Continued – Priority Groups
By Larry Dandridge
According to the VA webpage “Your Health Care Costs” found at https://bit.ly/4e0HeoY, whether or not a veteran needs to pay copays — and how much they pay — depends on which of the VA’s eight priority groups the VA assigns the veteran to when they enroll in VA health care.
The VA assigns the highest priority to veterans with service-connected disabilities. The VA assigns the lowest priority to veterans who earn higher incomes and don’t have any service-connected disabilities that make them eligible for VA disability compensation.
Example: If a veteran has a VA service-connected disability rating of 50%, if the VA determines that the veteran cannot work because of the veteran’s disability, or if the veteran has received a Medal of Honor, the VA assigns the veteran to Priority Group 1. If a veteran is assigned to Priority Group 1, they will not pay copays for any care, tests, or medications.
VA priority groups
According to the VA webpage “VA Priority Groups” at https://bit.ly/4cE8aIE, after the VA processes a veteran’s application for VA healthcare, the VA will assign the veteran to one of eight priority groups. The veteran’s priority group may affect how much (if anything) the veteran will have to pay toward the cost of their care.
Veterans can learn more about health care costs at the VA webpage “Your Health Care Costs” at https://bit.ly/41Q7gUy. Veterans can check current VA copay rates at the VA webpage “Current VA Health Care Copay Rates” at https://bit.ly/4ez6cfg, which covers Urgent Care, Outpatient, Inpatient, Medication, and Geriatric and Extended Care copay rates, and services that do not require a copay, past copay rates, and other information.
Factors used by the VA to assign veterans to a priority group. The VA bases a veteran’s priority group on:
• The veteran’s military service history, and
• The veteran’s disability rating, and
• The veteran’s income level, and
• Whether or not the veteran qualifies for Medicaid, and
• Other benefits the veteran may be receiving (like VA pension benefits)
The VA assigns veterans with service-connected disabilities the highest priority. The VA assigns the lowest priority to veterans who earn a higher income and who do not have any service-connected disabilities qualifying them for disability compensation (monthly payments). If a veteran qualifies for more than one priority group, the VA will assign the veteran to the highest one. A veteran’s Priority Group may change in some cases, such as if:
• The veteran’s income changes, or
• The veteran’s service-connected disability gets worse, and the VA gives the veteran a higher disability rating.
Priority Group 1
The VA may assign a veteran to Priority Group 1 if any of these descriptions are true:
• The veteran has a service-connected disability that the VA rated as 50% or more disabling, or
• The veteran has a service-connected disability that the VA concluded makes them unable to work (also called unemployable), or
• The veteran received the Medal of Honor (MOH).
Priority Group 2
The VA may assign a veteran to Priority Group 2 if the veteran has a service-connected disability that the VA rated as 30% or 40% disabling.
Priority Group 3
The VA may assign a veteran to Priority Group 3 if any of these descriptions are true:
• The veteran is a former prisoner of war (POW), or
• The veteran received the Purple Heart medal, or
• The veteran was discharged for a disability that was caused by — or got worse because of — their active-duty service, or
• The veteran has a service-connected disability that the VA rated as 10% or 20% disabling, or
• The veteran has been awarded special eligibility classification under Title 38, U.S.C § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”.
Priority Group 4
The VA may assign a veteran to Priority Group 4 if either of these descriptions is true:
• The veteran is receiving VA aid and attendance or housebound benefits, or
• The veteran has received a VA determination of being catastrophically disabled.
Priority Group 5
The VA may assign a veteran to Priority Group 5 if any of these descriptions are true:
• The veteran does not have a service-connected disability, or the veteran has a non-compensable service-connected disability that the VA rated as 0% disabling, and the veteran has an annual income level that’s below our adjusted income limits (based on the veteran’s resident zip code), or
• The veteran is receiving VA pension benefits, or
• The veteran is eligible for Medicaid programs.
Priority Group 6
Assignment based on disability rating or general service history. The VA may assign a veteran to Priority Group 6 if any of these descriptions are true:
• The veteran has a compensable service-connected disability that the VA rated as 0% disabling, or
• The veteran participated in Project 112/SHAD (Shipboard Hazard and Defense 1962-1973). Learn more at https://bit.ly/4sKbKXC, or
• The veteran served in World War II between Dec. 7, 1941, and Dec. 31, 1946, or
• The veteran served in the Persian Gulf War between Aug. 2, 1990, and Nov. 11, 1998, or
• The veteran served on active duty at Camp Lejeune for at least 30 days between Aug. 1, 1953, and Dec. 31, 1987
The VA may also assign a veteran to Priority Group 6 if all of these descriptions are true:
• The veteran served in a theater of combat operations after Nov. 11, 1998, and
• The veteran was discharged from active duty on or after Oct. 1, 2013, and
• The veteran meets the minimum active-duty service requirement.
The veteran has 10 years of enhanced eligibility from the date of their discharge or release. At the end of this 10-year period, the VA will assign the veteran to the highest priority group he or she qualifies for.
Next week’s article will cover assignment to Priority Group 6 based on exposure to toxins or other hazards, toxic-exposure risk activity, deployment in support of certain military operations, exposure to ionizing radiation, or exposure to Agent Orange, and Priority Groups 7 and 8 (Gross household income levels) and eligibility based on sub-priority groups a, b, c, d, e, and g and more.
Continued next week.
Larry Dandridge is a Vietnam War wounded warrior, a combat and 100% service-connected disabled veteran, an ex-Enlisted Infantryman, an ex-Warrant Officer Pilot, and a retired Lt. Colonel. He is a former Veterans Service Officer, a Patient Adviser at the RHJ VA and Durham VA Medical Centers, a Fisher House Charleston Goodwill Ambassador, and the Veteran Benefits Advisor for the AUSA Coastal Carolina Chapter, MOPH Chapter, MOAA Triangle Chapter, and VFW Post 7383. Larry is also the author of the award-winning Blades of Thunder (Book One) and a contributing freelance writer with The Island News. Contact him at LDandridge@earthlink.netor 843-276-7164.