Inpatient Health Care Copay
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There are two inpatient copay rates – the full rate and the reduced rate. The reduced inpatient copay rate, which is 80% of the full inpatient rate, applies to veterans meeting specific income requirements as discussed in the Geographic Means Test (GMT) section below. Both the full inpatient copay rate and the reduced inpatient copay rate are computed over a 365 - day period.
Priority Group 8 and certain other veterans are responsible for VA’s inpatient copay of $1,100 for the first 90 days of care during any 365-day period. For each additional 90 days, this charge is $550. In addition, there is a $10 per diem charge.
NOTE: VA’s inpatient copay rate is based on the current Medicare deductible of $1,100.
* Enrollment Restriction:
In order to ensure the availability of quality and timely health care to veterans with service connected conditions, special authority based on military service, low income, and those with special health care needs, in January 2003 VA made the difficult decision to stop enrolling new Priority Group 8 (high income) veterans whose income exceeded VA Income Thresholds.
The new regulations went into effect on June 15, 2009 and enable the Department of Veterans Affairs (VA) to relax income restrictions on enrollment for health benefits. While this new provision does not remove consideration of income, it does increase income thresholds. You may be eligible for enrollment under this new provision.
Recognizing that the cost of living can vary significantly from one geographic area to another, VA National Geographic Income Thresholds (established using Department of Housing and Urban Development low income thresholds for housing assistance) were added to the VA National Income Thresholds to identify veterans living in high cost areas who may qualify for the reduced inpatient copay rate.
Priority Group 7 and certain other veterans are responsible for paying 20 percent of VA’s inpatient copay or $220.00 for the first 90 days on inpatient hospital care during any 365-day period. For each additional 90 days, this charge is $110.00. In addition, there is a $2 per diem charge.
- live in high-cost areas
The GMT inpatient copay rate is calculated by reducing the full inpatient rate (copay and per diem) by 80%.
- $2 per day of hospitalization, and
- $220.00 for the first 90 days of hospitalization and $110.00 for each additional 90 days
NOTE: These rates change annually.
The VA National Geographic Income Thresholds table is very large and difficult to read so we have put together a few tips on using the GMT Income Thresholds. Also available to assist in using the GMT Income Thresholds tables are the Frequently Asked Questions (FAQs) about the GMT available.
If you are now receiving VA compensation for a service-connected disability or VA pension benefits, your VA medical care and/or prescription copays may be reduced or eliminated. You may also be eligible for a refund of copay charges you have previously paid based on this decision. For further information, please call our VA Health Resource Center at 1-877-222-VETS (8387) or contact the Enrollment Coordinator at your local VA medical center.
Federal Benefits for Veterans and Dependents
VA National Income Thresholds |
VA National Geographic Income Thresholds
For questions about Health Care Eligibility, please visit the VA inquiry website.
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