09/28/2026
CAN THE VA CHARGE YOU A COPAY FOR HEALTH CARE?
Being enrolled in VA health care does not automatically mean that every appointment, prescription, test, or hospital stay will be free. Whether you owe a copay depends on your service-connected disability rating, VA priority group, household income, type of care, and whether the treatment is for a service-connected condition.
The first distinction veterans need to understand is the difference between service-connected and non-service-connected treatment. The VA generally does not charge a copay for treatment of a VA-rated service-connected disability. This can apply even when the veteran’s overall rating does not otherwise exempt the veteran from copays.
Veterans with a service-connected disability rating of at least 10% generally do not pay outpatient or inpatient care copays. Veterans rated 50% or higher are normally placed in Priority Group 1 and do not pay copays for VA medical care or medications.
That does not mean every veteran with a lower rating will always owe a copay. Certain veterans may qualify for free or reduced-cost care because of income, receipt of a VA pension, former prisoner-of-war status, a Medal of Honor, catastrophic disability, special exposure eligibility, recent combat service, or another qualifying factor.
The VA uses eight priority groups when determining enrollment priority and potential copay responsibility. Your priority group is not the same thing as your disability percentage. The VA considers your service-connected rating, income, military history, special eligibility, and other factors when assigning the group.
Some services do not require a copay regardless of the veteran’s disability rating or priority group. These include:
-- Compensation & Pension (C&P) examinations
-- Care for a VA-rated service-connected disability
-- Counseling and care related to Military Sexual Trauma (MST)
-- Readjustment counseling and related mental health services
-- Certain military exposure registry examinations
-- Laboratory tests
-- Electrocardiograms
-- Certain preventive screenings and immunizations
-- Certain care related to combat service or qualifying toxic exposures
-- Approved VA research-related care
-- Certain smoking-cessation and weight-management programs
For veterans who are not otherwise exempt, the 2026 outpatient copays for non-service-connected care generally include:
-- $15 for a primary care visit
-- $50 for a specialty care visit
-- $50 for certain specialty tests, including a Magnetic Resonance Imaging (MRI) scan or Computed Tomography (CT) scan
The VA does not charge a separate copay for X-rays, laboratory tests, or qualifying preventive tests and services. Copay rates can change, so veterans should confirm the amount shown on the current VA rate schedule or their billing statement.
Urgent care has separate rules. To use the VA urgent care benefit, the veteran must generally be enrolled in VA health care and must have received care from the VA or an authorized VA provider during the previous 24 months. The urgent care facility must also participate in the VA’s approved network.
For veterans in Priority Groups 1 through 5, the first three urgent care visits during each calendar year currently have no copay. Each additional visit during that year generally has a $30 copay.
Veterans in Priority Group 6 may receive qualifying urgent care without a copay when the treatment is connected to a special eligibility authority. Otherwise, a $30 copay may apply. Veterans in Priority Groups 7 and 8 generally owe a $30 copay for each urgent care visit. A visit only for a flu shot does not require an urgent care copay.
Do not confuse urgent care with emergency care. Emergency treatment at a non-VA facility follows different eligibility, notification, and payment rules. The fact that a veteran has no VA copay does not automatically mean every non-VA emergency bill will be paid.
Prescription copays also follow different rules. Veterans in Priority Group 1 generally do not pay copays for VA medications. Veterans in Priority Groups 2 through 8 may owe copays for medications prescribed to treat non-service-connected conditions.
For 2026, outpatient medication copays are based on the medication tier and the number of days supplied:
-- Tier 0 medications have no copay
-- Tier 1 preferred generic medications are $5 for a 30-day supply, $10 for a 31-to-60-day supply, and $15 for a 61-to-90-day supply
-- Tier 2 medications are $8 for a 30-day supply, $16 for a 31-to-60-day supply, and $24 for a 61-to-90-day supply
-- Tier 3 brand-name medications are $11 for a 30-day supply, $22 for a 31-to-60-day supply, and $33 for a 61-to-90-day supply
The annual medication copay cap is currently $700. Once a veteran reaches that amount in qualifying medication copays during the calendar year, additional covered medications generally do not generate another copay for the remainder of that year.
The VA may also charge inpatient copays to certain veterans receiving hospital care for non-service-connected conditions. The amount can depend on the veteran’s priority group, income, location, and length of hospitalization. Veterans with a service-connected rating of at least 10% generally do not owe an inpatient copay.
Geriatric and extended care have their own copay rules. The first 21 days during a 12-month period generally do not require an extended-care copay. Beginning on the 22nd day, the VA may consider the type of care and financial information reported on VA Form 10-10EC when determining the amount.
Authorized Community Care is not automatically free merely because the VA approved the referral. The same VA copay rules may still apply based on the veteran’s eligibility and the type of care received. The VA generally bills the veteran for the applicable copay.
A Community Care provider should not demand that the veteran pay the entire bill simply because its claim has not been processed. If you receive a bill from the provider for authorized care, do not ignore it and do not immediately assume you owe it. Contact the provider’s billing office and the VA Community Care office to confirm that the claim was submitted correctly and that the authorization covered the service.
The VA may bill a veteran’s private health insurance for treatment of a non-service-connected condition. This does not mean the veteran is being charged twice. Money collected from the insurance company may reduce or satisfy the veteran’s VA copay responsibility. The VA does not bill private insurance for treatment of a service-connected disability.
If you receive a VA copay bill that you believe is wrong, review:
-- The date and type of care
-- Whether the treatment was for a service-connected condition
-- Your service-connected rating on that date
-- Your assigned priority group
-- Whether the provider and service were properly authorized
-- Whether the charge is from the VA or directly from a community provider
-- Whether your income or eligibility information needs to be updated
You have the right to dispute all or part of a VA copay bill. Submit a written statement explaining why the charge is incorrect and include supporting evidence. You can submit the dispute through Ask VA or deliver it to the business office or health administration office at your VA medical center.
The VA advises veterans to dispute a bill within 30 days of receiving it to avoid interest, fees, or other late charges. A dispute received within 90 days of the date the charge first appeared on the billing statement generally prevents collection activity until the dispute is resolved. Waiting longer can allow the VA to continue collection or transfer the debt to the U.S. Department of the Treasury.
If the bill is correct but you cannot afford it, assistance may be available. Depending on your circumstances, you may request:
-- A waiver of all or part of the debt
-- A compromise offer for a reduced one-time payment
-- A monthly repayment plan
-- A hardship determination for exemption from certain future copays
A request for debt relief generally requires VA Form 5655, Financial Status Report. A repayment plan generally uses VA Form 10-323. A request for a future copay hardship exemption generally uses VA Form 10-10HS.
A hardship exemption may eliminate certain medical copays for the remainder of the calendar year, but it does not apply to prescription medication copays. Veterans seeking free medications based on income may need to provide updated financial information separately.
Do not assume that every VA bill is correct, but do not ignore it either. Determine what the care was for, confirm your eligibility on the date of treatment, and challenge an incorrect charge before it becomes a collection problem.
If the information on my Page is helping you better understand your VA health care benefits, you can support my mission to assist veterans through Buy Me a Coffee at buymeacoffee.com/cctony
