition documentation. The bill should be reversed.
You were charged for mental health care
Mental health is free for any priority group. This is a billing error.
You were charged at the wrong priority group rate
Verify your current priority group at va.gov. If it has changed (e.g., due to new disability rating), the bill may be wrong.
You believe you should be exempt entirely
Check the exemptions list. If you qualify for an exemption (50%+ rating, POW, catastrophically disabled, etc.), call your VA enrollment coordinator (1-877-222-VETS / 1-877-222-8387) to update your status.
You cannot afford to pay even a correct bill
File for hardship waiver using VA Form 5655. Provide documentation of income, expenses, and family size.
Denials and appeals · A service was denied
A service was denied
There are two kinds of VA denials, and they have very different appeals processes. Knowing which you are facing is the first step to fighting it.
Clinical decisions
Decisions made by VA medical staff about your care: a doctor will not order a specific test, a treatment is determined unnecessary, a community care referral is not approved. These are clinical appeals, handled internally.
Administrative decisions
Decisions about your eligibility, priority group, copays, disability ratings, or benefits. These have a formal appeals process.
Your first call: the patient advocate
Every VA medical center has patient advocates. They are paid by VA to help veterans resolve any kind of problem. Often they can fix issues without formal appeal. Find yours at va.gov/health/patientadvocate.
For clinical appeals
Submit VA Form 10-2649A (Patient Advocate Tracker). The VA must respond within 7 working days. If unresolved, escalate to the facility director.
For administrative appeals
You have three options: Higher-Level Review (a senior reviewer takes a fresh look), Supplemental Claim (you submit new evidence), or Board of Veterans Appeals direct review (a Veterans Law Judge decides).
Working with a VSO
Veterans Service Organizations can file appeals on your behalf at no cost. Highly recommended for administrative appeals, they know the system.
Note the appeal deadline
Administrative appeals must generally be filed within 1 year of the decision. Some clinical issues have shorter timelines. Check your decision letter.
Denials and appeals · Patient advocate
Your VA patient advocate
Patient advocates are VA employees whose entire job is to help veterans resolve problems. They are your first call for almost any VA issue, big or small. Most veterans do not know they exist or how powerful they can be.
Where to find yours
Every VAMC has a patient advocate office, usually near the main entrance or admissions. Find contact info at va.gov/health/patientadvocate or call your VA main number.
What they help with
Anything: scheduling problems, billing disputes, communication issues with care teams, denials of services, complaints about staff, navigating community care, or just getting answers when no one else returns your calls.
How to engage
Walk in, call, or email. Describe the problem clearly. They will document the case and work it through proper channels.
Response time
Most non-clinical issues should be resolved within 7 working days. Urgent issues are handled same-day.
What they cannot do
They cannot override clinical decisions or change the law. But they can ensure the right people are involved in your case and can escalate to facility leadership.
When to escalate
If your patient advocate cannot resolve the issue, you can request a meeting with the facility director or the Veterans Integrated Service Network (VISN) office.
Denials and appeals · Clinical appeals
Clinical appeals
Clinical appeals are about medical decisions: whether a particular test, treatment, or referral is appropriate. The process is internal to the VA but has formal steps.
1
Step 1: Talk to your provider
Many clinical disputes resolve in conversation. Ask for the reasoning behind the decision and discuss your concerns. Document the conversation in MyHealtheVet.
2
Step 2: Request a second opinion within VA
You have the right to a second VA medical opinion at no cost. Ask your primary care provider to refer you, or contact the chief of the relevant service.
3
Step 3: Submit a Patient Advocate Tracker (Form 10-2649A)
This formalizes the complaint. The patient advocate will route it to clinical leadership for review.
4
Step 4: Request a clinical case review
For complex cases, the VA conducts a multi-specialty review. Request this through your patient advocate.
5
Step 5: Escalate to Office of the Inspector General if needed
If you believe care decisions reflect medical malpractice or discrimination, contact the VA OIG. This is for serious situations only.
Clinical appeals are not the same as disability appeals
If you are disputing a disability rating decision, that is an administrative appeal handled by VBA, not VHA. Different process entirely.
Denials and appeals · Higher-level review
Higher-Level Review
Under the Appeals Modernization Act, Higher-Level Review is one of three options for appealing administrative VA decisions. A senior VA reviewer takes a fresh look at the existing record without new evidence.
