VA Health Care Benefits & Legal Eligibility
You may be eligible to receive VA health care benefits if you served on active duty in the U.S. military and did not receive a dishonorable discharge. Veterans who enlisted after September 7, 1980 or who started serving on active duty after October 16, 1981 must have served for 24 consecutive months, unless they received a discharge based on a service-related disability or a hardship. If you served in the military before those dates, no minimum service requirement applies. People who served in the National Guard or the Reserve may be eligible if they served on active duty by federal order and completed their full period of service.
VA hospitals and clinics across the U.S. provide roughly the same scope of services. Your benefits may cover not only doctors’ appointments and in-patient hospital services but also mental health care, emergency services, and other types of medical treatment. If you are suffering from a spinal cord injury or condition, you can receive treatment at a VA center dedicated for that purpose. If you are suffering from the aftermath of sexual trauma during active duty, you can receive counseling and health care for any related psychological and physical conditions, even if you are not otherwise eligible for VA health care benefits.
Applying for VA Health Care
You may be automatically enrolled for health care benefits if you have a disability related to your service, for which your disability rating is at least 50 percent. The VA also may grant automatic enrollment in the first year after your discharge if you have a service-related disability that does not yet have a rating. Another situation in which you may get automatic enrollment is if your only reason for getting care is to treat a service-related disability.
In other cases, you can apply for VA health care benefits online, by phone, or in person. The VA not only will determine whether you are eligible and can be enrolled but also which priority group you are assigned and whether you will need to make co-payments. You can appeal a denial of benefits if you believe that the VA made a mistake. The notification will inform you about the steps required for an appeal.
Priority Groups
The Veterans Health Administration has recognized that its resources are overstretched and that it cannot provide all veterans with care. It will assign each applicant to one of eight priority groups, which affects how soon they will be enrolled for benefits and how much they will need to pay toward their medical costs. Some veterans may be eligible for two or more groups, in which case the VA will place them in the group with the highest priority. Factors that affect placement include a veteran's military service history, disability rating, income level, and Medicaid eligibility.
The rules governing placement in priority groups are very technical. If you received a military honor or spent time as a prisoner of war, you likely will receive priority. If you have a disability related to your service, your disability rating will affect your priority group. Financial exigency is another factor that the VA will consider. If you were recently discharged following service in combat, you have five years in which you have priority status to enroll in the program. You can do this even if you do not currently need treatment through the VA so that your entitlement is established for the future.
The VA applies an annual income threshold to determine whether an applicant is eligible for benefits. Veterans who are receiving disability compensation or a pension should not have trouble meeting this threshold. Otherwise, they may need to send financial information to the VA to prove their eligibility.
