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Veterans, Military and Their Families

 

How to Navigate VA Health Care Benefits

Follow this guide to understand the paths to eligibility and determine your best options

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For the over 19 million Americans who served in the armed forces, accessing health care benefits from the U.S. Department of Veterans Affairs (VA) can be a confusing process at times. If you think you are eligible for these benefits, review the information below to find out how to apply. You can also download and print this pocket guide that contains information on obtaining VA health care benefits.

Three paths to VA health care

Even if you didn't serve in an active military position you may still be eligible for VA health benefits as long as you did not receive a dishonorable discharge. For all veterans, VA health care can be obtained through three different paths:

  • Disability status: those with a service-connected injury, illness or disability incurred during or aggravated by military service,
  • Service history: recipients of a Purple Heart, a Medal of Honor, or former prisoner of war,
  • Income need: those with an income below a certain level defined by the VA.

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Keep in mind eligibility for VA benefits can change over time based off of funding received from Congress and the department's priorities. When possible, enroll in both Medicare and VA health care to secure your best options.

Path 1: Disability Status

If you have a service-connected injury or illness, you can first seek disability compensation based on your condition. The VA pays a tax-free monthly payment to veterans who were sick or injured while serving in the military and to veterans whose service made an existing condition worse. Disability payments are made for physical (such as chronic illness or injury) and mental health conditions (such as post-traumatic stress disorder, or PTSD) that developed before, during or after service. Once qualified for disability pay, gaining health care benefits is much simpler.

Tips on Obtaining VA Health Care Benefits

• First, understand what the VA can provide you by getting advice from those who best know its system. That means reaching out to an accredited Veterans Service Representative. Reach out to your state VA office or veterans and military service organization for help. VA benefits are based on your individual situation, and eligibility can change over time.

• Have a copy of your military service record, known as a DD-214. The easiest way to receive a copy is to register for an eBenefits account. If you don't want to register online, visit your local VA facility, your state or county veterans office, or a veterans service organization such as the American Legion, VFW (Veterans of Foreign Wars), or DAV (Disabled American Veterans).

• Once you apply, the VA can provide an eligibility determination based on their criteria. Since the criteria change, the VA needs your information to identify which services you qualify for that address your specific needs.

• In most cases only the veteran receives health care benefits. Keep this in mind if you need care for your entire family or spouse.

To qualify you must have served on active duty, active duty for training, or inactive duty training and have a VA disability rating for your condition. These ratings are assigned after receiving a disability exam, also called a compensation and pension exam. The staff at your local VA medical center or local doctor's office that is partnered with the VA will contact you to schedule an exam.

If you meet both parameters above, you must also have at least one of the following:

  • A sickness or injury while serving in the military that can be linked to your current condition. The VA refers to this as an in-service disability claim.
  • An illness or injury before joining the military that was made worse from military service. This is called a preservice disability claim.
  • A disability related to active-duty service that didn't appear until after service ended. This is referred to as a post-service disability claim.

Path 2: Service History

You can qualify for VA health care benefits if you meet one of these criteria.

  • You are a former prisoner of war (POW).
  • You received a Purple Heart.
  • You received a Medal of Honor.
  • You served in Vietnam between 1962 and 1975.
  • You served in Southwest Asia/Gulf War between 1990 and 1998.
  • You served at least 30 days at Camp Lejeune between 1953 and 1987.

Path 3: Income Need

To qualify for VA health care based on income, you or your family must receive or qualify for Medicaid benefits or earn less than the VA's specified income requirements. See its income parameters here.

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