Understanding your eligibility for VA medical benefits can be challenging. To start, there’s a complex qualification system that considers service-related factors as well as your income. And, not all eligible veterans receive the same set of benefits. Your benefits package, for example, may range from limited healthcare services with full copayments to a broader set of medical and related services with no copayments at all.
What are VA benefits?
VA benefits are a set of assistance programs provided to service members — specifically, those who’ve served either on active duty in the U.S. uniformed services, or on federally ordered, active duty in the National Guard or Reserves. Depending on your service record and whether you were injured in the line of duty, you might qualify for several programs, including disability income, life insurance benefits, education and career counseling, pension benefits, as well as VA medical benefits.
What do VA medical benefits cover?
VA medical benefits cover preventative care, such as annual physical exams and immunizations. Inpatient treatments including surgeries, acute care, and kidney dialysis are also covered, along with emergency and walk-in services at some VA health facilities and VA-approved health clinics. Some veterans may additionally qualify for vision care, dental care, caregiver support, prescription drugs, some mental health services, help with transportation to and from medical appointments, and assisted living and home health care.
VA long-term care benefits
In certain situations, the VA may also provide long-term care services for eligible veterans who need them. Those care services range from full-time medical supervision to physical therapy to help with daily tasks like dressing and grooming. You might receive these services in your own home or in a nursing home, assisted-living center, or adult day health center that’s either run by the VA or approved by the VA. Eligibility for VA-supported long-term care is based on several factors, including what your VA physician recommends and your service record, income, and proximity to available services.
What qualifies you for VA medical benefits
Active military, naval, or air service duty without a dishonorable discharge is a prerequisite for receiving basic VA medical benefits. If you served after September 7, 1980, you must have also fulfilled the VA’s minimum duty requirement. That means you completed 24 continuous months of active duty or you completed the full period for which you were called. If you are a member of the Reserves or National Guard, active duty for training purposes doesn’t meet the minimum duty requirement; you need to have been called to active duty by federal order. The minimum duty requirement is waived if you were disabled while serving or discharged for a hardship.
Beyond the minimum duty requirement, the VA also has a priority group system that influences what benefits you can receive and what your copayments will be. There are eight priority groups. Three of them, Priority Groups 5, 7, and 8, have income-related eligibility factors; the rest rely on service-related qualifications. For example, veterans awarded the Medal of Honor or who’ve been deemed unemployable due to service-related conditions fall into Priority Group 1. Priority Group 2 includes those who have service-related disabilities with 30% or 40% disabling. Priority Group 3 includes Purple Heart recipients and former Prisoners of War, plus veterans with service-related disabilities and 10% or 20% disabling. Veterans receiving aid and attendance or housebound benefits, plus veterans who are catastrophically disabled are in Priority Group 4. And, Priority Group 6 eligibility is based on when and where the veteran served; those who served in the Republic of Vietnam between 1962 and 1975, for example, fall into this group. The full list of criteria by Priority Group is available here.
As noted, you can qualify for Priority Groups 5, 7, or 8 based on income, assuming you meet the minimum duty requirements. Priority Group 5 includes those who are receiving VA pension benefits, are eligible for Medicaid, or whose income is below the VA’s National Income Threshold. Priority Groups 7 and 8 have higher income thresholds that vary based on where you live and how many dependents you have.
What is the VA income threshold?
There are multiple VA income thresholds that determine your eligibility for different levels of VA medical benefits. If your income is below the VA National Income Threshold, for example, you may fall into Priority Group 5 and receive copayment-free healthcare services. In 2020, the VA National Income Thresholds are as follows:
- $34,171 or less if you have no dependents
- $41,005 or less if you have one dependent
- $43,356 or less if you have two dependents
- $45,707 or less if you have three dependents
- $48,058 or less if you have four dependents
If your income is higher than the national threshold, you still may qualify for benefits under the Priority Group 7 or Priority Group 8 thresholds. At Priority Group 7, you’d have access to VA healthcare with reduced copayments. At Priority Group 8, you’d be responsible for full copayments. The table below shows the 2020 income thresholds for VA medical benefits in New York, California, Texas, and Miami, for eligible veterans with no dependents.
|Priority Group||Benefits Level||New York, NY||Los Angeles, CA||Houston, TX||Miami, FL|
|7||Health care with reduced copayments||$59,750||$58,450||$32,900||$47,450|
|8||Health care with full copayments||$65,6725||$64,295||$36,190||$52,195|
Table data source: VA.gov
You can check the income thresholds that apply to you by using the VA’s calculator here. You will provide your zip code and number of dependents; the calculator then returns different income thresholds that qualify you for various levels of benefits. If your income is under the lowest threshold, you qualify for free medications, beneficiary travel benefits, and free medical care. If your income is under the highest threshold, you can receive medical benefits, but you will be responsible for full inpatient and outpatient copayments.
What is considered income for VA benefits?
The income thresholds only tell half the story, however. The VA compares that it calls your countable income to those stated thresholds. As you might expect, countable income as calculated by the VA may not be the same income number that’s on your tax return.
So, what does the VA consider countable income? Generally, any payments you receive that aren’t specifically excluded will count towards your income. Wages obviously count as income, as do alimony payments, unemployment compensation, workers compensation, pensions, Social Security benefits, interest, dividends, IRA distributions, business income, and even life insurance proceeds. Less common sources like gambling winnings, timber sales, royalties, and revocable trust payments are also included in your countable income.
Some of the specific exclusions to countable income are caregiver payments, FEMA payments, casualty insurance proceeds, scholarships, relocation expenses, VA pension payments, welfare, Supplemental Security Income, and withheld Social Security overpayments. Payments generated from these sources do not count as income with respect to VA benefits eligibility.
Does veterans disability count as income?
Veterans disability compensation is counted as income in certain scenarios. If you are applying for VA benefits and your spouse receives VA disability, for example, that disability compensation is considered countable income for your household.
Does Social Security count as income for VA health benefits?
Social Security benefits do count as income with respect to eligibility for VA health benefits. Survivor benefits and lump sum death benefits from Social Security also count.
Deducting medical expenses from countable income
There’s one more thing to know about how the VA evaluates your income. You may be able to reduce your countable income by deducting certain medical expenses, including your Medicare premiums and the cost of doctor visits, wheelchairs, chiropractic treatments, dental work, prescription drugs, home health services, hospital expenses, and therapy sessions. See a list of eligible medical expenses here.
You can deduct medical expenses from countable income when your out-of-pocket, unreimbursed healthcare expenses exceed 5% of the VA Maximum Annual Pension Rate (MAPR) for the previous year. In 2020, MAPR for veterans with no dependents ranged from $13,752 to $22,939.
How to apply for VA benefits
The only way to determine your VA benefits precisely is to apply and submit a financial assessment. The VA recommends you apply for benefits online, but you can also do it over the phone at 877-222-VETS, or by visiting a VA medical center in person. To complete the application, you’ll need your Social Security number, your military discharge papers, your latest tax return, basic financial information for you and others in your household, plus account numbers for your current health insurance.
If you need assistance completing the VA benefits application, you can get free guidance from a Veterans Service Officer (VSO). Visit the VA’s benefits website to search for a VSO near you.