VA Health Care Coverage: What's Covered, What It Costs, and How It Works With Other Insurance

No. VA health care is a health system, not an insurance plan. When you enroll, the Veterans Health Administration (VHA) becomes your provider: its hospitals, clinics, pharmacies and, when needed, private doctors it pays for. There are no premiums or deductibles. What you owe is a fixed copay that depends on your priority group and on whether the care is for a service-connected condition.

VA health care covers a defined package of services, set by regulation, that every enrollee gets. The differences between veterans are about cost. If you are not enrolled yet, start with the VA health care enrollment guide, which explains eligibility and Form 10-10EZ.

The package is written into 38 CFR 17.38, in Title 38 of the Code of Federal Regulations. Every enrolled veteran is eligible for the care in it when a VA provider decides it is needed.

Basic care

• Outpatient and inpatient medical, surgical and mental health care, including substance use treatment
• Prescription drugs, over-the-counter drugs and medical and surgical supplies
• Emergency care in VA facilities, and in non-VA facilities when authorized
• Rehabilitation, home health, hospice, palliative and respite care
• Prosthetics, eyeglasses and hearing aids (with the limits below)
• Reconstructive surgery after disease or trauma; pregnancy, delivery and newborn care
• Bereavement and family counseling tied to your treatment; beneficiary travel

Preventive care: periodic exams, health education, immunizations, screenings, vision testing, mental health prevention, genetic counseling and chiropractic services.

VA's benefits overview adds that mental health care includes counseling, therapy and specialized care for post-traumatic stress disorder (PTSD), depression and substance use disorders. PTSD is treatable, and that care is part of the package. The prescription benefits guide covers the VA formulary and mail-order refills.

The regulation also lists exclusions: abortion and abortion counseling, in vitro fertilization, drugs or devices not approved by the Food and Drug Administration (FDA) outside clinical trials or compassionate use, gender alterations, care while incarcerated, and health club memberships.

4 benefits have their own eligibility rules.

Dental. Free VA dental care is limited to defined classes on VA's dental care page. The classes are: a compensated service-connected dental condition; former prisoners of war (POWs); a 100% rating or unemployability paid at the 100% rate; a noncompensable service-connected or combat-related dental condition; dental conditions that worsen a service-connected condition or block other VA treatment; Veteran Readiness and Employment participants; and a one-time course of care through the Homeless Veterans Dental Program. Everyone else can buy reduced-cost coverage through the VA Dental Insurance Program (VADIP). It is open to anyone enrolled in VA health care or CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).

Vision. VA covers routine eye exams and preventive vision testing for every enrollee. Eyeglasses are covered only for listed groups: a compensable service-connected disability, former POWs, Purple Heart recipients, benefits under 38 U.S.C. 1151 (Title 38 of the United States Code) or a housebound pension. They are also covered for vision loss from a condition VA is treating, or a functional impairment that interferes with daily tasks.

Hearing aids. Broader than most expect. VA's hearing aids fact sheet says any enrolled veteran can receive hearing aids at no cost, with no service connection required. You may owe a copay for the audiology visit.

Long-term care. Nursing home and home-based extended care use a separate application, VA Form 10-10EC, and separate copays. There is no copay for the first 21 days, then up to $97 per day inpatient and up to $15 per day outpatient.

The figures below are effective January 1, 2026, from VA's copay rates page. 3 rules apply before any of them:

• Care for a service-connected condition is free in every group.
• A service-connected rating of 10% or higher exempts you from all outpatient and inpatient copays.
• X-rays, lab tests, preventive tests, screenings and immunizations never carry a copay. Neither does readjustment counseling. Through December 29, 2027, your first 3 outpatient mental health or substance use visits each calendar year are also copay-free.

Source: https://www.va.gov/health-care/copay-rates/, effective January 1, 2026.

In short: group 1 pays nothing. Groups 2-6 pay no outpatient or inpatient copays with a 10%+ rating, but can owe medication copays for non-service-connected drugs. Group 6 veterans owe copays only for care unrelated to their qualifying exposure or service. Groups 7-8 owe outpatient, medication and inpatient copays. Which group you land in is explained in VA priority groups explained.

VA's other-insurance page sets the rules.

You do not need other insurance. Having it does not change the VA benefits you can get. VA still recommends keeping it: it covers family members and pays for non-VA care VA has not authorized.

