Hack the VA: What your VA priority group really means

Jonathan Kaupanger
February 06, 2018 - 1:19 pm

Anthony Behar

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When you sign up for VA healthcare, you’re given a priority group.  VA uses these groups to help with demand for VA services, basically the more need a person has, the more money VA needs to spend on them. Changes in available resources could reduce the number of priority groups VA can enroll, so it’s good to know where you fit in. 

These priority groups also determine another important aspect of VA care: if and how much of a copay you’ll have when using VA services. Links to the VA’s adjusted income limit page is added to the priority groups below, where that information is important. Here’s a quick description of each group.

  • Group 1: Vets with service-connected disabilities (SCD) rated 50 percent or more. Also, if VA decides you are unemployable due to SCD’s, you’re in the first group.
  • Group 2: Veterans with SCD at 30 or 40 percent.
  • Group 3: 
    • Former prisoners of war (POWs)
    • Purple Heart awardees 
    • Medal of Honor recipients
    • Veterans who are discharged because a disability was either caused or aggravated in the line of duty. 
    • SCD’s of 10 to 20 percent
    • Veterans who have a special eligibility classification.
  • Group 4:  Vets with an increased compensation or pension, based on your need for regular aid and attendance.  This group is also for veterans who are permanently housebound or have the VA’s catastrophically disabled determination.
  • Group 5:
    • Veterans who receive VA pension benefits or those eligible for Medicaid. 
    • Veterans with an annual income below the VA’s geographically adjusted income limit
    • Nonservice-connected veterans and non-compensable service-connected vets with a VA rating of 0 percent are here.
  • Group 6: 
    • Compensable 0 percent service-connected veteran. 
    • Vets exposed to ionizing radiation during the occupation of Hiroshima and Nagasaki. 
    • Veterans who served in Vietnam between Jan. 9, 1962 and May 7, 1975
    • Veterans who served in Southwest Asia theater of operations between Aug. 2, 1990 and Nov. 11, 1998
    • Veterans who served in a theater of combat operations after Nov. 11, 1998 and discharged from active duty on or after Jan. 28, 2003, for five years post discharge
    • Veterans who served on active duty at Camp Lejeune for at least 3 days between Aug. 1, 1953 and Dec. 31, 1987.
  • Group 7: Veterans who have a gross household income below the geographically adjusted VA income limit and who agree to pay copays.
  • Group 8: Veterans with a gross income above VA national income limits but agree to pay copayments. 

For the income verification process, you only have to do this if you receive free medical care or medications based on household income.  VA gets this information from the IRS and Social Security Administration.  You’ll be informed about this through a letter from the VA, and can dispute the information at this time.  If you don’t respond within 45 days, you will get a reminder letter, but if you wait past 75 days, then the VA assumes that the information is correct and then the veteran is informed about their copay status.

If you are in a financial situation like a loss of your job, a sudden decrease in income or an increase in out-of-pocket family healthcare expenses, there are a few VA programs to help: 

  • If you can’t pay your debt in full, you have a right to come up with a repayment plan at any time during your VA healthcare enrollment, VA Form 1100, Agreement to Pay Indebtedness information is located here. Most often, a repayment plan can’t go past three years. 
  • You do have the right to request a waiver of part or all of your debt too. Just submit an explanation and a completed Financial Status Report (VA Form 5655).  The explanation should include why you aren’t responsible for the debt and any undue hardships the payment would cause you. You can even request a hearing in connection with your request of this waiver. 
  • If your household income has decreased you might qualify for a copayment exemption for the remaining calendar year.  You could even get put into a higher Priority Group. The form Request for Hardship Determination (VA Form 10-10HS) is here. 

One last bit of information that you can use: For VA forms, if you don’t have a hyperlink to access the form, just Google the number.  But you need to include “VA Form” and then the number.  It’s usually easier to google these things than find them on the VA’s website.