VA, VA health care copay rates

Current VA Health Care Copay Rates | Veterans Affairs Skip to Content An official website of the United States government Here’s how you know The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. The https:// ensures that you're connecting to the official website and that any information you provide is encrypted and sent securely. Talk to the Veterans Crisis Line now Health care Get benefits About VA health benefits Long-term care Dental care VA Dental Insurance Program (VADIP) Vision care Blind and low-vision services Cuidado dental de VA Eligibility Active-duty service members VA priority groups Elegibilidad Active-duty service members VA priority groups How to apply Cómo solicitar Apply now After you apply Después de solicitar Foreign Medical Program (FMP) Manage benefits Manage your health care with My HealtheVet Manage health appointments Refill prescriptions and manage medications Review medical records online Send and receive secure messages File and manage travel reimbursement claims Order medical supplies Request hearing aid repairs and accessories Get a Veteran Health Identification Card (VHIC) Review and pay your VA copay bill Dispute your VA copay charges Request VA financial hardship assistance Update your VA health benefits information File a VA Foreign Medical Program claim Request a decision review More resources Current VA health care copay rates Past rates: 2025 Past rates: 2024 Past rates: 2023 Health needs and conditions Health issues related to service era Operation Enduring Freedom Iraq War Gulf War Cold War Era Vietnam War Korean War World War II VA mental health services PTSD Depression Suicide prevention Military sexual trauma Substance use problems Exposure to hazardous materials Women’s health care needs Health topics A to Z Wellness programs Community care Income limits Million Veteran Program Access and quality in VA health care Patient rights and responsibilities In this section Current VA health care copay rates Review 2026 copay rates for VA and VA-approved health care. Effective January 1, 2026 Note: Some Veterans don’t have to pay copays (they’re “exempt”) due to their disability rating, income level, or special eligibility factors. Learn how we determine whether you’ll pay copays Urgent care copay rates (Care for minor illnesses and injuries) There’s no limit to how many times you can use urgent care. To be eligible for urgent care benefits, including through our network of approved community providers, both of these must be true: You must be enrolled in the VA health care system, and You must have received care from us within the past 24 months (2 years) If you’re only getting a flu shot at your visit, you won’t have to pay any copays, no matter your priority group. Learn more about urgent care benefits Priority group Copay amount for first 3 visits in each calendar year Copay amount for each additional visit in the same year 1 to 5 $0 (no copay) $30 6 If related to a condition that’s covered by a special authority: $0 (no copay) If not related to a condition covered by a special authority: $30 each visit $30 7 to 8 $30 $30 Note: Special authorities include conditions related to combat service and exposures (like Agent Orange, active duty at Camp Lejeune, ionizing radiation, Project Shipboard Hazard and Defense (SHAD/Project 112), Southwest Asia Conditions) as well as military sexual trauma, and presumptions applicable to certain Veterans with psychosis and other mental illness. Outpatient care copay rates (Primary or specialty care that doesn’t require an overnight stay) If you have a service-connected disability rating of 10% or higher You won’t need to pay a copay for outpatient care. If you don’t have a service-connected disability rating of 10% or higher You may need to pay a copay for outpatient care for conditions not related to your military service, at the rates listed below. Type of outpatient care Copay amount for each visit or test Primary care services (like a visit to your primary care doctor) $15 Specialty care services (like a visit to a hearing specialist, eye doctor, surgeon, or cardiologist) $50 Specialty tests (like an MRI or CT scan) $50 Note: You won’t need to pay any copays for X-rays, lab tests, or preventive tests and services like health screenings or immunizations. Inpatient care copay rates (Care that requires you to stay 1 or more days in a hospital) If you have a service-connected disability rating of 10% or higher You won’t need to pay a copay for inpatient care. If you’re in priority group 6 If the inpatient care isn’t for a service-connected condition or special-authority care, you may need to pay an inpatient care copay based on priority group 7 or 8 income limits. If you’re in priority group 7 or 8 You’ll pay either our full copay rate or reduced copay rate. If you live in a high-cost area, you may qualify for a reduced inpatient copay rate no matter what priority group you’re in. To find out if you qualify for a reduced inpatient copay rate, call us toll-free at (TTY: 711). We’re here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET. Length of stay Copay amount First 90 days of care during a 365-day period $347.20 copay + $2 charge per day Each additional 90 days of care during a 365-day period $173.60 copay + $2 charge per day Note: You may be in priority group 7 and qualify for these rates if you don’t meet eligibility requirements for priority groups 1 through 6, but you have a gross household income below our income limits for where you live and you agree to pay copays. Review the current VA national income limits Length of stay Copay amount First 90 days of care during a 365-day period $1,736 copay + $10 charge per day Each additional 90 