Health Care Priority Groups
The number of Veterans who can be enrolled in VA health care each year is limited by the amount of money Congress provides.
When VA receives your application for health care, you are placed into one of eight priority groups.
Priority Group 1
50% SC or Higher
Priority Group 2
30% or 40% SC
Priority Group 3
10% or 20% SC
Former POWs, Purple Heart Recipients
Priority Group 4
Severe Nonservice-connected Disabilities
Priority Group 5
Veterans With Minimal Income,
Veterans Receiving VA Pension or Medicaid
Priority Group 6
Age, Special Needs, and More...
Priority Group 7
Veterans With Modest Income
Priority Group 8
Veterans With Higher Income
Who is in Group 1
You're in Priority Group 1 if you have service-connected (SC) disabilities rated 50% or more disabling. You're also in this group if you are determined by VA to be unemployable due to service-connected (SC) conditions.
This is the highest priority group.
What's the Benefit? If you're in Group 1, you're eligible to receive all the services provided in the Medical Benefits Package at no cost to you.
Who is in Group 2
You're in Priority Group 2 if you have service-connected (SC) disabilities rated 30% or 40% disabling.
What's the Benefit? If you're in Group 2, you're eligible to receive all the services provided in the Medical Benefits Package.
Treatment is free—except for outpatient medication for conditions that aren't service-connected.
Some Veterans do not have to pay the medication co-payment...
Who is in Group 3
You're in Priority Group 3, if you meet any of these criteria:
Have service-connected (SC) disabilities rated 10% or 20% disabling
Are a former POW
Were awarded the Purple Heart
Were discharged for a disability that began or was made worse in the line of duty
Have a disability because of VA health care or participation in Vocational Rehabilitation
Details
What's the Benefit? If you're in Group 3, you're eligible to receive all the services provided in the Medical Benefits Package.
Treatment is free—except for outpatient medication for conditions that aren't service-connected.
Some Veterans do not have to pay the medication co-payment...
Who is in Group 4
You're in Priority Group 4, if you meet either of these criteria:
Are receiving VA pension with Aid and Attendance or Housebound benefits
OR
Have been determined by VA to be catastrophically disabled
Note: If you think that you're catastrophically disabled, VA will provide an examination at no cost even though you aren't enrolled in its health care program.
What's the Benefit? If you're in Group 4, you're eligible to receive all the services provided in the Medical Benefits Package.
Some Veterans in Priority Group 4 must make co-payments.
Who Pays in Priority Group 4
(All Types of Co-Payments)
Aid and Attendance (Pension)
When we use the term "Aid and Attendance" (A&A) here, we are specifically referring to the additional benefit paid to Veterans in VA's Pension program.
To be eligible for A&A, you must either be—
A patient in a nursing home
OR
So severely disabled that you need the assistance of another person in performing the day-to-day functions of life
Housebound (Pension)
When we use the term "Housebound" here, we are referring to the additional benefit paid to Veterans in VA's Pension program.
To be eligible for this housebound benefit, your disabilities must be so severe that you're unable to travel beyond your home.
Who is in Group 5
You're in Priority Group 5, if you meet any of these criteria:
You are—
A Veteran with no service-connected (SC) disabilities whoes annual income and net worth are below the threshold of the VA Means Test
OR
A noncompensable , 0% SC Veteran with income and net worth below the established thresholds of the VA Means Test
OR
A Veteran receiving VA pension benefits
OR
A Veteran eligible for Medicaid benefits
What's the Benefit? If you're in Group 5, you're eligible to receive all the services provided in the Medical Benefits Package.
Treatment is free—except for outpatient medication for conditions that aren't service-connected.
Some Veterans do not have to pay the medication co-payment...
Who is in Group 6
Group 6 consists of two groups.
Veterans Who Are Exempted from Most Co-Payments. You're in this broader section of Priority Group 6 if you're a Veteran with—
0% compensable service-connected (SC) disabilities
OR
Service in World War I
OR
Service in the Mexican Border War
Except for outpatient medicines for nonservice-connected conditions, you can receive all the services in the Medical Benefits Package at no cost.
