Medication – Prescription copayment charges were established by Congress. The charge ranges from $5 to $11 for each 30 day or less supply of medications provided on an outpatient basis for. Due to COVID-19 the VA has been unable to mail bills to Veterans for copays, and a consolidated bill will be mailed in the future. However, Veterans can still check balances and make payments using one of three options: 1. Call 1-888-827-4817.
Copayments
Medical Debt Relief
Prescription co-payments. Prescription co-payments are charged only for outpatient treatment. The following veterans do not have to pay anything for medications: A veteran who is 50 percent disabled or more with a service-connected disability; A veteran who has been determined by the VA as unemployable due to his service-connected conditions. Tier 1 CO-PAY MEDICATION LIST 2021. Aspirin buffered tablet. Aspirin chewable tablet. Aspirin enteric coated tablet. Allopurinol tablet. Celecoxib capsule. Diclofenac tablet. Ibuprofen tablet. Meloxicam tablet. Naproxen tablet. Clopidogrel Bisulfate tablet. Warfarin Sodium tablet. Alendronate tablet. Atorvastatin tablet. In January, Veterans should receive a patient statement that includes new copay charges for any care or prescriptions from April 6, 2020, through December 31, 2020, and any unpaid copays from before April 2020. Veterans are not required to make payments until after December, but they can make them now if they want. How do I pay my VA copay bill?
American Rescue Plan: Copayment Cancellations and Refunds
Due to the passage of the American Rescue Plan in March 2021, copayments for medical care and prescriptions provided by the Veterans Health Administration (VHA) during the period of April 6, 2020 through September 30, 2021 will be canceled. All copayments paid to VA for medical care and prescriptions during the period of April 6, 2020 to present will be refunded.
Please review the COVID-19 Medical Debt Relief page for answers to some common questions.
COVID-19 Medical Debt Relief FAQs
Enrolled Veterans will be assessed copayments for care or services (including urgent care) based on their eligibility and/or income on file in the VA health care system. For care or services furnished through the Veterans Community Care Program, the same copayment requirements will apply. Copayment rates are listed below.
For information on how to pay your bill or copayment, visit our Billing and Payments page.
Billing and Payments
Veteran Copayments— Published October 6, 2017
You can explore your eligibility for VA health care benefits using the online Health Benefits Explorer or by contacting the VA Call Center.
VA Call Center: 877-222-VETS (8387)
Monday through Friday, 8:00 a.m. – 8:00 p.m. ET
Urgent Care (Community Care)
Veterans may be charged a copayment for urgent care that is different from other VA medical copayments.
- Copayments depend on the Veteran’s assigned priority group and the number of times an urgent care provider is visited in a calendar year.
- Copayment charges are billed separately by VA as part of VA’s billing process. There is no limit to the number of times a Veteran can go to an urgent care provider. For more information, visit the OCC Urgent Care page.
OCC Urgent Care page
| Veteran Priority Groups | Copayment Amount |
|---|---|
| 1-5 |
|
| 6 | If related to a condition covered by a special authority:
If not related to a condition covered by a special authority: $30 per visit |
| 7-8 | $30 per visit |
| 1-8 | $0 copay for visit consisting of only a flu shot |
Outpatient Care
Outpatient care is defined as primary or specialty care that does not require an overnight stay. Copayments for outpatient care are listed in the table.
NOTE: Veterans who have a service-connected rating of 10% or higher are not required to pay a copayment for outpatient medical care.
| Examples of Outpatient Care | Copay |
|---|---|
| Primary Care Services | $15 per visit |
| Specialty Care Services: Services such as outpatient surgery, dermatology, audiology, optometry, cardiology and specialty tests like MRI or CAT scan. | $50 per visit |
Inpatient Care
Inpatient care occurs when a patient’s condition requires admission to a hospital. There are two inpatient copayment rates: the full rate and the reduced rate. Veterans living in high cost areas may qualify for a reduced inpatient copayment rate. Copayment rates for an inpatient hospital stay are listed in the table below.
