Priority Groups and You
Once your eligibility status has been determined, you will be assigned to a priority group.

Congress requires VA to manage the health care system using eight priority groups. These priority groups determine who may be eligible to receive health care benefits each year.

VA receives funding for the health care system from the federal budget and other resources (e.g. health insurance policy collections). The sum of available funds is compared to the number of veterans who use the health care system. Veterans who are in receipt of a rating decision for a service-connected injury or illness receive priority consideration for health benefits. All other veterans are eligible for care as determined by their priority grouping.

Financial Issues
If you are a non-service connected veteran or 0% non-compensable service connected veteran, you are required to complete an annual means test/financial assessment. Depending on your income level, you may be required to make co-payments for your care and/or medications. Veterans who are rated with a service-connection of 50% or less are required to make co-payments for medications that are not related to that service-connected injury or illness. Medications related to the service-connection are free of co-payment charges. If your income is below the pension threshold, you may take a co-pay test to waive these charges (see your local VeteransService Center).

Means Test/Financial Assessment
Each year, you must complete a means test/financial assessment. The means test/financial assessment is based on the previous year's family income, assets and debts. This information is used to determine your co-payment.

You can agree to make co-payments without providing any financial information. If you indicate this on your application form, you will automatically be put into a co-pay category.

• Should you decline to complete the financial assessment or not agree to make the co-payments, you will not be eligible for VA healthcare.
• Financial information may be subject to verification with the Internal Revenue Service and Social Security Administration.

Financial Assessment for Long-Term Care Services
For veterans who are not automatically exempt from making co-payments for long-term care services, a separate financial assessment (VA Form 10-10EC, Application for Extended Care Services) based on current year’s income and assets. Must be completed to determine whether they qualify for cost-free services or to what extent they are required to make co-payments. For those veterans who do not qualify for cost-free services, the financial assessment is used to determine the amount of the co-payment requirement. Unlike co-payments for other VA health care services, which are based on fixed charges for all, long-term care co-payment charges are individually adjusted based on each veteran’s financial status.

Hardship Determinations
Request for hardship determination may be made based on a change in your financial situation. To request consideration for hardship, you must make a written request to your local Veterans Service Center. After review of your request, a determination will be made that may result in an adjustment to your eligibility and may impact your co-payment status.

Waivers
You may request a waiver for a portion of or the entire amount of your co-payment charges. Contact the Network Medical Care Collection Fund (MCCF) Office/Billing Manager at (518) 626-6816 for more detailed information.

Medication Co-Payments
As part of your VA health care, prescription medications are available. In most cases, co-payment is required for prescriptions if they are for treatment of a non-service connected condition. You should contact the nearest VA health care facility for the most current information.

Health Insurance
We need to know about your health insurance. VA encourages you to maintain any health insurance plans you currently hold. VA bills private insurance companies for all non-service connected care a veterans receives. (VA does not bill insurance companies for treatment of service-connected conditions.)

You do not have to pay any balances that are not covered by your insurance carrier. Many insurance companies apply the VA healthcare charges toward the satisfaction of your annual deductible.

Your co-payments may be offset by the payments we receive from your insurance company.

Your current insurance status (insured or uninsured) has no bearing on your VA health care benefits. You are eligible for care regardless of your current insurance status.

CAUTION! Before canceling insurance coverage, enrolled veterans should carefully consider the risks:

• There is no guarantee that in the subsequent year Congress will appropriate sufficient funds for VA to provide care for all enrollment priority groups.
• Non-veteran spouses and other family members generally do not qualify for VA heath care.
• If participation in Medicare Part B is cancelled, it cannot be reinstated until January of the next year and there may be a penalty for reinstatement.

Reporting Health Insurance Information
By law, VA is obligated to bill health insurance carriers for services provided to treat nonservice-connected conditions. To ensure that current insurance information is on file — including coverage through employment or through a spouse — you will need to verify the status of your health insurance at each patient visit. Since collections received from insurance companies help supplement the funding available for providing services to veterans, patients are asked to cooperate by disclosing all relevant health insurance information.

Co-Payments
You may be required to pay a co-payment for care and prescriptions.

If you can’t afford the co-payments, you may request a waiver. Contact the Network Medical Care Collection Fund (MCCF) Office/Billing Manager at (518) 626-6816 for more detailed information.

If co-payments become a hardship, you may establish a payment plan. Failure to pay could result in garnished wages, VA compensation benefits or your income tax refunds.

Generally you will be charged only one co-payment on a single day, whether it be an inpatient, outpatient, or long-term care co-payment, based on the highest level of service provided that day. Medication co-payments, which are applicable only to outpatients, vary depending upon the number of prescriptions filled. If you are an outpatient who has both a specialty care visit as well as a basic care visit on the same day, you will be charged for the specialty care visit since it is the more expensive level of care.