Google +LinkedInPinterestYouTubeInstagramTwitterFacebook

Ask a Service Officer: VA priority groups

Featured in Digital Dispatch

Q. Am I eligible for enrollment in the VA’s health care Priority Groups?

A. Since VA funding from Congress is limited, VA set up eight Priority Groups to make sure that certain groups of veterans are able to be enrolled before others. Based on your specific eligibility status, you will be assigned a Priority Group, which range from 1 to 8 with 1 being the highest priority for enrollment.

  • Priority Group 1: Veterans with a 50 percent or higher service-connected rating and/or determined by VA to be unemployable.
  • Priority Group 2: Veterans with service-connected disabilities rated 30 percent or 40 percent.
  • Priority Group 3: POW, Purple Heart recipients and veterans who were discharged for disabilities incurred or aggravated in the line of duty, service-connected at 10 percent or 20 percent and receiving benefits under 38 US Code 1151 or vocational rehabilitation.
  • Priority Group 4: Veterans in receipt of compensation or pension at the housebound or aid and attendance rate, and/or veterans determined by VA to be catastrophically disabled.
  • Priority Group 5: Non-service-connected veterans and noncompensable service-connected veterans rated 0 percent and/or with net worth not greater than VA financial thresholds, and veterans receiving pension benefits or eligible for Medicaid.
  • Priority Group 6: Veterans who are 0 percent service-connected, exposed to ionizing radiation, served in Vietnam from 1962 to1975, served in a combat theater and were discharged after Jan. 28, 2003 (for a period of five years after discharge).
  • Priority Group 7: Veterans with income below the geographically-adjusted income threshold for their resident location and agrees to pay copays.
  • Priority Group 8: Veterans with gross household incomes above the VA national income threshold and agrees to pay copays.

If you do not fall into one of the Priority Groups, you may still be eligible for enrollment into the system. See your local VA medical center eligibility advisor for details of your eligibility. You may also use the Priority Group 8 calculator: www.military.com/ContentFiles/Priority-Group-8-Enrollment-Calculator.html

It is important to remember that although you may not be enrolled in a Priority Group, you may still be eligible for care should you experience a catastrophic health event. This is why it’s important to enroll in the VA health care system using VA Form 10-10EZ.

Do you have a claims question? Email it to: askso@legion.org 

 

 

 

Veronica

March 24, 2014 - 5:23pm

How does the VA verify eligibility? Do they do an in-person exam to determine the service-connected rating? Will this be performed by an actual VA doctor? Thanks.

Vincent - Veteran (1984 - 1988, Honorably))

March 2, 2014 - 8:47pm

You can, assuming your VA doctor is prescribing them, not an outside doctor. And of course, you first need to be an enrollee in the VA Healthcare System. Based on your last sentence, you would be enrolled in as a "Priority 8" enrollee. Now, with that said, and because your income is higher, you would be expected to pay all co-pays, which are more than fair. There are NO deductibles or enrollment fees currently. This all can change if the VA budget is reduced and you are "disenrolled." YES, it can happen from what I've been reading. For my sake and fellow "honorably" discharged veterans in "Priority 8" and also "Priority 7", this is a REAL possibility now. I'm just grateful up to this point, what the VA has allowed me. It appears that the writing is on the wall to disenroll millions of Priority 7 & 8's someday. Good Luck, Vincent

Jimmie Adams

January 17, 2014 - 9:44am

Why is it that a honorably discharged veteran can't receive there prescribed medical supplies through the VA. They say that the person makes too much money. is that true?

Add new comment

By submitting this form, you accept the Mollom privacy policy.

Tell us what you think