Some Veterans are required to make copays to receive VA health care and/or medications.
Inpatient Care: : Priority Group 7 and certain other Veterans are responsible for paying 20 percent of VA’s inpatient copay or $226 for the first 90 days of inpatient hospital care during any 365-day period. For each additional 90 days, the charge is $113. In addition, there is a $2 per diem charge.
Priority Group 8 and certain other Veterans are responsible for VA’s inpatient copay of $1 ,132 for the first 90 days of care during any 365-day period. For each additional 90 days, the charge is $566. In addition, there is a $10 per diem charge.
Extended Care: For extended care services, Veterans may be subject to a copay determined by information supplied by completing a VA Form 10-10EC. VA social workers can help Veterans interpret their eligibility and copay requirements. The copay amount is based on each Veteran’s financial situation and is determined upon application for extended care services and will range from $0 to $97 a day.
Outpatient Care: A three-tiered copay system is used for all outpatient services. The copay is $15 for a primary care visit and $50 for some specialized care. Compensable Service-connected Veterans and Veterans determined to be Catastrophically Disabled are exempt from copay requirements for inpatient and outpatient medical care for service-connected and non-service connected treatment. Non compensable zero percent service-connected Veterans may be required to complete a copay test to determine if copay requirements are required for treatment of their non service-connected conditions.
The copay amount is limited to a single charge per visit regardless of the number of health care providers seen in a single day. The copay amount is based on the highest level of service received. There is no copay requirement for preventive care services such as screenings and immunizations.
Outpatient Visits Not Requiring Copays: Certain services are not charged a copay. Copays do not apply to publicly announced VA health fairs or outpatient visits solely for preventive screening and or vaccinations, such as vaccinations for influenza and pneumococcal, or screening for hypertension, hepatitis C, tobacco, alcohol, hyperlipidemia, breast cancer, cervical cancer, colorectal cancer by fecal occult blood testing, education about the risks and benefits of prostate cancer screening, HIV testing and counseling, and weight reduction or smoking cessation counseling (individual and group). Laboratory, flat film radiology, electrocardiograms, and hospice care are also exempt from copays. While hepatitis C screening and HIV testing and counseling are exempt, medical care for HIV and hepatitis C are NOT exempt from copays.
Medication: Non-service connected Veterans in Priority Group 7 and 8 are charged $9 for each 30-day or less supply of medication provided by VA for treatment of non-service connected conditions.Veterans enrolled in Priority Groups 2 through 6 are charged $8 for each 30-day or less supply of medication; the maximum copay for medications that will be charged in calendar year 20I0 is $960 for non-service connected medications The following groups of veterans are not charged medication copays: 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 who are determined to be Catastrophically Disabled; 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 medication for treatment of cancer of the head or neck; Veterans receiving medication for a VA-approved research project; and former POWs.
NOTE: Copays apply to prescription and over-the-counter medications, such as aspirin, cough syrup or vitamins, dispensed by a VA pharmacy. However, veterans may prefer to purchase over-the-counter drugs, such as aspirin or vitamins, at a local pharmacy rather than making the copay. Copays are not charged for medications injected during the course of treatment or for medical supplies, such as syringes or alcohol wipes.
HSA/HRA: Health Savings Accounts (HSA) cannot be utilized to make VA copays. In addition, if the Veteran receives any health benefits from the VA or one of its facilities, including prescription drugs, in the last three months, he/she will not be eligible for an HSA. Health ReimbursementArrangements (HRA) is not considered health plans and third party payers cannot be billed.