Copayment Requirements by Priority Group - Veterans Affairs
IB 10-431 May 30, 2019
Copayment Requirements by Priority Group
Enrolled Veterans will be assessed copayments for VA health care based on their eligibility and/or income on file in the VA Enrollment System. For care furnished through the Veterans Community Care Program, the same copayment requirements will apply. VA will determine the Veteran's copayment obligation after the service is provided. For information on Copayment Rates, see fact sheet IB 10-430 and Enrollment Priority Groups, see fact sheet IB 10-441.
Inpatient Hospital Care
Priority Group 1
No
Priority Group 2
No
Priority Group 3
No
Priority Group 4
No
Priority Group 5
No
Priority Group 6
*Yes
Priority Group 7
Yes
Priority Group 8
Exceptions (*)
No copayment when related to special authority
Yes
Outpatient Medical Care
No copayment when related to special authority
No
No
No
No
No
*Yes
Yes
Yes
Medication
No
*Yes
*Yes
No
*Yes
*Yes
Yes
Extended Care
Services
No
No
No
*Yes
*Yes
*Yes
Yes
Urgent Care (Community Care)
*Yes
*Yes
*Yes
*Yes
*Yes
*Yes
Yes
No copayment when prescribed for serviceconnected condition; former Prisoner of War
Yes (POW); income is below applicable threshold;
or when related to special authority
No copayment when catastrophically disabled and for non-institutional extended
Yes care services; income is below applicable
threshold; or when related to special authority
No copayment for first 3 visits in a calendar year; or when related to special authority
Yes
IB 10-431
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