When to choose this option
When you believe the original decision was wrong based on the evidence already in your file. No new evidence will be considered.
How to file
Submit VA Form 20-0996 within 1 year of the original decision. File at va.gov/decision-reviews/higher-level-review.
What happens next
A senior VA adjudicator (someone more experienced than the original decider) reviews your case. They can affirm, reverse, or partially reverse the decision.
Timeline
Typically 4 to 5 months for a decision.
Informal conference
You can request a phone conference with the reviewer to discuss the case. Recommended; it is a chance to point out specific errors.
If denied
You can then file a Supplemental Claim (with new evidence) or appeal to the Board of Veterans Appeals.
Denials and appeals · Board appeal
Board of Veterans Appeals
The Board of Veterans Appeals (BVA) is the highest level of VA administrative appeal. A Veterans Law Judge reviews your case and issues a decision. Appeals can take longer than other options but offer the most thorough review.
Three docket options
Direct Review (no new evidence, no hearing): fastest, ~1 year. Evidence Submission (you submit new evidence within 90 days): ~2 years. Hearing (in-person, video, or virtual hearing before the judge): ~2-3 years.
How to file
Submit VA Form 10182 (Notice of Disagreement) within 1 year of the decision you are appealing. File at va.gov/decision-reviews/board-appeal.
Hearing format
You can choose central office (Washington, DC), travel board (judge visits regional offices), video conference, or virtual telehearing. Travel board hearings have long wait times.
What happens at a hearing
You and your representative present testimony and arguments to the judge. The judge asks questions. The hearing is recorded.
Outcomes
The Board can grant, deny, or remand (send back to the regional office for additional development). Remands extend the timeline.
After BVA decision
If denied, you can appeal to the U.S. Court of Appeals for Veterans Claims within 120 days. This is a federal court, not a VA tribunal.
A VSO is essential for BVA appeals
The Board process is formal. An accredited representative from a VSO can prepare arguments, organize evidence, and present at hearings. Free.
Denials and appeals · VSO support
Working with a VSO
Veterans Service Organizations (VSOs) are nonprofit organizations whose accredited representatives help veterans navigate the VA at no charge. For appeals, claims, and complex issues, working with a VSO dramatically improves your chances of success.
What VSOs do
Help with disability claims, appeals, healthcare enrollment, education benefits, home loans, employment, and any other VA-related matter. They have direct access to VA databases through accreditation.
Major VSOs
American Legion, Veterans of Foreign Wars (VFW), Disabled American Veterans (DAV), Vietnam Veterans of America (VVA), AMVETS, Paralyzed Veterans of America (PVA). State veterans affairs offices also offer free representation.
How to find one
Visit va.gov/vso to search by state and zip code. You can also walk into any local American Legion, VFW, or DAV post and ask to be connected with their service officer.
Cost
Free. Accredited VSO representatives cannot charge for help with VA claims and appeals. Be wary of anyone asking for fees.
You do not need to be a member
You can use VSO services without joining their organization. The representatives serve any veteran.
What to bring
DD-214 (discharge papers), any prior VA correspondence, medical records related to your claim, and a list of your specific concerns.
Updates and life changes · Income review
Annual income review
Veterans in priority groups 5, 7, and 8 are required to update their income annually with the VA. This is sometimes called the "means test." Failing to update can result in being moved to a higher copay tier.
Who must update annually
Priority groups 5, 7, and 8. Groups 1-4 and 6 do not need to update income because their priority is based on disability rating or special status.
How to update
Online at va.gov/health-care/update-health-information, by mail (VA Form 10-10EZR), or in person at any VA medical center.
When to update
The VA sends a notice typically once a year. You can also update any time your income changes significantly (more than $1,000/year change is the threshold).
What to provide
Prior year tax return or current year income documentation, household size, deductible expenses (out-of-pocket medical costs).
What happens if you do not respond
You may be reclassified to priority group 8 with full copays, even if your actual income would qualify for a lower copay tier.
What happens if your income goes down
You may be eligible for a lower priority group with reduced or eliminated copays. Update promptly to take advantage.
What happens if your income goes up
You may move to a higher copay tier. Report this; the VA will reconcile retroactively if you do not.
