VA Priority Groups

The Veterans Health Administration (VHA) operates and maintains a nationwide network of medical treatment centers, medical research centers and information resource centers. Through its nationwide network of facilities, the VHA provides inpatient and outpatient care, geriatric evaluations, nursing home care and domiciliary, home health, adult day, residential / respite care programs for veterans.

To receive health care through the VHA, a veteran must “enter the system”. To enter the system, the veteran must complete and file a VA Form 10-10EZ – Application for Medical Benefits (Enrollment Form). The primary purpose of the enrollment for is to request enrollment in the VA Health Care System.  Typically, veterans who have not previously enrolled or applied for VA health benefits should use VA Form 10-10EZ.

In addition to completing VA Form 10-10EZ, the veteran must also get medically evaluated by a VA doctor to “enter the system”. Unfortunately, it can take up to two years for the VA to schedule the medical evaluation after receiving Form 10-10EZ. Thereafter, once the medical evaluation is completed, the veteran is assigned to a “Priority Group”. Access to the VA health care system is determined through assignment to a Priority Group. There are 8 Priority Groups to which a veteran can be assigned:

Priority Group 1 – Includes veterans with VA-rated service-connected disabilities of 50% or more disabling, and veterans determined by the VA to be unemployable due to service-connected conditions.

Priority Group 2 – Veterans with VA-rated service-connected disabilities of 30% to 40% disabling.

Priority Group 3 – Veterans who are former prisoners of war; veterans awarded a purple heart medal; veterans who were discharged for a disability that was incurred or aggravated in the line of duty; veterans with VA-rated service-connected disabilities of 10% to 20% disabling; veterans disabled by “treatment or vocational rehabilitation”.

Priority Group 4 – Veterans who are receiving aid and attendance or housebound benefits, and veterans who have been determined by the VA to be catastrophically disabled.

Priority Group 5 – Non-service connected veterans and non-compensable service-connected veterans rated as 0% disabled by the VA and whose annual income and net worth are below the VA national income threshold; veterans receiving VA pension benefits; and, veterans eligible for Medicaid programs.

Priority Group 6 – World War I veterans; compensable 0% service-connected veterans; veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki; Project 112/SHAD participants; currently enrolled vets and new enrollees who were discharged from active duty on or after January 28, 2003; and, veterans discharged from active duty before January 28, 2003 and who apply for enrollment on or after January 28, 2008.

Priority Group 7 – Includes veterans with income and/or net worth above the VA national income threshold and income below the geographic income threshold who agree to pay co-pays.

Priority Group 8 – Veterans with income and/or net worth above the VA national income threshold and the geographic income threshold who agree to pay co-pays. Priority Group 8 includes Subpriority Groups a, c, e and g.

As of January 2008, Subpriority Groups 8e and 8g are not eligible for enrollment in the VHA as a result of the high demand for VA health care combined with the limited resources available to treat such individuals. Subpriority Groups 8e and 8g are veterans who do not have service-connected disabilities and who have high net worth and income.

As a general rule, veterans in Priority Groups 2 through 6 are not required to pay co-payments for inpatient services, outpatient services, and long-term care services. In other words these services are free.

Veterans in Priority Groups 7 and 8 generally must pay co-pays.

Importantly, veterans receiving VA pension benefits — regardless of that veteran’s income – are assigned to Priority Group 5. Veterans in Priority Group 5 can enroll in the VA health system and receive free inpatient care, outpatient care and long term care. They have no co-payments for medical services. However, Priority Group 5 veterans must pay VA prescription drug co-pays unless that veteran’s household income is below the current maximum income rate for pension benefits.