Ask a Service Officer: VA priority groups

Cajun Comeau, North Carolina Department Service Officer

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 

 

 

Tags: Digital Dispatch