Updates and life changes · Priority changes
When your priority group changes
Priority group is not fixed. It can change based on disability rating updates, income changes, becoming eligible for special authority, or aging into Medicare. Knowing what triggers a change helps you maximize your benefits.
New service-connected disability rating
A new disability rating, especially crossing the 50% threshold, can move you from any priority group up to Group 1 (50%+ rated). Update your enrollment as soon as the rating decision arrives.
Increased existing rating
A combined service-connected rating that increases (e.g., from 40% to 60%) can move you to a higher priority group with no copays.
Loss of income or eligibility for Medicaid
Becoming eligible for Medicaid moves you to Group 5 with no copays. Notify the VA when you become Medicaid-eligible.
Award of VA pension
Veterans receiving VA pension are automatically Group 5.
Catastrophic disability determination
A formal determination by the VA that you are catastrophically disabled moves you to Group 4. No copays.
Age and Medicare eligibility
Becoming eligible for Medicare does not change your VA priority group, but it does add another layer of coverage. See "VA and Medicare Together."
How to request a re-evaluation
Submit a new VA Form 10-10EZR with documentation of the change. Or call your VA enrollment coordinator (1-877-222-VETS / 1-877-222-8387).
Updates and life changes · With Medicare
VA and Medicare together
You can have both VA health care and Medicare. Neither replaces the other. They cover different things in different ways. Most veterans should enroll in Medicare when eligible, even if they get all their care at the VA.
They are separate programs
VA health care is for veterans only. Medicare is federal insurance for people 65+ or with certain disabilities. Both can pay for your care at different times.
Medicare does not pay for VA care
When you receive care at a VA facility or through VA-authorized community care, the VA pays. Medicare does not duplicate this.
VA does not pay for Medicare-billed care
When you see a doctor outside the VA system without VA authorization, the VA generally will not pay. Medicare will pay if you are enrolled.
Why most veterans should enroll in Medicare anyway
It gives you coverage if you ever cannot or do not want to use VA. Especially valuable if you travel, move, or face long VA wait times. Also: enrolling on time avoids late-enrollment penalties.
Part B late enrollment penalty
If you delay Medicare Part B past your initial enrollment, you pay a 10% penalty for each year you delayed, for life. The VA does not exempt you from this penalty.
Special enrollment period for veterans
Veterans with VA care who lose VA eligibility get a Special Enrollment Period for Medicare. But this protection has limits; enrolling on time is safer.
Coordination of benefits
If you go to a non-VA hospital in an emergency, Medicare pays primary. The VA does not become primary.
Talk to a SHIP counselor about your specific situation
State Health Insurance Assistance Program counselors are free and trained on Medicare. They understand VA-Medicare interactions. Find yours at shiphelp.org.
Updates and life changes · Moving
Moving to a new area
Unlike Medicaid, VA health care follows you across state lines. But you do need to formally transfer your care to a new VA facility, or you may face delays getting appointments.
1
Update your address with the VA
Online at va.gov, in MyHealtheVet, or by calling 1-877-222-VETS. Update before you move if possible.
2
Identify your new VA facility
Use va.gov/find-locations to find the closest VAMC or CBOC to your new address. Call to confirm services offered.
3
Request a transfer
Call the new facility and ask to be transferred. They will request your records from your old facility.
4
Schedule a new patient appointment
New facilities typically require a new patient visit before scheduling specialty care. This may take longer than at your old facility.
5
Ensure prescriptions transfer
VA pharmacy is national. Your prescriptions follow you, but mail-order delivery address must be updated. Update through MyHealtheVet.
6
Reconnect with mental health care
Mental health relationships do not transfer the same way. You may need to start with a new therapist or psychiatrist. Vet Centers are also national; you can transfer to a new one.
Updates and life changes · Caregivers
Enrolling a caregiver
The Program of Comprehensive Assistance for Family Caregivers (PCAFC) is one of the most valuable VA programs and one of the most underused. The 2026 expansion broadened eligibility significantly. If you have a family caregiver helping you, applying is worth it.
1
Confirm eligibility
The veteran must have a serious injury or illness related to military service. As of 2026, both post-9/11 and pre-9/11 veterans are eligible. The caregiver must be at least 18 and provide personal care services.
2
Apply at caregiver.va.gov
The application asks about the veteran's condition, the caregiver's relationship and care responsibilities, and other VA benefits the veteran receives.
