What should I know about VA healthcare?

Contents

• What is VA health care?
• Who is eligible?
• What are my rights and responsibilities with VA health care?

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What is VA health care?

If you served in the military, you might be eligible for health care from the Department of Veterans Affairs (VA). VA health care benefits may include:

• Inpatient and outpatient care at VA medical facilities,
• Mental health care
• Prescription drug coverage,
• Long-term care, and
• Care from other providers if the VA cannot provide help.

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Who is eligible?

You may be eligible for VA health benefits if:

• You served on active duty in the : 

  • Military, 

  • Reserves, or 

  • National Guard. If you were part of the Reserves or National Guard you must have been called to active duty by a federal order and completed your full-term of service. If you were only on active-duty status for training purposes you are not qualified for VA health care.

• You didn’t get a dishonorable discharge.

 

Some Veterans must be a minimum duty requirement. If you enlisted after September 7, 1980, or you entered active duty after October 16, 1981, you must have:

• Served for 24 months straight, or

• The full period you were called to active duty.

 

You must meet the minimum duty requirement to get health benefits UNLESS:

• You were discharged by a disability that was caused or made worse by your service, or

• You were discharged for a hardship or “early out” or

• You served before September 7, 1980.

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What are my rights and responsibilities with VA health care?

If you meet the eligibility requirements for VA health care, you have a right to the benefits. It is your responsibility to apply for these benefits, or have someone apply on your behalf.

 

If you are denied benefits or disagree with any other VA decision, you have the right to file an appeal. You are responsible for following the appeals process and meeting deadlines.

 

Once you are approved for benefits, you have rights and responsibilities as a VA patient. These include:

• You have the right to be treated with respect.

• You have the right to be free from discrimination.

• You have the right to access your health information.

• You have the right information about the costs of your health care. 

  • You are responsible for paying your portion of these costs.

• The VA must keep your health record confidential.

• You have the right to be involved in all decisions about your care.

• You are responsible for providing information to your care team about your conditions and preferences.

• You have the right to make complaints about your care.

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Contents

• How can I apply for VA health care benefits?
• What is a VA priority group and how is it assigned?
• How can I appeal a VA health care decision?

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How can I apply for VA health care benefits?

To fill out the application, you’ll need:

• Your Social Security number

• A copy of your discharge papers (DD214 or separation documents),

• Financial information for you and your dependants,

• Your most recent tax return, and

• Account numbers for your current health insurance (if any). 

 

You can apply for VA health care:

• Online,

• By phone. Call 1-800-222-8387.

• In person at your local VA medical center or clinic.

• By mail. Fill out an Application for Health Benefits (Form 10-10EZ). Mail the application to:

  • Health Eligibility Center

2957 Clairmont Rd., Suite 200

Atlanta, GA 30329

 

The VA should give you a decision on your application within a week. If more than a week goes by before you hear back about your application, call the VA at 877-222-8387.

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What is a VA priority group and how is it assigned?

When you apply for VA health care, you will be assigned a priority group. Your group will be from 1 to 8. Your priority group affects:

• How soon you’re signed up for benefits, and 

• How much you’ll have to pay towards the cost of your care.

 

Veterans in the lowest number priority groups will be signed up quickly.

 

Priority groups are based on:

• Military service history,

• Disability rating,

• Income level,

• If you qualify for Medicaid, and 

• Other benefits you might be getting. 

 

You might qualify for a higher priority group if you:

• Receive financial compensation (payments) from VA for a service-connected disability

• Were discharged for a disability resulting from something that happened to you in the line of duty

• Were discharged for a disability that got worse in the line of duty

• Are a recently discharged combat Veteran

• Get a VA pension

• Are a former prisoner of war (POW)

• Have received a Purple Heart

• Have received a Medal of Honor

• Get (or qualify for) Medicaid benefits

• Served in Vietnam between January 9, 1962, and May 7, 1975

• Served in Southwest Asia during the Gulf War between August 2, 1990, and November 11, 1998

• Served at least 30 days at Camp Lejeune between August 1, 1953, and December 31, 1987

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How can I appeal a VA health care decision?

You can file an appeal if you disagree with any decision from the VA, including if you are denied health care.

 

You can have a representative to help with your appeal. This process can take years to complete. To appeal a decision:

• File a Notice of Disagreement. You must file your notice within one year of the date on the letter notifying you of the decision. Mail the notice to the address on the decision letter.

• Statement of the Case. After you file the Notice of Disagreement, your file will be reviewed by a Decision Review Officer. The officer will decide whether you have enough evidence to grant your appeal. They will send this decision in a Statement of the Case.

• VA Form 9. If you disagree with the Statement of the Case, you need to return the VA Form 9 within 60 days. 

  • This is your last chance to send any additional evidence for the VA to review.

• Appeal to the Board. Your case will be sent to the Board of Veterans’ Appeals. A judge will review your case. 

• Hearing. If you wish, you can request a hearing with a Veterans Law Judge.

• Decision. The Board will decide to:

  • Allow benefits,

  • Ask for more evidence, or

  • Deny benefits.

• Court of Appeals. If you disagree with the Board’s decision, you can appeal to the Court of Appeals for Veterans Claims. You must appeal within 120 days.

 

What if I can’t wait years for an appeal of a VA decision?

You can ask for your appeal to be moved to the front of the line if you:

• Are 75 years old or older, 

• You have a serious illness,

• Are having major financial problems, or

• You have some other good reason.

This is called having your appeal Advanced on Docket. You make this request by writing to the Board of Veterans’ Appeals.

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