Let\u2019s look at these.<\/p>\n
Criteria to Keep In Mind<\/h2>\n
There are two criteria which decide what copays you pay, if any. They are your disability rating<\/strong> (if any) and priority group<\/strong> you fall under.<\/p>\n There are two kinds of disability ratings:<\/p>\n If a veteran who served during a war-time period has an injury or illness after active-duty service that prevents him or her from working (a stroke, for example), he or she can request a non-service-connected disability pension. This is also known as a VA or Widower\u2019s pension.<\/p>\n However, this disability rating is NOT service connected, hence you will have copays if using VA healthcare, unless you are means tested and qualify via income level for free healthcare.<\/p>\n Urgent care is care for minor illnesses and injuries. To be eligible for urgent care coverage, you must have been receiving VA healthcare for 24 months. Once you qualify, there is no limit to how often you can receive urgent care at a VA health facility or an approved community clinic.<\/p>\n Outpatient care is considered primary or specialty care that does not require the veteran to remain in the hospital overnight. In essence, any care that is not considered urgent care<\/strong>.<\/p>\n If you have a 10% service-connected<\/strong> disability rating, YOU DO NOT HAVE TO PAY A COPAY.<\/strong> Non-service connected ratings or any condition not connected to your service may be required to pay the following copays (and I use may<\/strong>, because if you are means tested and qualify for no-cost care, you won\u2019t pay a copay).<\/p>\n Other services in this category where you won\u2019t pay a copay include for:<\/p>\n Inpatient care is care that requires you to remain in the hospital. If you have a 10% or higher service-connected disability rating, you won\u2019t pay any copays.<\/strong><\/p>\n If you belong to priority groups 7 or 8, you will either pay a full or reduced copay rate. However, if you live in a high cost of living area, you may qualify for a reduced rate, no matter in which priority group you belong. If you\u2019re not sure if you qualify, you can call (877) 222-8387 (TTY: 711) to find out.<\/strong><\/p>\n To learn more about priority groups, click here.<\/a><\/p>\n To see the VA national income limits, click here.<\/a><\/p>\n Medication copay rates vary by the priority group you belong to and which tier the prescription falls under. Unlike Medicare Advantage, where typically tiers 1 and 2 (the generic tiers) have a $0 copay, the VA has their own unique structure. It has a four (4) tier system with a Tier 0, versus a five (5) or six (6) tier Medicare Advantage structure. There is a $700 MOOP (Maximum Out Of Pocket Limit) for medications.<\/strong> Once you\u2019ve spent $700 within a calendar year, you pay nothing until the following year.<\/p>\n NOTE: Also, if you receive any medications while in inpatient care, whether at a VA facility or approved community facility, you will pay NO copays, as it\u2019s considered care provided by your hospital stay.<\/span><\/p>\n Elder care and long-term care are available through the VA. Like many Skilled Nursing Facility policies in Medicare Advantage plans, the first 21 days of a 12-month period are at no cost (20 days for Medicare Advantage plans). However, on day 22, the following copays may apply depending on the level of care you are receiving and income qualifications<\/strong>.<\/p>\nThe Two Kinds of Disability Ratings<\/h2>\n
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Urgent Care<\/h2>\n
![\"\"](\"https:\/\/yourcarerep.com\/wp-content\/uploads\/VA-2023-Urgent-Care-Copays-Table.jpg\")
<\/p>\nOutpatient Care<\/h2>\n
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![\"\"](\"https:\/\/yourcarerep.com\/wp-content\/uploads\/2023-Outpatient-Copays.jpg\")
<\/p>\nInpatient Care<\/h2>\n
![\"\"](\"https:\/\/yourcarerep.com\/wp-content\/uploads\/full-priority-group-8-inpatient-copay-rates.jpg\")
<\/p>\n![\"\"](\"https:\/\/yourcarerep.com\/wp-content\/uploads\/reduced-priority-group-7-inpatient-copay-rates.jpg\")
<\/p>\nMedication Copay Rates<\/h2>\n
![\"\"](\"https:\/\/yourcarerep.com\/wp-content\/uploads\/2023-Outpatient-Medication-Copays.jpg\")
<\/p>\nGeriatric and Extended Care<\/h2>\n
![\"\"](\"https:\/\/yourcarerep.com\/wp-content\/uploads\/2023-Geriatric-Care-Copays.jpg\")
<\/p>\n