3
Complete the medical evaluation
The VA will schedule an in-home or facility-based evaluation to verify the level of care needed. This determines the stipend amount.
4
Approval and onboarding
If approved, the primary caregiver receives training, mental health benefits, and starts receiving the monthly stipend. There may also be respite care available immediately.
5
Annual reassessment
PCAFC participation is reviewed annually. The veteran's condition, the caregiver's role, and the appropriate stipend tier are all reassessed.
If you applied before and were denied as pre-9/11, reapply
The 2026 expansion explicitly opened eligibility to pre-9/11 veterans. Previously denied caregivers should submit a new application.
Help · Talk to someone
There are real people who help, free
You do not have to figure VA on your own. Veterans Service Organizations, the patient advocate at your VA, and the Veterans Crisis Line are all free and exist for this exact purpose.
For most VA questions
Veterans Service Organizations (VSOs)
Free accredited representatives help with claims, appeals, enrollment, healthcare access, and more. American Legion, VFW, DAV, AMVETS, PVA, others.
Crossover questions that do not fit neatly under one topic. Tap any question to see the answer.
Your priority group is the single most important factor in how VA care works for you. It determines:
What care is free: Service-connected conditions are always free regardless of group. Beyond that, lower group numbers (1-6) generally mean fewer or no copays. Higher numbers (7-8) mean copays for most services.
Wait times: The VA prioritizes appointments by group when capacity is constrained. Group 1 generally has shorter waits.
Some services entirely: Group 8 veterans who enrolled after 2003 may face restrictions on certain services.
Your group is set when you enroll and can change based on disability rating updates, income changes, or special authority eligibility. Check your group at va.gov in the My Health section.
If you are eligible for both, you do not have to choose. Most veterans should use both strategically.
Use VA when: The condition is service-connected (free), mental health (free), specialty care the VA does well (cardiology, oncology), prescriptions (much cheaper than Medicare Part D for most veterans), or you live near a good VAMC.
Use Medicare when: You travel and need care away from your VA facility, you face long VA wait times, you need a specialist not available at your VAMC and community care is not approved, or you simply prefer a specific community provider.
The big mistake to avoid: Skipping Medicare enrollment because you have VA care. The Part B late enrollment penalty is permanent and is not waived by VA enrollment. Enroll on time.
A service-connected disability is a medical condition the VA has formally determined was caused or worsened by your military service. This is determined through a VA disability claim process.
Why it matters: Care for service-connected conditions is always free at the VA, regardless of priority group, income, or any other factor. You also receive monthly disability compensation based on your rating.
How to file: A VSO can help at no cost. The process involves submitting evidence (military records, medical records, statements) and may include a Compensation & Pension exam.
It is never too late: There is no time limit to file a service-connection claim. Veterans from any era can file decades after discharge.
PACT Act expansion: Many toxic exposure conditions (burn pits, Agent Orange, radiation) are now presumptively service-connected. If you served in eligible locations and have qualifying conditions, file a claim.
Through the MISSION Act, you can see a non-VA provider at VA expense when you meet any one of six criteria:
1. The VA does not provide the service you need. 2. You live in a state without a full-service VA facility. 3. The VA cannot offer an appointment within 20 days (primary/mental health) or 28 days (specialty). 4. The drive to the nearest VA facility offering the service exceeds 30 minutes (primary/mental health) or 60 minutes (specialty). 5. Your VA primary care provider determines community care is in your best medical interest. 6. You qualified under "grandfathered" provisions of the older Veterans Choice Program.
Always get VA approval first. Going to a non-VA provider without VA authorization generally means the VA will not pay. Emergencies are an exception (call your VA within 72 hours (1-877-222-VETS / 1-877-222-8387)).
Yes. Veterans are targeted heavily by predatory operations. Common ones:
Claims sharks: Companies that charge fees (sometimes $5,000+) to file VA disability claims. This is illegal. Only accredited VSO representatives can charge for accredited services, and most charge nothing for claims.
Fake VA calls: Calls claiming to be from "VA Benefits Department" asking for personal information. The VA does not call asking for SSN or banking details.
Pension poaching: Schemes targeting older veterans receiving pension to move assets into trusts that benefit the company, not the veteran.
