Community Care
For those Veterans who are unable to reasonably receive care at their local VA run medical facility.
General Community Care
Getting regular care outside the VA.
Eligibility
Be enrolled in VA health care; AND have
VA approval.
Circumstances VA Will Consider Veterans for Approval
Veterans only need to meet 1 of these to be eligible:
Veteran needs a service NOT available at a VA medical facility;
Veteran lives in a State (AK, HI, NH) or U.S. Territory (Guam, America Samoa, Northern Mariana Islands, U.S. Virgin Islands) that does NOT have a full-service medical facility;
VA medical staff determine Veteran would be best treated by a community medical facility;
Veteran is far away from their VA medical facility:
30-minute average drive time for primary care, mental health, and non-institutional extended care services, or
60-minute average drive time for specialty care.
Long wait times to be seen:
20 days for primary care, mental health care, and non-institutional extended care services, unless the Veteran agrees to a later date in consultation with their VA health care provider, or
28 days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with their VA health care provider.
The VHA has determined the specific care at your local VA medical facility is below VA standards of quality.
Finding a Provider
Veterans can either choose their preferred community provider or a VA staff member can help select one. The selected community provider MUST be part of VA’s network.
To find a community provider click HERE.
Scheduling Appointments
IMPORTANT NOTE:
BEFORE scheduling an appointment, ensure you are eligible AND are authorized for community care!
Ways to schedule appointments:
Directly schedule an appointment and inform a VA staff member about the appointment;
Use MyHealtheVet scheduling to request an appointment;
Have a VA staff member schedule the appointment; or
Have the VA's Third Party Administrator (TPA) schedule the appointment.
Medications
Prescriptions should be sent to and filled by the nearest VA pharmacy. However, Veterans can receive short-term prescription medication for a 14-day or fewer supply that can be filled at a non-VA pharmacy. A prescription for more than a14-day supply MUST be filled by VA.
Cost (Co-pays)
Treatment for a service-connected disability and any treatment for Veterans with a Combined rating of 10% or more owe NO copays!
IMPORTANT NOTES:
Community providers CANNOT bill or collect a VA copayment directly from Veterans. All VA copayments are billed as part of the VA’s billing process.
If the Veteran has issues with billing they should contact the VA Community Care Contact Center:
877-881-7618, Option 1 (8 a.m. – 9 p.m. Eastern Standard Time)
Outpatient Care
Outpatient care is defined as primary or specialty care that does NOT require an overnight stay.
For current copay rates click HERE.
NOTE:
Specialty care would be your outpatient surgery, dermatology, audiology, optometry, cardiology and specialty tests like an MRI or CAT scan.
| Care | Priority Groups 1-6 | Priority Groups 7-8 |
|---|---|---|
| Primary | FREE! | Copay Owed. |
| Specialty | FREE! | Copay Owed. |
Inpatient Care
Inpatient care occurs when a patient’s condition requires admission to a hospital for one or more nights.
For current copay rates click HERE.
| Care | Priority Groups 1-6 | Priority Groups 7-8 |
|---|---|---|
| Primary | FREE! | Copay Owed. |
Medications
IMPORTANT NOTE:
Veterans never owe copays for medication related to service-connected disabilities! Regardless of what priority group they may be in.
For current copay rates click HERE.
| Priority Groups 1, 4 | Priority Groups 2, 3, 5, 6, 7, 8 |
|---|---|
| FREE! | Copay Owed. |
Urgent Care
For minor injuries and illnesses that are NOT life-threatening, such as colds, strep throat, sprained muscles, and skin and ear infections.
Eligibility
Be enrolled in VA Healthcare;
Go to an in-network urgent care provider; AND
Have received care through the VA or Community Care within the past 2 years.
Finding a Provider
Use the VA Facility Locator;
Contact your local VA medical facility; or
Call 877-881-7618.
Getting Care
Tell the provider you would like to use your VA urgent care benefit to receive care.
Ask and verify the urgent care provider is part of the VA contracted network. The urgent care provider may have a sign posted that indicates they are part of VA’s contracted network.
IMPORTANT NOTE:
DO NOT pay a copayment at the time of urgent care visit!
If they are giving you a hard time call:
Regions 1-3 (AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, PR, RI, SC, SD, TN, VA, VI, VT, WI or WV): 888-901-6609
Regions 4-6 (AK, AS, AZ, CA, CO, GU, HI, ID, MP, MT, NM, NV, OR, TX, UT, WA and WY): 866-620-2071
Medications
VA will pay for a 14-day supply (no refills) of prescription medication from the in-network urgent care provider.
Prescriptions can be filled at an in-network pharmacy, at the VA, or at a non-network pharmacy.
If a non-network pharmacy is used, Veterans MUST pay for the prescription and then file a claim for reimbursement with their local VA medical facility.
Prescriptions MUST be filled in the same state as the Veteran’s urgent care visit.
For a 14-day supply or greater, or for routine, non-urgent medications, the prescription MUST be submitted to VA to be filled.
Opiates are limited to seven days or less.
To find an in-network pharmacy use the VA Facility Locator.
Cost (Co-pays)
For current copay rates click HERE.