VA bills private insurance, but not you. VA must bill your private insurer for care that treats non-service-connected conditions. You never owe the balance the insurer refuses to pay, and money VA collects can offset part or all of your copay. Listing your insurance on Form 10-10EZ helps rather than hurts.

Medicare and Medicaid. VA does not bill Medicare or Medicaid, though it may bill a Medicare supplement plan. VA still advises signing up for Medicare at 65, because delaying Part B carries a late penalty. With both, you choose which benefit to use at each visit. The Medicare coordination guide walks through the decision.

TRICARE. Retirees can hold TRICARE and VA care together. VA notes the trade-off: TRICARE has premiums but covers your family; VA care does not.

Does it count as coverage under the Affordable Care Act? VA's ACA page says the health care law does not change your VA benefits or out-of-pocket costs. It also says the federal penalty for going without insurance no longer applies from 2019 on. VA issues Form 1095-B to enrollees as proof of health coverage for tax purposes (from 2026 you request it rather than receiving it by mail). If your state has its own coverage mandate, check that state's rules. Compare the options in the health insurance options guide.

The Veterans Community Care Program, created by the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018, lets VA send you to a community provider at VA's expense. Under VA's eligibility page, you may be eligible if at least 1 of these is true:

1. You need a service VA does not provide at any facility.
2. You live in a state or territory with no full-service VA health facility.
3. You and your VA provider agree that community care is in your best medical interest.
4. VA cannot provide the service in a way that meets its quality standards.
5. You were eligible under the old 40-mile distance rule as of June 6, 2018 (certain states only), or
6. VA cannot meet its access standards: a 30-minute average drive time or 20-day wait for primary care, mental health and non-institutional extended care, or a 60-minute drive or 28-day wait for specialty care.

Watch out: Community Care must be approved by your VA care team before the visit, except urgent care and emergencies. Urgent care requires enrollment plus a VA or in-network visit in the past 24 months. For an emergency at a non-VA hospital, VA must be notified within 72 hours of when care starts. The emergency room coverage guide explains what VA pays.

Will VA pay a non-VA ER visit if I called within 72 hours?

Calling within 72 hours meets 1 of VA's requirements. VA's emergency care page says VA must be notified within 72 hours of when emergency care at a non-VA facility starts, through its emergency care reporting portal or by phone. The conditions VA applies when it decides what it pays for a non-VA emergency room (ER) visit are in the emergency room coverage guide. The 1 case with a flat answer is emergent suicide care under the COMPACT Act, below, where the cost is $0.

Free emergent suicide care under the COMPACT Act

Since January 17, 2023, under the Veterans Comprehensive Prevention, Access to Care, and Treatment (COMPACT) Act of 2020, a veteran in acute suicidal crisis can go to any VA or non-VA emergency room at no cost. It covers emergency treatment, up to 30 days of inpatient or crisis residential care, up to 90 days of outpatient care, medications and transportation. Enrollment is not required.

It covers 3 groups: veterans with more than 24 months of active service under conditions other than dishonorable, former service members with more than 100 days of combat or contingency service, and anyone who experienced military sexual trauma. VA should be notified within 72 hours at 844-724-7842; the hospital can make that call. If you are in crisis now, dial 988 then press 1.

VA health care enrollment covers you only. CHAMPVA covers your spouse or dependent child if VA has rated you permanently and totally disabled from a service-connected disability. It also covers survivors of a veteran who died from one or was so rated at death. Your family must not be eligible for TRICARE, the Defense Department's program for military retirees' families, which takes precedence. The CHAMPVA benefits guide explains costs and how to apply; more options are in health care support options for family members.

States layer their own health benefits on top of VA care: state veterans homes for long-term care, Medicaid programs that pay for dental or home care VA does not, and state mental health lines. Use the finder to see what applies where you live.

You apply once, with VA Form 10-10EZ, online, by phone, by mail or in person. Since March 5, 2024, the PACT Act lets toxic-exposed, Gulf War and post-9/11 veterans enroll without filing a disability claim first. The enrollment guide covers eligibility and what to have ready; the post on Form 10-10EZ walks the form field by field.

Bridge to your claim: Every VA visit creates a treatment record. A record of care for a condition that started in service is the kind of evidence VA weighs in a later disability claim. A 10% rating removes your outpatient and inpatient copays.