VA loan refinance scams: Aggressive marketing for VA-backed home loan refinances that may not benefit you.
Report scams: VA Office of Inspector General hotline at 1-800-488-8244. Also report to the FTC at reportfraud.ftc.gov.
The Appeals Modernization Act created three tracks with different speeds:
Higher-Level Review: 4-5 months on average. Senior reviewer takes a fresh look at existing evidence.
Supplemental Claim: Variable, depends on what new evidence is being reviewed. Often 4-6 months.
Board of Veterans Appeals (Direct Review): ~1 year. No new evidence, no hearing.
Board of Veterans Appeals (Evidence Submission): ~2 years. New evidence considered.
Board of Veterans Appeals (Hearing): 2-3 years. In-person, video, or virtual hearing before a Veterans Law Judge.
U.S. Court of Appeals for Veterans Claims: If denied at the Board, federal court appeal. Adds another year or more.
A VSO representative can help choose the fastest appropriate track for your situation.
Limited circumstances:
CHAMPVA: A separate health insurance program for spouses and children of veterans who are 100% service-connected disabled, who died of a service-connected condition, or who were captured in service. Apply at va.gov/health-care/family-caregiver-benefits/champva.
PCAFC family caregivers: Primary caregivers in the Program of Comprehensive Assistance for Family Caregivers can receive CHAMPVA-like coverage if they have no other insurance.
Survivors: Some surviving spouses and dependent children qualify for VA-paid health care under the Dependents and Indemnity Compensation (DIC) program.
Most general VA medical care is for veterans only. Family members typically need separate coverage (employer, marketplace, Medicare, etc.).
You have options:
Switch facilities: You can transfer to a different VA medical center within your area or move to a different area. Call the new facility to begin transfer.
Change primary care providers: Within the same facility, you can request a different primary care team. Call your VA primary care.
Use community care: If wait times or quality concerns are persistent, you may be eligible for community care through MISSION Act provisions.
File a complaint: Through the patient advocate, then escalate to facility leadership, then to the VISN office, then to the VA OIG if necessary.
Switch to non-VA care entirely: If you have other insurance (Medicare, employer plan, marketplace), you can use that and skip VA. You stay enrolled in VA in case you want to return.
The Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 is the most significant expansion of VA benefits in decades. It establishes presumptive service-connection for many toxic exposure conditions.
Who is covered: Veterans of Vietnam, the Gulf War, post-9/11 conflicts, and others who served in locations with documented toxic exposures (burn pits, Agent Orange, radiation, contaminated water).
What changed: The list of presumptive conditions expanded dramatically. Many cancers, respiratory conditions, and other illnesses are now automatically considered service-connected if you served in qualifying locations.
Why this matters for healthcare: If your condition is now PACT-presumptive, file a claim. Once approved, it becomes service-connected, meaning related care is free and you may receive disability compensation.
How to apply: Submit a disability claim through va.gov, with help from a VSO. The PACT Act made the process more streamlined for these conditions.
Several significant updates:
Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act: Streamlined community care referrals by removing the second-opinion review. When your VA clinician agrees community care is appropriate, no additional approval is needed.
PCAFC expansion: Family caregiver eligibility extended to caregivers of pre-9/11 veterans. Previously the program was limited to post-9/11 veterans.
Mental health community care: Easier access to non-VA mental health care. The 20-day wait time threshold for mental health is now strictly enforced.
2026 copay rate updates: Annual rate adjustments. Verify current rates at va.gov/health-care/copay-rates.
Continued PACT Act implementation: More conditions added to the presumptive list, more veterans receiving service-connection grants.
Data sources & methodology
Federal VA data
Department of Veterans Affairs (va.gov) · Veterans Health Administration · 38 CFR · VA MISSION Act of 2018 · Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (2024) · PACT Act of 2022.
2026 figures and policy
Copay rates published annually by VA. PCAFC expansion to pre-9/11 veterans verified through PCAFC Monthly Stipend Fact Sheet. Community care eligibility per VA Office of Community Care. Veteran Crisis Line operational since 2007.
Free, unbiased help: Veterans Service Organizations (va.gov/vso) · Veterans Crisis Line (988 then press 1) · VA Patient Advocate (va.gov/health/patientadvocate) · State Veterans Affairs offices · SHIP for VA-Medicare coordination (shiphelp.org).
