As a United States veteran, your eligibility for health care benefits from the U.S. Department of Veterans Affairs depends on your position within the VA’s priority enrollment groups system. This system determines which groups of veterans have the most immediate and significant needs and provides them with tiered benefits. Keep reading to learn about the group you are likely to be assigned to and how it impacts your access to health care benefits.
VA Priority Groups
- VA Priority Group 1
- VA Priority Group 2
- VA Priority Group 3
- VA Priority Group 4
- VA Priority Group 5
- VA Priority Group 6
- VA Priority Group 7
- VA Priority Group 8
The VA places great importance on providing high-quality health care to U.S. veterans after they have completed their service. To ensure that veterans receive the medical care they need in a timely manner, the VA has established a system that prioritizes veterans into groups based on their medical needs, required care, and income level in some cases. This helps veterans with the most urgent needs receive prompt access to essential healthcare coverage, while also ensuring that all enrolled veterans receive high-quality care.
What is a priority group?
If you’re a U.S. veteran who completed active military, naval, or air service with a discharge other than dishonorable, and served for at least 24 consecutive months on active duty, you may qualify for VA health care benefits. However, the benefits you’re eligible for and the speed at which you can enroll in the VA benefits program may depend on the priority group to which you’re assigned.
The VA assigns enrollment priority to veterans based on the level of medical care they require and the associated costs. Veterans in Group 1 have the highest priority, followed by other groups in descending order of priority. The enrollment group you’re assigned to may also impact the co-payment amount you’re responsible for as part of your medical care.
How your Priority Group is determined
The VA will assign you to a priority group based on your medical needs and the costs the VA must cover to meet those needs. If you qualify for multiple groups, the VA will assign you to the group with the highest priority level to ensure your most pressing medical needs are met. The number of veterans in each priority group is determined by the amount of money the VA can spend on that group.
In addition to your medical needs, the VA will consider your service history, disability rating, income level, Medicaid eligibility, and other benefits you may receive, such as a VA pension. Veterans with severe service-connected disabilities are given the highest priority, while those with high incomes and non-service-related disabilities that do not qualify for VA disability benefits are given the lowest priority.
It’s important to note that your priority group assignment is not permanent and can change if there is a significant adjustment to your income or if a service-connected disability worsens, leading to a change in your disability rating.
8 VA Priority Groups for VA Health Care
The VA categorizes priority groups according to the following categories.
VA Priority Group 1
Veterans in Priority Group 1 have disabilities rated by the VA as 50% or higher, have been deemed unemployable due to a service-related condition, or are Medal of Honor recipients. This group does not have to pay for medications and typically does not have to pay a copayment for medical services.
VA Priority Group 2
Priority Group 2 includes veterans with service-connected disabilities rated by the VA as between 30% and 40% disabling. However, veterans in this group must pay for each 30-day or smaller supply of medication for non-service-connected medical conditions, unless exempted. They may also have to pay copayments for other medical services provided by a VA facility.
VA Priority Group 3
Veterans in Priority Group 3 include Purple Heart recipients, former prisoners of war, and those with a disability-related discharge, as well as those with service-connected disabilities rated by the VA as between 10% and 30% disabling. This group also includes veterans with special eligibility classification, which provides benefits for individuals disabled by treatment or vocational rehabilitation.
VA Priority Group 4
Veterans in Priority Group 4 include those classified by the VA as catastrophically disabled, as well as those receiving aid and attendance benefits or housebound benefits from the VA
VA Priority Group 5
Priority Group 5 includes veterans with a service-connected disability rated at 0%, as well as those with non-service-connected disabilities or service-related disabilities deemed non-compensable. To qualify for this group, veterans must also have an annual income below the VA’s geographically adjusted income limit, which varies by zip code. Veterans who are eligible for their state’s Medicaid program or receive VA pension benefits are also part of this priority group.
VA Priority Group 6
For the VA’s Priority Group 6, veterans must fall into one of the following categories:
- Veterans of World War I
- Veterans who served during the Mexican border period
- Veterans who served on active duty at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987
- Veterans who were exposed to ionizing radiation during atmospheric testing or the occupation of Hiroshima and Nagasaki
- Veterans who participated in Project 112/SHAD
- Veterans who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975
- Veterans who served in the Persian Gulf War between August 2, 1990, and November 11, 1998
- Veterans who have a compensable 0% service-related disability
Veterans who are currently enrolled (and new enrollees) are eligible for an enhanced veterans benefits package if they served in combat operations after November 11, 1998, and were discharged from active duty on or after January 28, 2003. This benefit is available for five years following their separation of service.
VA Priority Group 7
Veterans in Priority Group 7 have a gross household income below the geographically adjusted VA income limit for their resident location and agree to pay copayments as part of their health care coverage. For inpatient services, this group must pay a co-pay ranging from $155.60 to $311.20, along with a $2 per diem. They are also responsible for copayments for medications and may have to pay copayments for outpatient services, including urgent care.
VA Priority Group 8
Priority Group 8 includes veterans with a gross household income higher than the VA’s predetermined income limits, plus geographically adjusted income limits for their resident location. They agree to pay copayments as part of their health care coverage, ranging from $778 to $1,556, with a $10 per diem. They must also pay copayments for medications and may be responsible for copayments related to outpatient services, including urgent care services.
Priority Group 8 is further divided into six sub-groups that prioritize veterans based on specific criteria:
- Sub-Group A: Veterans with non-compensable VA disabilities rated at 0% who enrolled as of Jan. 16, 2003, and have remained enrolled or were placed in this sub-group due to a change in eligibility status.
- Sub-Group B: Veterans with non-compensable VA disabilities rated at 0% who enrolled on or after June 15, 2009, with income that exceeds the current geographic or VA limit by up to 10%.
- Sub-Group C: Veterans with non-service-connected disabilities who have been enrolled since Jan. 16, 2003, and have remained enrolled or were placed in this sub-group due to a change in eligibility status.
- Sub-Group D: Veterans with non-service-connected disabilities who have been enrolled since June 15, 2009, with income that exceeds the current geographic or VA limit by up to 10%.
- Sub-Group E: Veterans with non-compensable VA disabilities eligible only for the care of their service-connected condition.
- Sub-Group F: Veterans with non-service-connected disabilities.
How Much Does VA Health Care Cost?
The VA’s health care benefits philosophy aims to provide free health care to veterans with service-connected disabilities, those who are catastrophically disabled, and those who cannot afford health care. Those outside this priority group may be asked to share in the costs of their medical services.
In some cases, the VA may require you to pay a fixed amount for certain types of care, tests, and medications you receive from a VA or approved community healthcare provider for conditions unrelated to your military service. This amount is called a copayment.
Whether you have to pay a copayment depends on various factors, such as your VA disability rating, military service record, priority group, and income level. The VA may ask for income verification to determine how much you are responsible for paying.
VA Health Care
VA health care coverage is one of the most valuable benefits available to U.S. veterans. Understanding where you rank within the VA’s priority groups is important to access the right level of care.
The VA provides many medical services to veterans at no cost, including mental health care and care related to military sexual trauma. If you haven’t checked your eligibility for VA health care benefits, it’s important to claim the benefits you’ve earned through military service.