Who is Eligible for VA Benefits?

There are many military veterans who do not know that they are eligible to receive VA health care benefits. One of the main reasons for this is that there is a common misconception that veterans with a service-connected disability rating can only use VA medical care facilities. However, this is not true. Veterans who have a service-connected disability rating are able to use VA medical centers. But it is not just those people who can receive health care benefits.

Let’s debunk some of the myths and common misconceptions that exist about VA health care eligibility, discuss who is exactly eligible to receive them, and how VA health care benefits can be applied for.

There are two things that you need to keep in mind:

The first is that this is general information only. Every case is unique, and the VA makes the final decisions on benefits.

VA health eligibility means you can visit VA medical clinics and centers for health care. However, it doesn’t necessarily mean that all of your health care will be 100% free (there might be some free medical care, but many veterans have a co-pay that they must pay).

There might be limitations on the kind of health care you are eligible for, and certain types of medical care might require you to pay for some of the costs, or you might have a co-pay, depending on the type of medical care you receive, what your coverage is, and your VA Priority Group.

Who qualifies to receive VA medical benefits?

A priority system is used to determine veterans medical benefits. Anyone who served in the military on active duty might be eligible for some VA health care benefits at least. A person who was in the National Guard or reserves might also qualify if the individual was called up to serve on active duty.

However, the VA health system cannot provide all veterans with full care. Therefore a complicated system has been set up by the VA to determine the benefits of veterans as well as out-of-pocket expenses. Veterans are divided into eight groups by the system. The highest-priority groups are eligible to receive the most services for the lowest costs.

These priority groups are based on income, service-connected disabilities, and other disabilities. Veterans who have severe service-connected disabilities receive the broadest coverage. Veterans who have low income combined with service-connected disabilities that are less severe or other types of disabilities are provided with midlevel priority, and veterans without low income or disability receive the least amount of VA care.

Eligibility Questionnaire For VA Health Care

Let’s start by discussing some of the basic eligibility requirements, which are based on the eligibility questionnaire for VA health care:

Are any of the following statements true?

You served in the active air, naval, or military service and released or discharged with a rating of General or Honorable under the Honorable Conditions.

You are or were a National Guard member or Reservists, and a Federal Order (for other than the purpose of training) called you to active duty, and you completed a full call-up period of service.

Veterans can select yes or no to answer the questions.

If your answer is yes then you are taken to the next question: Are any of the statements below true?

You were separated or discharged for hardship, early out, or for medical reasons.

Within the last 5 years, you served in a theater of combat operations.

You have been discharged from the military due to a disability (not a preexisting one).

You get state Medicaid benefits.

You receive VA disability benefits or a VA pension.

You were awarded a Purple Heart Medal.

You were a Prisoner of War.

You served in the Persian Gulf from August 2, 1990, through November 11, 1998

You reserved in the Republic of Vietnam from January 9, 1962, through May 7, 1975

If your answer to the second question was yes, then you most likely qualify to receive VA health care. You can proceed to the next section that is labeled “Applying for VA Health Care Benefits.”

If you answer to either of the above two questions was No, you might still be eligible to receive VA medical benefits based on criteria like your household income or military service. An application will need to be submitted for VA health care benefits to find out based on the specific information that you provide.

Important note on household income

Using net worth as one of the determining factors for copayment responsibilities and health care programs as eliminated by the VA in 2015. Now the VA only considers the deductible expenses and gross household income of the Veteran from the previous year.

Your veteran’s income, as well as deductible expenses, are automatically determined by the VA by matching records with the Social Security Administration and Internal Revenue Service.

That eliminates the need for an annual income eligibility form from having to be filed each year by the veteran. It is estimated this change will allow around another 190,000 more veterans to be eligible to receive health care benefits over the next 5 years.

Essential Documents

When you are applying for the first time for VA benefits, you will be required to submit a copy of your discharge papers, which show what your service dates were, and the kind of discharge you had, or furnish he VA with your full name, dates of service, branch, and social security number.

You need to keep your paperwork in a safe place where it can be accessed by you or a family member. Your preference regarding the use of a VA provided headstone and burial at a national cemetery should be documented and stored with your paperwork.

The Application Process

A veteran must file the Veteran’s Application for Compensation and/or Pension to receive veterans disability benefits. You can download the form at the Department of Veterans Affairs website (www.va.gov/vaforms) and then submit it to the nearest VA Regional Office, or you can fill out the form online at the Veterans Online Application website (www.ebenefits.va.gov).

A DD214 (discharge or separation paperwork) must also be provided by the veteran for all service periods as well as copies of evidence of their claimed disability, medical records, and evidence that shows that the disease or disability was caused by their active service. The veteran must also submit copies of marriage or divorce records, adoption or birth records for all dependent children, and nursing home records, if applicable.

Active service members who are applying for benefits as they approach discharge through the BDD process also must submit to a medical separation exam, and all related paperwork must be submitted to the VA.

Who is Eligible for VA Benefits?