Veterans: Which priority group are you part of?


By Harold B. Wolford - Veterans Corner



What are VA priority groups and how do they affect me? When veterans apply for VA health care, they will be assigned to one of eight priority groups. This system helps to make sure that veterans who need care right away can get signed up quickly. It also helps to make sure the VA can provide high quality care to all veterans enrolled in the VA health care program.

Your priority group may affect how soon the VA signs you up for health care benefits, and how much (if anything) you’ll have to pay toward the cost of your care. What factors will the VA use to assign veterans to a priority group? They’ll base your priority group on your military service history, your disability rating, your income level, whether or not you qualify for Medicaid, and other benefits you may be receiving (like VA pension benefits).

The VA assigns veterans with service-connected disabilities the highest priority. The VA assigns the lowest priority to veterans who earn a higher income and who don’t have any service-connected disabilities qualifying them for disability compensation (monthly payments). If you qualify for more than one priority group, they will assign you to the highest one. The VA may assign you to a priority group based on the following criteria:

• Priority group 1 if any of the following descriptions are true. You have a service-connected disability that we’ve rated as 50% or more disabling, or have a service-connected disability that the VA concluded makes you unable to work (also called unemployable), or received the Medal of Honor (MOH).

• Priority group 2 if you have a service-connected disability that the VA rated as 30% or 40% disabling.

• Priority group 3 if any of the following descriptions are true. You are a former prisoner of war (POW), received the Purple Heart (MOPH) medal, were discharged for a disability that was caused by — or got worse because of — your active-duty service, have a service-connected disability that the VA rated as 10% or 20% disabling, or were awarded special eligibility classification under Title 38, U.S.C § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”

• Priority group 4 if either of the following descriptions is true. You are receiving VA aid and attendance or housebound benefits, or have received a VA determination of being catastrophically disabled.

• Priority group 5 if any of the following descriptions are true. You don’t have a service-connected disability, or you have a non-compensable service-connected disability that the VA rated as 0% disabling, and you have an annual income level that’s below our adjusted income limits (based on your resident zip code), or are receiving VA pension benefits, or are eligible for Medicaid programs

• Priority group 6 if any of the following descriptions are true. You have a compensable service-connected disability that the VA rated as 0% disabling, or were exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki, or participated in Project 112/SHAD, or served in the Republic of Vietnam between Jan. 9, 1962, and May 7, 1975, or served in the Persian Gulf War between Aug. 2, 1990, and Nov. 11, 1998, or served on active duty at Camp Lejeune for at least 30 days between Aug. 1, 1953, and Dec. 31, 1987.

The VA may also assign you to priority group 6 if you meet all of the requirements listed here. You are currently or newly enrolled in VA health care, and served in a theater of combat operations after Nov. 11, 1998, or were discharged from active duty on or after Jan. 28, 2003, and were discharged less than five years ago. Note: As a returning combat veteran, you’re eligible for these enhanced benefits for five years after discharge. At the end of this enhanced enrollment period, the VA will assign you to the highest priority group you qualify for at that time.

• Priority group 7 if both of the following descriptions are true for you. Your gross household income is below the geographically adjusted income limits (GMT) for where you live, and you agree to pay copays.

• Priority group 8 if both of the following descriptions are true for you. Your gross household income is above VA income limits and geographically adjusted income limits for where you live, and you agree to pay copays.

If you’re assigned to priority group 8, your eligibility for VA health care benefits will depend on which subpriority group they place you in. You may be eligible for VA health care benefits if the VA places you in one of these subpriority groups:

• Subpriority group a — All of these must be true. You have a non-compensable service-connected condition that we’ve rated as 0% disabling, and enrolled in the VA health care program before Jan. 16, 2003, and have remained enrolled since that date and/or were placed in this subpriority group because your eligibility status changed.

• Subpriority group b — All of these must be true. You have a non-compensable service-connected condition that we’ve rated as 0% disabling, and enrolled in the VA health care program on or after June 15, 2009, and have income that exceeds current VA or geographical limits by 10% or less.

• Subpriority group c — All of these must be true. You don’t have a service-connected condition, and enrolled in the VA health care program as of Jan. 16, 2003, and have remained enrolled since that date and/or were placed in this subpriority group because your eligibility status changed.

• Subpriority group d — All of these must be true. You don’t have a service-connected condition, and enrolled in the VA health care program on or after June 15, 2009, and have income that exceeds current VA or geographical limits by 10% or less.

You’re not eligible for VA health care benefits if they place you in one of these subpriority groups:

• Subpriority group e — All of these must be true. You have a non-compensable service-connected condition that we’ve rated as 0% disabling, and don’t meet the criteria for subpriority group a or b above. Note: You’re eligible for care for your service-connected condition only.

• Subpriority group g — All of these must be true. You don’t have a service-connected condition, and don’t meet the criteria for subpriority group c or d above.

Once I’m enrolled in VA health care, will my priority group ever change? Your priority group may change in some cases, such as if your income changes, or your service-connected disability gets worse and the VA gives you a higher disability rating.

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By Harold B. Wolford

Veterans Corner

Harold B. Wolford is president of the Vietnam Veterans of America Chapter 1095. He served in the United States Army from 1970 to 1973. Wolford can be reached via email at harold@wolfordhome.com.

Harold B. Wolford is president of the Vietnam Veterans of America Chapter 1095. He served in the United States Army from 1970 to 1973. Wolford can be reached via email at harold@wolfordhome.com.