VA Healthcare Priority Groups Explained | VA Copays & Benefits

Understanding VA Healthcare Priority Groups and Veteran Copayments

The Department of Veterans Affairs (VA) has come a long way since it was established on July 21, 1930. However, depending on which veteran you ask, many would say the VA healthcare system still has room for improvement.

As a disabled veteran myself, I receive all of my healthcare through the VA medical system. My service-connected disability rating is 60%, which means I currently pay no copayments for my healthcare services or prescriptions through the Department of Veterans Affairs.

Several years ago, I underwent shoulder surgery that would have cost tens of thousands of dollars through private healthcare. Thanks to my VA healthcare benefits, I paid absolutely nothing out of pocket.

Understanding VA Healthcare Benefits

Not every veteran receives free healthcare through the VA.

The amount a veteran pays for medical treatment and prescriptions depends largely on:

• Their VA disability rating

• Income level

• Service-connected conditions

• Military service history

• VA healthcare priority group

The VA uses eight different healthcare priority groups to determine eligibility and copayment requirements for veterans enrolled in the VA healthcare system.

What Are VA Healthcare Priority Groups?

VA healthcare priority groups help determine:

• Eligibility for VA medical benefits

• Prescription copays

• Healthcare costs

• Access to certain services

Below is a simplified breakdown of the VA priority group system.

VA Priority Group 1
Veterans with:

• Service-connected disabilities rated 50% or higher

• Veterans determined unemployable due to service-connected disabilities (TDIU)

These veterans generally receive free VA healthcare and prescriptions.

VA Priority Group 2
Veterans with:

• Service-connected disability ratings of 30% or 40%

VA Priority Group 3
Veterans with:

• Disability ratings of 10% or 20%

• Purple Heart recipients

• Former Prisoners of War (POWs)

• Veterans discharged due to service-related disabilities

VA Priority Group 4
Veterans:

• Receiving Aid and Attendance benefits

• Classified as catastrophically disabled

Some veterans in this group may still have limited copayments.

VA Priority Group 5
Veterans:

• Receiving VA pension benefits

• Eligible for Medicaid

• Low-income veterans meeting VA means test requirements

VA Priority Group 6
Includes veterans exposed to:

• Agent Orange

• Radiation exposure

• Gulf War environmental hazards

• Project SHAD participation

• Combat veterans after November 11, 1998

VA Priority Group 7
Non-service-connected veterans with:

• Income above VA national means test limits

• Income below geographic means test thresholds

These veterans typically pay copays.

VA Priority Group 8
Veterans with:

• Higher income levels

• Non-compensable disabilities

Most Priority Group 8 veterans are responsible for copayments. The VA stopped enrolling many new Priority Group 8 veterans after January 17, 2003.

What Is VA Means Testing?

The VA uses a financial review process called “means testing” to determine:

• Veteran copayment responsibilities

• Healthcare eligibility

• Enrollment qualification

The means test evaluates:

• Annual income

• Net worth

• Geographic cost of living

Veterans with lower income levels may qualify for reduced copays or free healthcare services.

VA Copayments for Healthcare Services

Veterans in Priority Groups 7 and 8 may be required to pay copays for medical services.

Typical VA outpatient copays include:

Primary Care Visits
Approximately $15 per visit

Specialty Care Visits
Approximately $50 per visit

Specialty care may include:

• MRI scans

• CAT scans

• Cardiology

• Surgery consultations

• Radiology services

VA Prescription Copays

Veterans may pay around:

• $8 for a 30-day supply of medication for non-service-connected conditions

However, many veterans qualify for free prescriptions, including veterans who are:

• 50% or more service-connected

• Rated unemployable by the VA

• Former POWs

• Low-income veterans

• Veterans with Agent Orange exposure

• Veterans with Gulf War-related illnesses

VA Inpatient Copays

Some veterans may also have inpatient hospital copays, including:

• Inpatient care charges

• Daily hospital fees

• Long-term care copayments

Lower-income veterans may qualify for significantly reduced inpatient costs depending on geographic means testing.

The Importance of Understanding VA Benefits

Many veterans do not fully understand:

• Their VA healthcare eligibility

• Copayment responsibilities

• Disability benefits

• Priority group classifications

Understanding how the VA healthcare system works can help veterans:

• Save money

• Access healthcare faster

• Maximize benefits

• Avoid unnecessary billing confusion

Final Thoughts

The VA healthcare system can sometimes feel confusing and frustrating for veterans trying to navigate benefits and eligibility requirements.

Despite its flaws, the Department of Veterans Affairs provides life-changing healthcare services for millions of veterans every year — including surgeries, prescriptions, mental health treatment, and long-term care.

As veterans, educating ourselves about VA healthcare priority groups, copays, and benefits allows us to better advocate for ourselves and fully utilize the healthcare services we earned through military service.