VA Priority Groups

Updated: May 13, 2020

Table of Contents

    VA Priority Groups The Department of Veterans’ Affairs assigns Enrollment Priority Groups (1-8) with 1 being the highest priority. An individual’s priority group is assigned based on the level of a veteran’s needs and how much it will cost the VA to treat them. If a member qualifies for more than one priority group, the VA will always place the member in the highest group that they qualify for. Being enrolled in the VA ensures that Veterans will continue to receive the medical care and support they deserve, long after they’ve served their country. The number of veterans in a specific priority group is determined by how much money the VA has available to them. Your copay will change depending on what priority group you are assigned to.


    VA Priority Groups


    VA Priority Group 1

    • Veterans with service-connected disabilities rated by VA as 50% or more disabling.
    • Veterans determined by VA to be unemployable due to service-connected conditions.
    • Veterans who have been awarded the Medal of Honor (MOH).

    VA Priority Group 2

    • Veterans with service-connected disabilities rated by VA as 30% or 40% disabling.

    VA Priority Group 3

    • Veterans who are former Prisoners of War (POWs).
    • Veterans who have been awarded a Purple Heart medal.
    • Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty.
    • Veterans with service-connected disabilities rated by VA as 10% or 20% disabling.
    • Veterans who have been awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”

    VA Priority Group 4

    • Veterans who receive aid and attendance or housebound benefits from VA.
    • Veterans who have been determined by VA to be catastrophically disabled.

    VA Priority Group 5

    • Veterans with a nonservice-connected or non-compensable service-connected disability and Veterans rated by VA as 0% disabled and who have an annual income below the VA’s geographically-adjusted income limit (based on your resident ZIP code).
    • Veterans receiving VA pension benefits.
    • Veterans eligible for Medicaid programs.

    VA Priority Group 6

      • Veterans with a compensable 0% service-connected disability.
      • Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki.
      • Project 112/SHAD participants.
      • Veterans of the Mexican border period or of World War I.
      • Veterans who served in the Republic of Vietnam between Jan. 9, 1962, and May 7, 1975.
      • Veterans of the Persian Gulf War who served between Aug. 2, 1990, and Nov. 11, 1998.
      • Veterans who served on active duty at Camp Lejeune for at least 30 days between Aug. 1, 1953, and Dec. 31, 1987.
      • Currently enrolled Veterans and new enrollees who served in a theater of combat operations after Nov. 11, 1998, and those who were discharged from active duty on or after Jan. 28, 2003, are eligible for the enhanced benefits for five years post discharge.

    Note: At the end of this enhanced enrollment priority group placement time period, Veterans will be assigned to the highest PG for which their status at that time qualifies.

    VA Priority Group 7

    • Veterans with gross household income below the geographically-adjusted VA income limit for their resident location and who agree to pay copayments.

    VA Priority Group 8

    • Veterans with gross household incomes above the VA income limits and the geographically- adjusted income limits for their resident location, and who agree to pay copayments.

    VA Health Care Enrollment/Eligibility

    If you’ve served in the active military, naval or air service, did not receive a dishonorable discharge and served 24 continuous months on active duty, you may qualify for VA health care benefits. There are a few ways to verify your eligibility.

    1. Phone: 1-877-222-VETS (8387) Monday – Friday 8am – 8pm ET
    2. Online: Filling out an application at Vets.gov
    3. In person: Visit your nearest VA health care facility.
    4. Mail: Download application from vets.gov/healthcare/apply/. Once competed, mail the application to

    Health Eligibility Center
    Enrollment Eligibility Division
    2957 Clairmont Road Suite 200
    Atlanta, GA 30329-1647

    Veterans eligible for enrollment: Veterans who are rated with a noncompensable 0% service-connected and are:

    • Subpriority a: enrolled as of Jan. 16, 2003, and who have remained enrolled since that date and/or were placed in this subpriority due to changed eligibility status.
    • Subpriority b: enrolled on or after June 15, 2009, and whose income exceeds the current VA income limits or the geographically-adjusted VA income limits by 10% or less.

    Veterans eligible for enrollment: Veterans who are nonservice-connected and:

    • Subpriority c: enrolled as of Jan. 16, 2003, and who have remained enrolled since that date and/or were placed in this subpriority due to changed eligibility status.
    • Subpriority d: enrolled on or after June 15, 2009, and whose income exceeds the current VA income limit and geographic income limit by 10% or less.

    Veterans not eligible for enrollment: Veterans not meeting the criteria above:

    • Subpriority e: noncompensable 0% service-connected (eligible for care of their service-connected condition only).
    • Subpriority g: nonservice-connected.

    VA Copays & Priority Groups

    Medications

    Priority Group 1: Veterans in this group will not have to pay for medications.

    Priority Group 2-8: Veterans in groups 2-8 are required to pay for each 30-day or less supply of medication for treatment of nonservice-connected condition (unless exempted).

    Inpatient Services

    VA Priority Group 7

    • Inpatient Copay for first 90 days of care during a 365-day period $272.80
    • Inpatient Copay for each additional 90 days of care during a 365-day period $136.40
    • Per Diem Charge $2/day

    VA Priority Group 8:

    • Inpatient Copay for first 90 days of care during a 365-day period $1,364
    • Inpatient Copay for each additional 90 days of care during a 365-day period $682
    • Per Diem Charge $10/day

    There are three reasons veterans get charged a copay.

    1. The care the individual needs is not a service-related injury.
    2. The individual’s income exceeds a certain threshold.
    3. The veteran’s income information is not available.

    If a veteran is living in a high cost area, they may qualify for a reduced inpatient copay.

    Copays can be paid in person, over the phone and online.


    VA Travel Reimbursement

    If a VA member falls under the following, he/she may be eligible to receive reimbursement for mileage or public transportation.

    1. Veterans with service-connected disabilities rated at 30% or more;
    2. Veterans traveling for treatment of a service-connected condition;
    3. Veterans receiving a VA pension;
    4. Veterans traveling for scheduled compensation or pension examinations;
    5. Veterans whose income does not exceed the maximum VA pension rate;

    Mileage reimbursement is made at the current rate of 41.5 cents per mile. The deductibles are $3 for a one-way trip, $6 for a round trip, with a maximum of $18 per calendar month. However, these deductibles can be waived if they cause a financial hardship to the veteran.

    The deductible is also waived for veterans traveling for scheduled compensation or pension examinations.


    For any questions, contact the VA toll-free at 877-222-VETS (8387), online (vets.gov), by mail or in person by visiting any VA health care facility.

    Written by MilitaryBenefits