When receiving VA health care, some veterans must make copays. Arm yourself with this knowledge before you need it, and add these expenses to your monthly budget and emergency fund as required.
Priority Group 7 (and certain other) veterans will pay 20 percent of the VA’s inpatient copay or $204.80 for the first 90 days of inpatient hospital care during any 365-day period. The charge decreases to $102.40 for each additional 90 days. Additionally, there is a $2 per diem charge.
The copay increases significantly for Priority Group 8 (and certain other) veterans. For the first 90 days of care during any 365-day period, the veteran is responsible for the VA’s inpatient copay of $1,024 and $10 per day. For each additional 90 days, the copay is $512 plus a $10 per diem charge.
The extended care copay amount is based on each veteran’s financial situation and will range from $0 to $97 per day. The copay determination is based on the information supplied by the veteran when completing a VA Form 10-10EC. VA social workers can help you interpret your eligibility and copay requirements.
For each 30-day or less supply of medication provided by VA for conditions that are not service-connected, most veterans are charged an $8 copay. The maximum copay for medications in 2008 is $960 for Priority Groups 2 through 6.
Some veterans are not charged copays for medication. These groups include:
- veterans with a service-connected disability of 50 percent or more
- veterans receiving medication for service-connected conditions
- veterans whose annual income does not exceed the maximum annual rate of the VA pension
- veterans enrolled in Priority Group 6 who receive medication under their special authority
- veterans receiving medication for conditions related to sexual trauma related to service on active duty
- certain veterans receiving mediation for treatment of cancer of the head or neck
- veterans receiving medication for a VA-approved research project
- former POWs
For outpatient care services, a three-tiered copay system is used. Certain services are not charged copay. The copay is $15 for a primary care visit and $50 for some specialized care.