The Department of Veterans Affairs (VA) offers comprehensive healthcare services to eligible veterans. Access to VA health care depends on a number of factors, including income limits.
The income thresholds for VA health care vary based on factors like your number of dependents, geographic location, and service-connected disability rating.
Overview of VA Health Care Eligibility
In general, the VA health care system is available to veterans who enlisted after September 7, 1980. On the other Hand they can be entered active duty after October 16, 1981, and who were discharged under conditions other than dishonorable.
Reservists and National Guard members who were called to active duty by a federal order and completed.
The full period for which they were called or ordered to active duty may also be eligible.
Eligibility for VA health care is primarily based on your discharge status, length of service, and service-connected disabilities. However, the VA does impose income limits to determine whether you need to pay copays for medical services.
Your yearly income, including your spouse’s income if you’re married, is used to determine your priority group and copay status.
VA Health Care Enrollment Priority Groups
The VA has established 8 priority groups to manage enrollment in the VA health care program based on income level, disabilities, injuries sustained. During military service, Medal of Honor recipients, and former prisoners of war. The 8 priority groups are:
- Group 1 : Veterans with service-connected disabilities rated 50% or more disabling and/or veterans. Determined by VA to be unemployable due to service-connected conditions.
- Group 2: Veterans with service-connected disabilities rated 30% or 40% disabling.
- Group 3: Veterans with service-connected disabilities rated 10% and 20% disabling; veterans. The Purple Heart medal; veterans awarded special eligibility for disabilities incurred in treatment or vocational rehabilitation; and veterans with service-connected disabilities who VA deems to be 10% disabling.
- Group 4 : Veterans receiving aid and attendance or housebound benefits and/or veterans determined by VA to be catastrophically disabled.
- Group 5: Veterans receiving VA pension benefits or eligible for Medicaid programs, and nonservice-connected. Veterans and noncompensable zero percent service-connected veterans whose gross annual household income and net worth are below the established VA limits.
- Group 6 : Veterans of World War I; veterans seeking care solely for certain conditions associated with exposure to toxic substances, radiation, combat in a war after the Gulf War, or for sexual trauma; compensated zero percent service-connected veterans; and veterans who served in a theater of combat operations after November 11, 1998.
- Group 7: Veterans with household income below the geographically-adjusted income limits for their resident location and who agree to pay copays.
- Group 8: Veterans with gross household incomes above VA income limits for their resident location and who agree to pay copays.
Veterans in Priority Groups 1-6 are eligible to receive free VA health care with no out-of-pocket costs. Veterans in Priority Groups 7-8 may have to make copayments depending on their income level.
VA Health Care Income Limits
The income thresholds used by the VA depend on where you live, your family size, and whether you have any special circumstances like a disability, severe injury, or other conditions. Below are some of the key income limits for VA health care in 2023 based on group priority:
- For Group 5, the income threshold is around $14,580 for a single veteran with no dependents and $18,960 for a veteran with one dependent. Income limits increase with the number of dependents.
- For Group 7, income limits range from around $31,900 (single veteran) to $48,555 (veteran with multiple dependents) depending on geographic location. Veterans earning above the Group 7 threshold are placed in Priority Group 8.
- The VA National Income Thresholds for copays in 2023 range from $36,578 for a single veteran to $53,139 for a veteran with 2 dependents. Veterans earning above these national thresholds must make copayments when using VA health care services.
- The annual VA Geographic Means Test Income Thresholds used for Group 7 eligibility range from around $39,105 (single veteran in Iowa) to $82,602 (veteran with 4 dependents in New Jersey). Geographic means test thresholds are adjusted based on where veterans live.
- Veterans with a service-connected disability rating of 10% or more are eligible for free VA health care for any condition regardless of their income level.
- Veterans with income levels above the VA’s National Income. Thresholds can still enroll in VA health care under Group 8 and receive care by paying applicable copays. There are no income limits for enrolling in Group 8.
The specific income thresholds applied are updated annually based on cost of living adjustments. The VA looks at your gross household income from the previous year to determine your priority group placement and whether you’ll need to make any copayments for medical services.
How VA Health Care Income Is Calculated
The income reported to the VA to determine your eligibility includes money from all sources for you and your dependents living in your household. Countable income includes:
- Social Security benefits
- Retirement and pension income
- Unemployment insurance
- Worker’s compensation
- IRA distributions
- Wages from employment
- Interest and dividends
Your gross household income is calculated before any deductions for taxes, health insurance premiums, or other expenses. The VA also looks at your overall net worth, including.
The market value of properties like your home minus any mortgages.
Only unreimbursed medical expenses can be deducted from your reported income for VA purposes.
Eligible medical expenses include insurance premiums and copayments, prescriptions, transportation for medical purposes, and in-home care.
The higher your medical expenses, the lower your countable income may be for VA health care eligibility.
Submitting Your Household Income to the VA
To get an accurate determination of your VA health care eligibility, you need to disclose your household income from the previous calendar year. You can submit proof of income and net worth as part of your initial application for VA health care benefits.
You may also need to verify your income with the VA annually to confirm whether you still qualify for your assigned priority group and copay status. Provide copies of the following documents:
- IRS tax return transcripts
- W2 forms
- Pay stubs
- Social security award letters
- Bank statements
- Real estate assessments
Submit your financial documents to your local VA medical center or clinic. You can also upload your income verification online if you have a premium My HealtheVet account. Contact your VA representative if you have any questions about required income documentation.
Accurately reporting your household finances ensures the VA can determine your health care eligibility and assign you to the correct priority group. This allows you to access the VA health care benefits you’ve earned at the lowest possible cost.