VA Medical Benefits

Updated: April 1, 2020
In this Article

    The VA provides a variety of health care services to veterans and their families. If you are new to VA health care you might not realize you have a multitude of options for medical and non-medical services alike.

    Do you need help with getting a prescription filled with a VA or non-VA provider? Are you interested in finding VA locations near you or nearby a place you frequently travel to? Do you need vision care? Read below for helpful information about these and many other services. If you are not currently signed up for VA health care services, contact your nearest VA regional office for assistance in taking advantage of the VA programs described here.

    Basic VA Health Care Services

    Basic VA health care services include health exams, health education, immunizations, counseling for genetic diseases, mental health services, assisted living programs, and prescriptions written by VA doctors.

    Services also include inpatient hospital care, such as:

    • Surgeries
    • Medical treatments
    • Dialysis
    • Acute care
    • Specialized care
    • Emergency care in a VA hospital, outpatient clinic, or Vet Center
    • Emergency care in a non-VA hospital, clinic, or other medical setting
      • Only under certain conditions

    Ancillary Services

    The VA will cover certain ancillary services recommended by a VA primary care provider. This includes testing to diagnose health conditions, therapy and rehabilitation services, and additional services, including prosthetic items, audiology, and radiation oncology.

    Non-Medical Services

     The VA may cover non-medical services deemed necessary to access medical care. This includes the following programs:

    • Beneficiary Travel Benefits reimburses mileage to eligible veterans and other beneficiaries for travel to and from appointments. Reimbursement may be provided for travel to and from VA health care, or travel to and from VA authorized non-VA health care. It may also be provided for use of either a “common carrier,” such as plane, train, bus, taxi, etc., or a “special mode,” such as ambulance or wheelchair van. In the latter case, use of “special mode” must be medically necessary.
    • Veterans Transportation Services provides veterans with transportation options in order to get to appointments. This program is designed to assist veterans who are visually impaired, elderly, or immobilized due to disease or disability, and who live in remote and rural areas.
    • The Caregiver Support Program offers training, educational resources, and support to caregivers of veterans.

    VA Medical Service Provider Locations

    Once a veteran has signed up for VA health care, he or she is able to choose a VA location to receive services. Locations may include:

    • VA medical centers, which may provide the following care options:
      • Traditional hospital services
        • Surgery
        • Critical care
        • Mental health
        • Physical therapy
      • Medical and surgical specialty services
        • Oncology
        • Geriatrics
        • Neurology
      • Advanced services
        • Organ transplants
        • Plastic surgery
          • Reconstruction or repair for traumatic injury
    • Community-based outpatient clinics (CBOCs)
      • Outpatient services
        • Health and wellness visits
        • Routine appointments
    • Vet Centers
      • Community-based counseling
      • Outreach programs
      • Referral services
    • Mobile Vet Centers
      • Serve rural communities
    • VA Community Living Centers, assisted living centers, or residential centers
      • Intensive nursing care
      • Assistance with independent living tasks
        • Bathing
        • Dressing
        • Medication management
    • In-home services
      • Medical treatment
      • Nursing care
      • Independent living tasks

    VA Referrals to Community Providers

    The VA may refer patients to community providers in the following circumstances:

    • Needed services are not offered at VA location
    • Appointments at nearest VA medical facility are unavailable
      • Within 30 days of the clinically indicated date; or
      • Preferred date of next appointment
    • Nearest VA medical facility is 40 miles from residence
    • Travel by air, boat, or ferry is required to access nearest VA medical facility
    • Travel to nearest VA medical facility is an “excessive burden”
      • Environmental factors
      • Geographic challenges
      • Health issues which make travel difficult

    VA Health Care Provider Assignment

    Once a veteran has signed up for VA health care and has chosen his or her main VA location, a VA health provider team, called a Patient Aligned Care Team (PACT), will be assigned. This team may include the following health care professionals:

    • Primary care provider
      • Main doctor; or
      • Nurse practitioner; or
      • Physician’s assistant
    • Clinical pharmacist
    • Registered nurse (RN) care manager
    • Licensed practical nurse (LPN); or
    • Medical assistant and clerk

    The team will also include the veteran, family members and/or caregivers. Also, if the PACT determines additional services are needed, they will coordinate with other providers, such as specialists or social workers, to join the team.

    PACT Coordination of Health Care Services

    PACTs may either provide or coordinate the following services for veterans:

    • Preventive care
      • Immunizations
      • Screenings for disease
    • Wellness care
    • Wellness education
    • Lifestyle coaching

    PACTs may also provide access to care based on need and preference. This may include any of the following:

    • Visits with primary care provider
    • Visits at group clinics
    • 24/7 telephone care
    • Messaging to PACT through My HealtheVet portal
    • Online educational information

    Because PACTS are assigned, changing a primary care provider will require discussion with either PACT leader or on-staff patient advocate.

    Health Benefits Copays

    Most veterans are eligible for free health care services through the VA. Eligibility is based on two factors:

    • Existence of a condition or disability due to military service
    • Financial assessment or means test at time of enrollment

    Income limits may affect eligibility. If a veteran has income that exceeds VA income limits, or chooses not to complete financial assessment at the time of enrollment, he or she will be required to pay copays for VA health care services.