NOTE: Veterans who have a service-connected disability rating of 10% or higher are not required to pay a copayment for inpatient medical care.
| Veteran Priority Groups | Copay (2021) | Period of Service/Care |
|---|---|---|
| Priority Group 7 Veterans Veterans with gross household incomes below the geographically-adjusted VA income limits for their resident location and who agree to pay copayments. | $296.80 | First 90 days of care during a 365-day period |
| $148.40 | Each additional 90 days of care during a 365-day period | |
| $2 | Per day charge | |
| Priority Group 8 Veterans Veterans with gross household incomes above the geographically-adjusted VA income limits for their resident location, who agree to pay copayments, and meet other specific enrollment and service-connected eligibility criteria. | $1,484 | First 90 days of care during a 365-day period |
| $742 | Each additional 90 days of care during a 365-day period | |
| $10 | Per day charge |
Medications
Medication copayments are required for each prescription, including each 30-day (or less) supply of maintenance medications prescribed on an outpatient basis for nonservice-connected conditions. This copayment may change annually.
Medication copayments are also charged for all over-the-counter (OTC) medications (like aspirin, cough syrup, and vitamins) that are dispensed from a VA pharmacy. You may want to consider purchasing over-the-counter medications on your own.
NOTE: There is an annual medication copayment cap of $700 for Veterans in Priority Groups 2 through 8. The medication copayment cap goes by calendar year (January 1 – December 31).
Va Prescription Copay Online
Veterans who have a service-connected rating of 40% or less, and whose income is at or below the applicable national income thresholds may wish to complete a medication copayment exemption test.
VA National Income LimitsVA Financial Assessment information
| Veteran Priority Groups | Copay | |||
|---|---|---|---|---|
| Priority Group 1 Veterans Veterans with VA-rated service-connected disabilities 50% or more disabling or Veterans determined by VA to be unemployable due to service-connected conditions or Medal of Honor recipients. | No copayment | |||
| Priority Group 2-8 Veterans Required to pay for each 30-day or less supply of medication for treatment of nonservice-connected condition (unless otherwise exempt). Limited to $700 annual cap. IMPORTANT: Some Veterans may qualify for reduced or no-cost prescriptions based on special eligibility factors. | Prescription Drug Tier | Days of Supply | ||
| 1‑30 | 31‑60 | 61‑90 | ||
| Tier 1: Preferred generics | $5 | $10 | $15 | |
| Tier 2: Non-preferred generics and some OTC medications | $8 | $16 | $24 | |
| Tier 3: Brand-name | $11 | $22 | $33 | |
Additional information on tiered medication copays can be found on the VA Pharmacy Benefits Management Services website.
Va Prescription Copay System
Geriatrics and Extended Care
Copayments for health care for older Veterans are based on three levels of care—inpatient, outpatient, and domiciliary (see below). Copayment rates will vary from Veteran to Veteran depending upon financial information submitted on VA Form 10-10EC, Application for Extended Care Services.
NOTE: Copayments for long-term care services start on the 22nd day of care during any 12-month period. There is no copayment requirement for the first 21 days.