NOTE:
$0 copay for visits consisting of only a flu shot.
| Priority Group |
Visits 1-3 |
Visits 4+ |
|---|---|---|
| 1-5 | FREE! | Copay. |
| 6 | Copay*. | Copay. |
| 7-8 | Copay. | Copay. |
*Free if related to a condition related to: Agent Orange, Camp Lejeune, Ionizing radiation, Project Shipboard Hazard and Defense (SHAD/Project 112), Southwest Asia Conditions as well as Military sexual trauma, and presumptions applicable to certain Veterans with Psychosis and other mental illness.
Medications
IMPORTANT NOTE:
Veterans never owe copays for medication related to service-connected disabilities! Regardless of what priority group they may be in.
For current copay rates click HERE.
| Priority Groups 1, 4 |
Priority Groups 2, 3, 5, 6, 7, 8 |
|---|---|
| FREE! | Copay. |
Emergency Care
When you reasonably believe that any delay in seeking immediate medical attention would cause your life or health to be placed in jeopardy.
IMPORTANT NOTES:
If you believe your life or health is in danger, call 911 or GO TO THE NEAREST EMERGENCY DEPARTMENT NOW!
Veterans do NOT need to check with VA before calling for an ambulance or going to an emergency department!
Eligibility
If care is required due to a 'service-connected' condition (38 USC § 1728)
By virtue of the condition being service-connected. The Veteran is eligible.
NOTES:
For Veterans who are rated Permanent and Total (P&T), ANY conditions they have will count.
For Veterans who are participating in Veteran Readiness and Employment, AND it is medically determined to have been in need of care or treatment to make possible the Veteran’s entrance into a course of training, or prevent interruption of a course of training, or hasten the return to a course of training which was interrupted because of such illness, injury, or dental condition; They are eligible.
If care is required due to a 'non-service-connected' condition (38 USC § 1725)
Be enrolled in VA Healthcare, and
the Veteran has received care from the VA within the past 2 years.
After Receiving Life Saving Care
Once a Veteran’s immediate emergency medical care needs have been addressed, the Veteran, a family member, friend, or hospital staff member SHOULD contact the nearest VA medical facility within 72 hours.
Alternatively, the Emergency Care Centralized Notification Center can be reached by phone at: 844-724-7842.
Online: Emergency Care Reporting.
IMPORTANT NOTE:
Failure to promptly notify the VA will result in delay of authorization of care and will prevent claims/payments from being made.
Filing a Claim
Claims for emergency medical care should be submitted to VA as soon as possible after care has been provided.
Veterans should obtain and submit COPIES of all related treatment and billing records to the closest VA medical facility.
DEADLINES
While these are the absolute deadlines; again, you should file as soon as possible.
If care was for a service-connected condition:
2 years.
If care was for a non-service-connected condition:
90 days!
Cost (Co-pays)
IF CLAIM IS FILED BEFORE DEADLINE:
FREE! Unless, the care is for a dental condition that is not service-connected. In such case, the VA will NOT pay incurred costs.
NOTES:
The VA CAN reimburse a Veteran for coinsurance and deductibles amounts (but not copayments) that a Veteran may owe to a provider under their health insurance plan.
Reimbursement for Travel
Veterans can receive reimbursement for travel to and from scheduled appointments, less a monthly deductible.
NOTE:
VA will reimburse travel for eligible Veterans that travel to receive community care. Payment will be made for the distance to either the NEAREST VA OR the community medical facility that could have provided the care or services.
General Community Care & Urgent Care
NOTE:
Veteran will only be eligible for reimbursement for one way travel (e.g., not round-trip) for unscheduled care.
Eligibility:
Have a disability rating of 30% or higher;
Are traveling for treatment of a service-connected condition (even if your rating is less than 30%);
Receive a VA pension;
Have an income that’s below the maximum annual VA pension rate; or
Are traveling to get a Service dog.
Filing a claim
Be sure to submit your claim within 30 days of your appointment. If you become eligible for travel reimbursement after your appointment, submit your claim within 30 days of when you become eligible.
To file a claim go to the AccessVA website.
Special Mode Transportation
Ambulance, ambulette, or wheelchair van
Eligibility:
You’re eligible for general health care travel reimbursement;
A VA health care provider determines that your medical condition requires an ambulance or a specially equipped van for travel; AND
The VA has approved your travel in advance, unless the travel is for an emergency situation where a delay would threaten your life or health.
For non-emergency transportation
Before using non-emergency transportation, be sure to contact your local VA travel office and get approval.
If the VA orders the service for your transport
You don't need to file a claim.
If you order the transport and need to pay the cost
You MUST submit a claim within 30 calendar days of the date of travel. You'll also need to include a copy of your paid invoice.
Filing a claim
Complete and submit VA Form 10-3532.
Emergency Care
Is worked out with the billing of care.
Frequently Asked Questions
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Contact your local VA medical facility to discuss options. Same-day primary and mental health services are available at all VA medical centers. In addition, the VA continues to expand its contracted network of urgent care providers so that most Veterans are within a 30-minute drive time from their home to a network urgent care/retail location.
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If the emergency department is part of VA’s contracted network and has agreed to furnish urgent care services in accordance with the contract requirements, the VA can pay for these services for eligible Veterans under this benefit.