    Filling Prescriptions by Non-VA Providers

     The VA may fill prescriptions from non-VA providers if the veteran meets the following criteria:

    • Enrolled in VA health care
    • Assigned VA primary care provider
    • VA provider has medical records from non-VA provider
    • VA provider agrees with prescription

    Travel for Appointments

    The VA may assist with travel for appointments, either through providing transportation, or reimbursement of travel expenses. Eligibility for these services is determined by financial need.

    Emergency Medical Care

    In emergency situations, injured persons should either call 911 or go to the nearest emergency room. If the nearest emergency room is not a VA medical center, the VA may cover the cost of emergency care. The nearest VA medical center should be contacted as soon as possible, so a patient transfer or patient administration representative may help to arrange payment. Payment for emergency care in these circumstances will end upon determination by a VA provider that transfer to a VA medical center is safe.

    Accessing VA Medical Care While Traveling

    The VA may provide medical care during travel. Four to six weeks notice should be given, when possible. The following information should also be provided to the PACT:

    • Travel dates
    • Destination(s) and temporary address
    • Phone number
    • Specific health concerns

    Prescription refills may also be mailed to a temporary address in approximately two weeks time.

    Translation Services

    VA medical centers may provide foreign language or American Sign Language services to non-English speakers or the hearing-impaired.

    Vision Care

    The VA may cover routine eye exams and preventive tests, as well as eyeglasses or services for blind or low-vision rehabilitation. Eyeglasses may be covered if: the veteran is disabled due to military service and receiving VA disability payments; is a former POW; is a Purple Heart recipient; receives benefits under Title 38; or receives increased pension due to being permanently housebound and in need of regular skilled care.

    Alternately, eyeglasses may be covered for veterans who are receiving VA care and who have vision problems that are the result of either an illness or the treatment of an illness, such as:

    • Stroke
    • Diabetes
    • Multiple sclerosis
    • Vascular disease
    • Geriatric chronic illnesses
    • A reaction to prescribed medicines
    • Cataract surgery
    • Surgeries of the eye, ear, or brain
    • Traumatic brain injury
    • Polytrauma
    • Functional impairment
    • Cognitive impairment
    • Vision and/or hearing loss

    Dental Care

    VA dental care benefits may cover some or all dental care. Coverage depends on a number of factors, including military service history, current health, and living situation. The VA uses these factors to place veterans into benefits classes, which entitle them to specific benefits assigned to each class. Examples include:

    • Class I, which may qualify for any needed dental work
      • Disability due to military service and receiving compensation
    • Class II, which may qualify for one-time dental care
      • Honorable discharge
      • Applied for dental care within 180 days of discharge or release
      • Per DD214, did not have complete dental exam and all needed dental treatment prior to discharge
    • Class IIA, which may qualify for dental care needed to keep a functioning set of teeth
      • Dental condition due to military combat or trauma, but not receiving disability compensation
    • Class IIB, which may qualify for one-time course of dental work, as determined by a VA dental care provider
      • Participating in Homeless Veterans Dental Program
      • Dental work must be needed for one of the following reasons
        • Relieve pain
        • Job readiness
        • Treat moderate, severe, or complicated and severe gum infections
    • Class IIC, which may qualify for any needed dental care
      • Former POW
    • Class III, which may qualify for dental care to treat conditions that adversely impact health issues incurred due to military service
      • Must be diagnosed by a VA dental care provider
    • Class IV, which may qualify for any needed dental care
      • Unemployable
      • Rated at 100% disabled due to military service
      • Receiving disability compensation
    • Class V, which may qualify for dental work, as determined by a VA dental care provider
      • Enrolled in a voc rehab program
      • Dental work must be needed for one of the following reasons
        • Enter voc rehab
        • Reach goals of voc rehab program
        • Maintain participation in voc rehab
        • Return to voc rehab from “discontinued” status due to illness, injury, or dental condition
        • Transition to and maintain a job during the period of employment assistance
        • Maintain independent living
    • Class VI, which may qualify for dental work to treat dental issues that adversely impact illness or injury
      • Must be determined by a VA dental care provider.

    Assisted Living and Home Health Care

    VA long-term care services are administered in a variety of settings, including nursing homes, assisted-living homes, private group homes, adult day health centers, or a veterans private residence. Services include the following:

    • 24/7 nursing and medical care
      • Pain management
      • Comfort care
    • Physical therapy
    • Independent living tasks
      • Bathing
      • Dressing
      • Meal prep
      • Medication management
    • Caregiver support

    In order to be eligible for VA long-term care services, the following criteria must be met:

    • Enrolled in VA health care
    • VA determination of need for specific service with ongoing treatment and personal care
    • Specific service, or space at a care facility, is locally available

    Other factors may affect eligibility, including insurance coverage or disability due to military service.

    Services Not Covered

    The following services are not covered by the VA:

    • Medication and medical devices not approved by the FDA
      • Exceptions made in 2 special cases
        • Approved clinical trials; or
        • Compassionate use or expanded access exemption
    • Abortion
    • Abortion counseling
    • Cosmetic surgery
      • Exceptions made in cases where the VA has determined medical necessity
        • Prevention or treatment of a certain injury, illness, disease, condition, or symptoms
    • Gender reassignment surgery
    • Health club membership
    • Spa membership
    • Non-VA inpatient hospital
    • Non-VA outpatient care
    • Inmate in non-VA government agency institution
    Written by Team