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VA Requirements for Medical Coverage

The Veterans' Administration is charged with providing a Medical Benefits Package to enrolled veterans. The coverage is comprehensive and provides a full range of both outpatient and in-facility services within the VA health system, and veterans can be seen at any of the 1,400 VA facilities around the country once enrolled. VA annually evaluates eligibility to be certain that each veteran receives the most possible benefits with the limited funds available, and each veteran is put into a Priority Group, which is dependent upon military service, any service-related disabilities, and current income levels, among other factors. Priority Group 1 receives the maximum benefits.

  1. Military Service

    • In general, the rule is that 24 months of active duty military service qualify a person for VA medical benefits. There are numerous exceptions to this rule: there is no length of service rule for enlisted Veterans that began active duty before September 8, 1980, or officers who began active duty before October 17, 1981. Eligibility for most benefits is based on service in the Army, Navy, Air Force, Marines, or Coast Guard, and WWII Merchant Marines, and discharged under other than dishonorable conditions.

      Reserve members and National Guard members called to active duty by a Federal Executive Order usually will qualify for benefits. Returning members who served on active duty in a theater of combat operations have special eligibility for medical services, hospital and nursing home care for the five years following discharge from active duty.

    Service Related Disabilities

    • Veterans with service-connected disabilities go into the highest priority groups. For instance, those veterans with more than a 50% disability, or those deemed unemployable due to disabilities, are Priority Group 1. Veterans with 30% to 40% disability are categorized as Priority Group 2, and those with 10% or 20% belong to Priority Group 3.

      Former POW's also qualify for Priority Group 3, as do those veterans awarded a Purple Heart. In the lower tiers, Priority Group 6 includes those who've been discharged since January 28, 2003, for a period of not less than five years.

    Income Requirements

    • Barring inclusion in any of the other Priority Groups, Priority Group 7 will also include those veterans whose income is below the GMT or geographically adjusted income level for where they live. They also must agree to co-pays.

      Priority Group 8 now includes those whose income is above the VA income thresholds by 10% or less, and these veterans must also agree to co-pays.

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