| Inpatient Care | Copay |
|---|---|
| Community Living Centers (formerly known as nursing homes) VA Community Living Centers are long-term care services provided to Veterans who need a skilled environment for short-term and long-term stays. | Up to $97/day |
| Respite Care Respite Care is a service that pays for someone to come to a Veteran's home or for a Veteran to go to a program while your family caregiver takes a break. Respite Care services may be available up to 30 days each calendar year. | Up to $97/day |
| Geriatric Evaluation A multidisciplinary team consisting of a doctor, nurse, and several other health providers conduct an evaluation to promote, preserve, or restore a Veteran’s health. The information gained from the Geriatric Evaluation helps you and your family decide what type of services and support would best meet your needs and preferences. | Up to $97/day |
| Outpatient Senior Care | Copay |
| Adult Day Health Care Adult Day Health Care is a program Veterans can go to during the day for social activities, peer support, companionship, and recreation. Adult Day Health Care is for Veterans who need skilled services, case management, and assistance with activities of daily living (e.g., bathing and getting dressed); instrumental activities of daily living (e.g., fixing meals and taking medicines); and/or are isolated or your caregiver is experiencing burden. Adult Day Health Care can provide respite care for your family caregiver and can also help you and your caregiver gain skills to manage your care at home. | Up to $15/day |
| Respite Care Respite Care is a service that pays for someone to come to a Veteran's home or for a Veteran to go to a program while your family caregiver takes a break. Respite Care services may be available up to 30 days each calendar year. | Up to $15/day |
| Geriatric Evaluation A multidisciplinary team consisting of a doctor, nurse, and several other health providers conduct an evaluation to promote, preserve, or restore a Veteran’s health. The information gained from the Geriatric Evaluation helps you and your family decide what type of services and support would best meet your needs and preferences. | Up to $15/day |
| Domiciliary Care for Homeless Veterans | Copay |
| Short-Term Rehabilitation and Long-Term Health Maintenance Care VA offers two types of Domiciliary Care: short-term rehabilitation and long-term health maintenance care. This program provides clinically appropriate levels of care for homeless Veterans whose health care needs are not severe enough to require more intensive levels of treatment. | Up to $5/day |
Resources
877-222-VETS (8387)
Monday – Friday
8 a.m. – 8 p.m. EST
VA Geriatrics and Extended Care Resources
• VA Geriatrics and Extended Care
• VA Community Living Centers
• Respite Care
• Adult Day Health Care
• Domiciliary Care for Homeless Veterans Program
PRESCRIPTION COPAY INCREASES FOR SOME VETERANS
June 23, 2010
(BUTLER, PENNSYLVANIA) – Some veterans will see an increase in their prescription copayments from $8 for each 30-day supply to $9. This change will take effect July 1, 2010.
“Because of the harsh economic reality facing many Veterans, we delayed the change,” said Secretary of Veterans Affairs Eric K. Shinseki, who postponed the increase originally scheduled for January 1, 2010. “Even with this increase, VA medication copays are lower than much of the private sector.”
Not all Veterans will see the copay increase: only Veterans in Priority Group 7 and 8. Veterans in Priority Groups 2 through 6 will see no increase in their non-service connected prescription copayments. All Veterans will continue to have their out-of-pocket expenses for VA outpatient medications capped at $960 per calendar year.
“Many Veterans won’t see any difference in their copays,” said VA Butler Healthcare’s Revenue Coordinator Michele Miller. “Veterans in Priority Group 7 and 8 should notify the preregistration department if or when they have a drastic change in income. There is a possibility the change would put them into a different priority group and exempt them from the new $9 copay charge.”
Veterans who have an injury or illness connected with their military service resulting in a disability rated 50 percent or greater – who are known as Priority Group 1 Veterans -- are exempt from the copay. Veterans may view the updated Copay Rates Fact Sheet on the VA Butler Healthcare website: http://www.butler.va.gov.
VA Butler Healthcare, located on a scenic wooded 88-acre campus in the heart of Butler County, Pennsylvania, is the provider of choice for over 17,000 Veterans throughout Western Pennsylvania and parts of Ohio. VA Butler, a member of VA Healthcare-VISN 4, provides primary care, specialty care, mental health and social support services to Veterans at its main campus and serves a rural Veteran population through community based outpatient clinics (CBOCs) in Armstrong County, southern Butler County (Cranberry Township), Clarion County, Lawrence County, and Mercer County. VA Butler Healthcare has over 6OO employees and volunteers dedicated to meeting the diverse needs of America’s heroes, now and in the future. For more information about VA Butler Healthcare, and links to special programs and initiatives, interested persons can log ontohttp://www.butler.va.gov”.Media queries and requests should be directed to David Virag at (724)-285-2576 orDavid.Virag@va.gov.