Change in Eligibility Criteria for VA’s Healthcare Program

The Veterans Health Administration is America’s largest integrated health care system, serving over 8.5 million veterans each year.  A veteran who served in the active military and was separated from service under any condition other than dishonorable may qualify for VA health care benefits.  The total number of VA treatment sites is now over 1,400 and services provided include primary care, in-patient and specialty care, dental care, prescriptions, and mental health support and services. Many of our clients and their loved ones are already making use of VA’s health care benefits or might want to consider doing so.

For purposes of determining eligibility, VA divides all potential health care benefit applicants into eight different “Priority Groups.” The groups relate to characteristics of the veteran’s service.  Retirees from military service, veterans with service-connected injuries or conditions rated by VA, and Purple Heart recipients, are all within the higher Priority Groups.  Which Priority Groups are deemed eligible for which benefit programs tends to vary from one presidential administration to the next.  Placement in a specific Priority Group will not only affect whether or not a veteran is eligible to receive care but will also affect the amount of a co-pay the veteran must pay for services received.

In general, the highest Priority Groups are automatically eligible for health care benefits.  For the lower Priority Groups, a veteran must meet certain financial criteria in order to be eligible.  Currently benefit eligibility and/or any applicable copay is dependent on the veteran’s net worth and his or her previous year's gross household income (earned and unearned income).  However as of January 1, 2015, VA is making a change and will no longer consider the veteran’s net worth as part of health care benefit eligibility. 

It must be noted that this change only affects enrollment in VA’s health care programs, not VA’s other benefit programs.  Criteria for VA’s non-service-connected “Pension” program will remain unchanged and will still include an assessment of applicants’ net worth to determine eligibility.

Veterans who are already receiving non-service-connected Pension benefits or service-connected Compensation benefits will be placed in a high enough Priority Group where health care benefit eligibility will not be dependent on any further financial assessment.  For others, the relaxation of net worth requirements referenced above may be what now permits health benefit eligibility that was not previously available.

To begin the enrollment process, veterans must simply fill out a form VA 10-10EZ Application for Health Benefits which can be submitted hardcopy or via an online application found at http://www.va.gov/healthbenefits/apply/veterans.asp.  VA anticipates that the necessary changes to its online and hardcopy application forms will be ready by January 1, 2015.

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