Veterans With Limited Exemption from Co-payments. You're in this specialized section of Priority Group 6 if you—
Were exposed to certain hazards in service
OR
Served in the military in certain situations described by the law
Medical Conditions Linked to Certain Hazards or Situations
You're eligible to receive free care for illnesses linked to the hazards you were exposed to or the specific military service. Other kinds of care will require co-payments. The amount of the co-payments will depend on your income.
Medical Conditions Linked to Certain Hazards or Situations
You could be in the more "specialized" part of Priority Group 6 if you have illnesses linked to any of the following:
Exposure to herbicides while serving in Vietnam
Exposure to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki
Participation in Shipboard Hazard and Defense (SHAD) / Project 112
Exposure to environmental contaminants or Gulf War illness, Service in the Gulf War, within the Gulf War theater
One other way you might qualify for this part of Priority Group 6 is by having served in combat service during a period of hostility after November 11, 1998, or in a war after the Gulf War.
(Note that the Gulf War has not yet been declared at an end.)
This rule applies for 5 years immediately following your discharge if you meet ONE of the following conditions:
You are currently enrolled in the health care system
OR
You were discharged from active duty on or after January 28, 2003
You are eligible for Priority Group 6 until January 27, 2011, if you meet BOTH of the following conditions:
You were discharged from active duty before January 28, 2003
AND
You applied for health care enrollment on or after January 28, 2008
At the end of that time, we'll keep you enrolled, but we'll review your status to decide what priority group you should be in.
If your enrollment in Priority Group 6 is based on one of the above experiences, then you're only exempted from co-payments when treatment is for a related medical or psychiatric problem.
Who is in Group 7
You're in Priority Group 7, if you—
Don't have any compensable service-connected (SC) disabilities
AND
Your income and/or net worth is—
Above the VA Means Test , but your income is
Below the Geographic Means Test
To stay enrolled in Group 7, you must—
Complete a yearly financial statement
AND
Agree to pay a co-payment fee for medical care received
What's the Benefit? If you're in Group 7, you're eligible to receive all the services provided in the Medical Benefits Package as long as you agree to make the required co-payments.
Your inpatient co-payments will be lower than the standard rate. Click the link below for details.
Co-Payments for InpatientCare
Net Worth Defined
Simply put, "net worth" means the value of everything you own, minus what you owe.
But VA doesn't count everything you own or owe. We have some very specific guidelines on how to compute your net worth.
The Veteran's Health Administration follows the guidelines in VA's Pension Program.
To see these rules, click the link below. This text will come from our Pension segment, and you'll see references to Pension.
How VA Computes Net Worth
Who is in Group 8
You're in Priority Group 8, if you agree to pay a specified copay. Your income and/or net worth are above VA Means Test threshold and the Geographic Means Test Threshold.
Click the link below to see if you meet the new income requirements for this priority group:
Priority Group 8 Calculator
Priorty Group 8 also has these sub-categories:
Subgroup a: Noncompensable 0% service-connected Veterans enrolled as of January 16, 2003 and who have remained enrolled since that date
Subgroup b: Noncompensable 0% service-connected Veterans whose income exceeds the VA Means Test threshold or the Geographic Means Test Threshold by 10% or less
Subgroup c: Nonservice-connected Veterans enrolled as of January 16, 2003 and who have remained enrolled since that date
Subgroup d: Nonservice-connected Veterans whose income exceeds the VA Means Test threshold or the Geographic Means Test Threshold by 10% or less
Subgroup e * : Noncompensable 0% service-connected Veterans applying for enrollment after January 16, 2003
Subgroup g * : Nonservice-connected Veterans applying for enrollment after January 16, 2003
What's the Benefit? If you're in Group 8, you're eligible to receive all the services provided in the Medical Benefits Package so long as you agree to make the required co-payments.
