The Department of Veterans Affairs (VA) uses a system known as Enrollment Priority Groups when determining VA health care benefits. The priority groups range from one to eight with veterans in the first priority group demonstrating the greatest need. When assigning veterans to a priority group, the VA considers each person’s medical needs along with how much it will cost the VA health care system to treat them. Sometimes veterans qualify for more than one priority group. When this happens, the VA automatically includes the veteran in the highest priority group.
Why the VA Uses a Priority Group Range When Assigning Health Care Benefits
The VA exists to ensure that veterans continue to have access to high-quality medical care after leaving the military. The number of veterans that the VA assigns to each Enrollment Priority Group depends on its annual budget. You may find that your copay changes if the VA moves you from one priority group to another.
Veterans do not always agree with which priority group the Department of Veterans Affairs assigns to them. Hill & Ponton welcomes you to learn more about legal actions you can take if you find yourself in this situation. Please call our main office at 888-373-9436 to request further assistance.
Priority Group 1
To receive placement in the highest priority group, you must have at least a 50 percent disability rating from injury or illness sustained in the line of duty. Any veteran who has received a Medal of Honor qualifies for Priority Group 1 as do veterans who meet the VA standard for unemployability. If you cannot work because of a disability, the disability must have started while you were on active duty.
Priority Group 2
Eligibility for the second-highest priority group requires you to have a VA disability rating between 30 and 40 percent.
Priority Group 3
You can meet any one of the following criteria to qualify for Priority Group 3:
- Purple Heart medal recipient
- Former Prisoners of War
- The VA has rated your service-related disability at 10 to 20 percent
- You received an honorable discharge for a disability that began or worsened while serving active duty
- You previously received special eligibility classification resulting from Title 38, U.S.C., § 1151. The VA also refers to Title 38 as “benefits for individuals disabled by treatment or vocational rehabilitation.”
Priority Group 4
The VA assigns this classification to veterans who receive housebound benefits or aid and attendance benefits already. You can also qualify for Priority Group 4 if the VA previously determined you to have a catastrophic disability.
Priority Group 5
You can receive VA health care benefits in Priority Group 5 if you currently receive VA pension benefits or are eligible to apply for Medicare. Other qualifications include:
- You have a disability unrelated to previous active duty service
- You have a service-related disability but the VA has deemed it a non-compensable service
- The VA previously assigned a zero percent disability rating
- Your annual income is below the geographic income thresholds established by the VA
Priority Group 6
You qualify for Priority Group 6 if you meet any of these criteria:
- You have a 0 percent compensable disability related to your active duty military service
- You served in the Republic of Vietnam anytime between January 9, 1962 and May 7, 1975
- You faced exposure to ionizing radiation due to the occupation of Hiroshima and Nagasaki or while completing atmospheric testing
- You are currently or were previously one of Project 112/SHAD participants
- You are a veteran of the Persian Gulf War whose active duty military service occurred between August 2, 1990 and November 11, 1998
- You are a veteran of World War I or the Mexican border period
- You completed at least 30 days of active duty military service at Camp LeJeune between August 1, 1953 and December 31, 1987
- You are a veteran or active duty military member who served in the theater of combat operations anytime after November 11, 1998. If your active duty discharge occurred after January 28, 2003, you will receive enhanced post discharge benefits for five years.
Priority Group 7
You qualify for placement in Priority Group 7 if your gross household income is less than the VA’s geographically adjusted income limit according to your current ZIP code. You must agree to make copayments when you receive health care services from the VA.
Priority Group 7 also includes the following subpriority group for veterans with a non-compensatable 0 percent service-related disability:
- Subpriority a: This applies to enrolled veterans who registered as of January 16, 2003 who have remained continuously enrolled or had a change in eligibility status that required the current VA staff to place them in this group.
- Subpriority b: This applies to enrolled veterans who registered as of June 15, 2009 and whose annual income is 10 percent or less above the geographically adjusted income limits.
Priority Group 8
The last priority group is available to veterans who have a disability unrelated to military service and whose gross household income is above the geographically adjusted income limit set by the VA for their region. Priority Group 8 also includes these subpriorities:
- Subpriority c: This applies to enrolled veterans who registered as of January 16, 2003 who have remained continuously enrolled or had a change in eligibility status that required the current VA staff to place them in this group.
- Subpriority d: This applies to enrolled veterans who registered as of June 15, 2009 and whose annual income is 10 percent or less above the geographically adjusted income limits.
Subpriority e and subpriority g also exist. However, veterans in these groups are not eligible for VA health care services. The one exception is veterans belonging to Priority Group 8 who have a non-compensable 0 percent service-related disability. Their medical benefits only include coverage for the service-related injury or disability. Veterans in Priority Group 8, subpriority g are ineligible for any VA medical benefits because they have a nonservice-related disability or injury.
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