Health Care for Veterans: Answers to Frequently Asked Questions

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SidathViranga Panangala
Specialist in Veterans Policy

Erin Bagalman
Analyst in Health Policy

TheVeterans Health Administration (VHA), within the Department of Veterans Affairs(VA), operates the nation’s largest integrated health care deliverysystem, provides care to more than 5.5 million veteran patients, andemploys more than 258,000 full-time equivalent employees. 

Eligibility and Enrollment. Contrary to claims concerning promises of “freehealth care for life,” not every veteran is automatically entitled tomedical care from the VA. Eligibility for VA health care is basedprimarily on veteran status resulting from military service. Generally, veteransmust also meet minimum service requirements; however, exceptions are made for veteransdischarged due to service-connected disabilities, members of the Reserve andNational Guard (under certain circumstances), and returning combatveterans. The VA categorizes veterans into eight Priority Groups, based onfactors such as service-connected disabilities and income (among others).Dependents, caregivers, and survivors of certain veterans are eligible for the CivilianHealth and Medical Program of the Department of Veterans Affairs (CHAMPVA),which reimburses non-VA providers or facilities for their medical care. 

Medical Benefits. All enrolled veterans are offered a standard medicalbenefits package, which includes (but is not limited to) inpatient andoutpatient medical services, pharmaceuticals, durable medical equipment, andprosthetic devices.

For female veterans, the VA provides gender-specific care, such asgynecological care, breast and reproductive oncology, infertilitytreatment, maternity care, and care for conditions related to militarysexual trauma. Under current regulations, the VA is not authorized to provide,or cover the costs of, in vitro fertilization, abortion counseling,abortions, or medication to induce abortions.

Generally the VA provides audiology and eye care services (including preventiveservices and routine vision testing) for all enrolled veterans, buteyeglasses and hearing aids are provided only to veterans meeting certaincriteria. Eligibility for VA dental care is limited and differs significantlyfrom eligibility for medical care. For veterans with service-connecteddisabilities who meet certain criteria, the VA provides short- andlong-term nursing care, respite, and end-oflife care.

Under certain circumstances, the VA may reimburse non-VA providers for healthcare services rendered to VA-enrolled veterans on a fee-for-service basis.Such Fee Basis Care may include outpatient care, inpatient care, emergencycare, medical transportation, and dental services. 

Costs to Veterans and Insurance Collections. While enrolled veterans do notpay premiums for VA care, some veterans are required to pay copayments formedical services and outpatient medications related to the treatment ofnonservice-connected conditions. Copayment amounts vary by Priority Groupand type of service (e.g., inpatient versus outpatient). The VA has the authorityto bill most health care insurers for nonservice-connected care; any insurer’spayment received by the VA is used to offset ‘‘dollar for dollar’’ aveteran’s VA copayment responsibility. The VA is statutorily prohibitedfrom receiving Medicare payments (with a narrow exception).


Date of Report: September 20, 2012
Number of Pages: 27
Order Number: R42747
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