Healthcare

Basic Eligibility Information

If you served in the active military and were separated under any condition other than dishonorable, you may qualify for VA healthcare benefits. Current and former members of the Reserves or National Guard who were called to active duty (other than active duty for training) by a federal order and completed the full period for which they were called or ordered to active duty may be eligible for VA healthcare as well. Veterans who enlisted after September 7, 1980, or officers who entered active duty after October 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible. The minimum duty requirement may not apply to veterans who were discharged for a disability incurred or aggravated in the line of duty, for a hardship, or for early out.

Enrollment is not automatic, There are determining factors for enrollment into VA healthcare.

The following are special priority groups for enrollment;

  • A former Prisoner of War; or
  • Those in receipt of a Purple Heart; or
  • A recently discharged Combat Veteran (within five years of discharge); or
  • Those discharged for a disability incurred or aggravated in the line of duty; or
  • Those receiving VA Service Connected disability (SCD) compensation; or
  • Those receiving VA pension; or
  • Those in receipt of Medicaid benefits; or
  • Those who served in Vietnam between January 9, 1962, and May 7, 1975; or
  • Those who served in SW Asia during the Gulf War between August 2, 1990, and November 11, 1998; or
  • Those who served at least 30 days at Camp Lejeune between August 1, 1953, and December 31, 1987.

For certain Veterans, the annual income means test may be a factor in the determination of eligibility for VA healthcare enrollment. Veterans who are below the annual income limits are eligible for healthcare. For more information, visit the Veteran Affairs Website. Co-pays will be based on income. Every year the VA will check with other federal agencies to determine income changes and if co-payment is required.

For Veterans who have a service-connected disability at 0%, but are not compensable (SCD 0%), they will receive medical treatment for their service-connected disability only. However, if the Veteran meets the requirements of the income test they may be eligible for VA healthcare enrollment.

Finally, if an individual received a discharge "under other than honorable conditions," that person may still be eligible for treatment at a VA medical facility for disabilities determined to be service connected unless the individual is subject to one of the statutory exemptions to benefits specified in 38 USC. § 5303.

Enrollment

Veterans meeting the requirements above should call our office for an appointment. We will help you fill out the required form and send it to the VA. The Veteran will receive a call from the VA to schedule three appointments. The first is a pharmacy call to learn about your current medications, the second appointment is to meet with an administrative assistant to complete your personal record, and the third is an appointment to see your primary care physician (PCP).

A Benefit Is Not Insurance

VA healthcare is not medical insurance, it simply means you are in the VA healthcare system and can receive medical treatment from the VA Medical Center or VA Clinic to which you are assigned. This benefit is only for the veteran, not family members. VA healthcare will not pay for routine treatment at a non-VA medical facility unless you were pre-approved to receive this treatment. This is called "VA Care in the Community." During a medical emergency, Veterans should immediately seek care at the nearest medical facility. A medical emergency is an injury, illness, or symptom so severe that without immediate treatment, you believe your life or health is in danger. If this happens, you should ask the facility to bill the VA because if they bill Medicare for another insurance, the VA will not pay the co-pay for the bill.