Eligibility for VA Health Care Benefits

VA health care eligibility begins with United States Armed Forces Active Duty military service. While on Active Duty, servicemembers receive health care through their branches of service.

Upon discharge from service, qualifying veterans become eligible for VA medical benefits. Servicemembers who are dishonorably discharged are never eligible for VA services or benefits of any kind.

Veterans who served exclusively in the Reserves or National Guard are eligible for benefits if they were called up into Active Duty and satisfactorily served their full call-up periods. Reserves and National Guard servicemembers who served Active Duty for training days only do not meet VA medical benefits eligibility minimum requirements.

Enhanced VA health benefits eligibility status may apply to veterans who were Prisoners of War, awarded certain medals or who suffer service-related disabilities. Once veterans have been determined to be eligible for benefits and are enrolled, they may remain enrolled for the rest of their lives.

VA Healthcare Eligibility Basic Service Requirements

VA medical coverage eligibility minimum service requirements do not apply to all veterans. Applicants may be exempt from VA medical eligibility service minimums if they:

  • Served September 6, 1980 or earlier.
  • Separated from the military on account of a service-related or service-aggravated disability.
  • Separated from the military on account of hardship or qualifying “early out” criteria.

All other veterans are generally held to minimum service requirements. Active Duty veterans who served beginning September 7, 1980 or later must have completed at least 24 consecutive months of service. To qualify for VA medical benefits, members of the Reserves or National Guard must have satisfied the full Active Duty period to which they were called.

The Department of Veterans Affairs advises that all veterans apply for VA health benefits and receive an official eligibility review, rather than attempting to determine their eligibility status themselves.

Dishonorably Discharged Veterans and VA Healthcare Eligibility

Veterans who were other than honorably discharged may be able to meet VA medical benefits eligibility criteria by applying for and receiving a Character of Discharge review. Character of Discharge reviews are available to veterans from all branches of service and applicants may enlist advocates to assist them in pleading their cases.

Reviews allow veterans to argue that their less than honorable discharges were related to or caused by mental health conditions, traumatic brain injuries, sexual assault or harassment or sexual orientation. If a Review board determines that the reviewee’s arguments are well supported and valid, they can elect to upgrade his or her discharge status to “honorable for VA purposes.”

Related Article: Eligibility for VA Disability Compensation

Veterans who are upgraded to “honorable for VA purposes” status become eligible for VA medical coverage. Like other enrollees, they may then keep those benefits for life.

The Character of Discharge review process may take up to a year to complete. Some applicants with serious health needs may be deemed eligible to begin receiving VA healthcare benefits while still in review.

Enhanced VA Medical Eligibility

Veterans from any branch of service may be afforded enhanced VA medical coverage eligibility. Enhanced VA health care eligibility status is applied to veterans who:

  • Were Prisoners of War (POWs).
  • Were awarded Purple Hearts or Medals of Honor.
  • Are receiving VA pensions.
  • Have or were separated due to service-connected disabilities, including veterans deemed Catastrophically Disabled.
  • Served in specific theaters during designated time periods.
  • Were stationed or living at Camp Lejeune for at least 30 days between August 1953 and December 1987.
  • Qualify as low- or very-low income under VA standards.

Enhanced VA medical eligibility may qualify veterans for prioritized care and services in VA facilities or additional services and benefits.

VA Health Benefits Income Eligibility

When determining VA health benefits eligibility income plays a role. Who is eligible for VA healthcare based on income is assessed using gross annual household income, which includes:

  • Salaries and wages of all income-earners in the household.
  • Unearned benefits (e.g. pensions, Unemployment benefits and other governmental support program funds).
  • Monies received from farm, business or property ownership.

As of January 2015, the Department of Veterans Affairs does not use net worth as part of its income eligibility assessments.

The VA permits qualifying expenses to be deducted from veterans’ annual incomes before assessments are completed. It also adjusts applicants VA health care eligibility to account for cost of living based on the states and regions of their permanent residences. Examples of expenses that may be deducted from income for medical benefits eligibility assessment purposes include:

  • Dependents.
  • Medical expenses.
  • Funeral and burial expenses.
  • Veterans’ educational expenses.

Applicants may be held to different VA health benefits income eligibility thresholds if they are:

  • In an enhanced eligibility priority category.
  • Housebound.
  • Receiving VA pensions.
  • Receiving VA pensions with Aid and Attendance allowances.

The VA offers an online screening tool to assist veterans in calculating their preliminary VA health benefits eligibilities. However, the tool is for estimation purposes only and may not accurately reflect final formal eligibility determinations. Veterans with questions about their eligibility may call 1-877-222-VETS (8387) for assistance. Hearing impaired veterans may alternatively call 1-800-829-4833.

Automatic VA Health Care Eligibility

VA medical benefits eligibility is automatically extended to certain populations of veterans regardless of all other qualification factors. For example, veterans stationed or in service at Camp Lejeune for 30 or more days between August 1, 1953 and December 31, 1987 may qualify for VA healthcare benefits and services even if they are not enrolled in any VA medical care programs.

Likewise, veterans suffering from Post-Traumatic Stress Disorder (PTSD) and other serious, service-related conditions may be eligible to receive services and care even if they have not yet enrolled with the VA or while their applications are pending. Extremely low income veterans may be found eligible for VA health benefits solely on account of income, as well.

Applicants who believe they may qualify for benefits under one of these or similar eligibility exemptions can use the VA’s online eligibility screening tool to receive information and direction about their options. Alternatively, they may contact the VA toll free by phone or speak to a representative at their local regional benefits center to help them apply for VA health benefits.

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