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SERVING OUR VETERANS: Veterans Health Administration – Priority Groups

April 12, 2019
Ron Montonye - Pierce County Veterans Service Officer , Pierce County Tribune

Did you know the Veterans Health Administration (VHA) is one of the largest medical health care systems in the world? The number of veterans who can be enrolled in the health care program is determined by the amount of money Congress gives the VA each year. Since funds are limited, the VA set up priority groups to make sure that certain groups of veterans are able to be enrolled before others. This occurred around 2004. Before that time, almost any qualifying veteran could use the VA health care system. This is why some veterans enrolled before that time can still use the system even though they may not fit into today's higher priority groups. They were basically "grandfathered in" so as not to lose benefits they had already been receiving.

Once a veteran applies for enrollment, their eligibility will be verified. Based on the veteran's specific eligibility status, they will be assigned a Priority Group. The Priority Groups range from one to eight, with one being the highest priority. A brief description of each Priority Group is as follows:

Priority Group 1: Veterans with service-connected disabilities rated by VA as 50% or more disabling, veterans determined by VA to be unemployable due to service-connected conditions, and veterans who have been awarded the Medal of Honor.

Priority Group 2: Veterans with service-connected disabilities rated by the VA as 30% or 40% disabling.

Priority Groups 3: Veterans who are former Prisoners of War, veterans who have been awarded a Purple Heart medal, veterans whose discharge was for a disability that was incurred or aggravated in the line of duty, veterans with service-connected disabilities rated by the VA as 10% or 20% disabling.

Priority Group 4: Veterans who receive aid and attendance or housebound benefits from the VA, and veterans who have been determined to be catastrophically disabled.

Priority Group 5: Veterans with nonservice connected or non-compensable service-connected disability and veterans rated by the VA as 0% disabled and who have an annual income below the VA's geographically-adjusted income limit. It also includes veterans who receive VA pension benefits and veterans who are eligible for Medicaid programs.

Priority Group 6: Veterans with a compensable 0% service-connected disability, veterans exposed to radiation during the occupation of Hiroshima and Nagasaki, veterans who served in the Republic of Vietnam between January 9, 1962 and May 7, 1975, veterans of the Persian Gulf War who served between August 2, 1990 and November 11, 1998, veterans who served on active duty at Camp Lejeune for at least 30 days between August 1, 1953 and December 31, 1987, and currently enrolled veterans and new enrollees who served in a theatre of combat operations after November 11, 1998, and those who were discharged from active duty on or after January 28, 2003.

Priority Group 7: Veterans with gross household income below the geographically-adjusted VA income limit for their resident location and who agree to pay co-payments.

Priority Group 8: Veterans with gross household incomes above the VA income limits and the geographically adjusted income limits for their resident location, and who agree to pay co-payments. It also includes veterans in Sub priority groups a through g. These sub priority groups are rather detailed so please contact me if you would like more information on these.

For those currently enrolled in the VA health care system, it is very important to follow on scheduling your annual physical with them. Failure to follow through on having your annual physical may result in your being dropped from the system. It should be noted that veterans with at least a 10% service-connected disability rating qualify for free eye glasses and hearing aids and are able to receive VA healthcare with co-payments. At 30%, dependents are included for prescription coverage. At 50%, all health care is covered with no co-payments. At 70% long term care is free.

Again, some of these Priority Group eligibility requirements get rather confusing. Please contact me if you have any questions on these or any questions in regard to enrolling in the VA health care system.

 
 

 

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