When a veteran signs up for healthcare through the Veterans Administration, they are assigned a priority group. Priority groups are used by the VA to determine the veteran’s level of need. In essence, the more care they need the more benefits the VA provides. In addition, changes in available resources that can reduce the priority groups the VA is able to enroll. Knowing in which priority group the veteran fits is very helpful.
The priority groups also determine whether a veteran will have a copay and if so, how much. VA copay information can be found at https://www.va.gov/health-care/copay-rates/. Below is a high-level description of each priority group.
*This blog is for educational purposes only and should not be considered legal advice. The use of the Paths Law Firm website does not constitute a client-lawyer relationship.
VA Priority Groups
Priority Group 1: Veterans that have a service-connected disability (SCD) disability rating of 50 percent or higher. If the VA determines the veteran is not able to work due to an SCD, the veteran will be placed in the first group.
Priority Group 2: Veterans that having an SCD between 30 to 40 percent.
Priority Group 3: The group consists of veterans who meet the following:
- Veterans who were Prisoners of war (POWs).
- Veterans awarded the Medal of Honor.
- Veterans warded the Purple Heart.
- Veterans discharged due to a disability caused or aggravated by their military service.
- Veterans having an SCD between 10 to 20 percent.
- Veterans with a special eligibility classification.
Priority Group 4: Veterans with increased pension or compensation based on a need for regular aid and attendance. In addition, this group consists of veterans to be considered to be permanently housebound or with a classification of catastrophically disabled.
Priority Group 5: This group consists of veterans who meet the following:
- Veterans currently receiving VA pension benefits or those who are eligible to receive Medicaid.
- Veterans receiving an annual income below the Veterans Administration’s geographically adjusted income limit.
- Veterans who have Nonservice-connected disability and veterans that are non-compensable service-connected with a VA rating of 0 percent.
Group 6: This group consists of veterans who meet the following:
- Veterans with 0 percent compensable service-connected disability.
- Veterans exposed to ionizing radiation during Hiroshima or Nagasaki.
- Veterans who served in the Vietnam war between January 9, 1962, and May 7, 1975.
- Veterans who served in the Southwest Asia theater of operations between August 2, 1990, and November 11, 1998.
- Veterans who served in a theater of combat operations after November 11, 1998, and was discharged from active duty service on or after January 28, 2003, for five years post-discharge.
- Veterans who actively served at Camp Lejeune for a minimum of 3 days between August 1, 1953, and December 31, 1987.
Group 7: Veterans with a gross household income less than the VAs geographically adjusted income limit and who agree to be liable for copays.
Group 8: Veterans having a gross household income that is above the VAs national income limits and agrees to be liable for copays.
The Veterans administration will obtain income information from the Internal Revenue Service (IRS) and the Social Security Administration (SSA) to help determine which priority group a veteran qualifies. This also aids the VA in determining the copay, if any. Once the Priority Group is determined, the VA will send a letter with their ruling. Applicants have 75 days to respond to the letter or appeal the ruling. After the 75 days, the VA will assume the veteran agrees with the copayment status.
If at anytime a change in financial status occurs, programs exist that may help a veteran applying for VA Financial Hardship Assistance. Paths Law Firm has the knowledge and experience to determine Veterans Administration eligibility. We will work with you on your individual needs to help you get the most benefits available.
If you need help or know someone that needs help applying for VA Benefits, Contact Paths Law Firm to schedule a consultation.