days of care during a 365-day period $868 copay + $10 charge per day Note: You may be in priority group 8 and qualify for these rates if you don’t meet eligibility requirements for priority groups 1 through 6, and you have a gross household income above our income limits for where you live, agree to pay copays, and meet other specific enrollment and service-connected eligibility criteria. Learn more about priority groups Medication copay rates If you’re in priority group 1 You won’t pay a copay for any medications. Note: You may be in priority group 1 if we’ve rated your service-connected disability at 50% or more disabling, if we’ve determined that you can’t work because of your service-connected disability (called unemployable), or if you’ve received the Medal of Honor. Learn more about priority groups If you’re in priority groups 2 through 8 You may pay a copay for these types of medications: Medications your health care provider prescribes to treat non-service-connected conditions, and Over-the-counter medications (like aspirin, cough syrup, or vitamins) that you get from a VA pharmacy. You may want to consider buying your over-the-counter medications on your own. Note: The costs for any medications you receive while staying in a VA or other approved hospital or health facility are covered by your inpatient care copay. The amount you’ll pay for these medications will depend on the “tier” of the medication and the amount of medication you’re getting, which we determine by days of supply. Once you’ve been charged $700 in medication copays within a calendar year (January 1 to December 31), you won’t have to pay any more that year—even if you still get more medications. This is called a copay cap. Outpatient medication tier 1-30 day supply 31-60 day supply 61-90 day supply Tier 0 (prescription and over-the-counter medicines with no copay) $0 $0 $0 Tier 1 (preferred generic prescription medicines) Review our list of tier 1 medications $5 $10 $15 Tier 2 (non-preferred generic prescription medicines and some over-the-counter medicines) $8 $16 $24 Tier 3 (brand-name prescription medicines) $11 $22 $33 If you have a service-connected rating of 40% or less and your income falls at or below the national income limits for receiving free medications , you may want to provide your income information to us to determine if you qualify for free medications. Review the current VA national income limits Find out how we determine your health care costs Find a full list of medications in each tier on our pharmacy benefits website Geriatric and extended care copay rates You won’t need to pay a copay for geriatric care (also called elder care) or extended care (also called long-term care) for the first 21 days of care in a 12-month period. Starting on the 22nd day of care, we’ll base your copays on these 2 factors: The level of care you’re receiving, and The financial information you provide on your Application for Extended Care Services (VA Form 10-10EC). Get VA Form 10-10EC to download Note: The 2026 community spouse resource allowance (CSRA) is $162,660 . If you have a spouse who is still living in the community and isn’t also receiving extended care services, CSRA reduces the value of liquid assets that we use to determine your extended care copay amount. Level of care Types of care included Copay amount for each day of care Inpatient care Short-term or long-term stays in a community living center (formerly called nursing homes) Overnight respite care (in-home or onsite care designed to give family caregivers a break, available up to 30 days each calendar year) Overnight geriatric evaluations (evaluations by a team of health care providers to help you and your family decide on a care plan) Up to $97 Outpatient care Adult day health care (care in your home or at a facility that provides daytime social activities, companionship, recreation, care, and support) Daily respite care (in-home or onsite care designed to give family caregivers a break, available up to 30 days each calendar year) Geriatric evaluations that don’t require an overnight stay (evaluations by a team of health care providers to help you and your family decide on a care plan) Up to $15 Domiciliary care for homeless Veterans Short-term rehabilitation Long-term maintenance care Up to $5 Services that don’t require a copay You won’t need to pay a copay for any of the services listed here, no matter what your disability rating is or what priority group you’re in. Readjustment counseling and related mental health services Counseling and care for issues related to military sexual trauma Exams to determine your risk of health problems linked to your military service Care that may be related to combat service for Veterans that served in a theater of combat operations after November 11, 1998 VA claim exams (also called compensation and pension, or C&P, exams) Care related to a VA-rated service-connected disability Care for cancer of head or neck caused by nose or throat radium treatments received while in the military Individual or group programs to help you quit smoking or lose weight (These aren’t considered whole health programs.) Care that’s part of a VA research project (like the Million Veteran Program) Laboratory (lab) tests Electrocardiograms (EKGs or ECGs) to check for heart disease or other heart problems VA health initiatives that are open to the public (like health fairs) Past rates Review health care copay rates for past years. 2025 rates (effective January 1, 2025) 2024 rates (effective January 1, 2024) 2023 rates (effective January 1, 2023) Other information you may need Find out how to pay your copay bill—and what to do if you disagree with the charges or are having trouble making payments. Learn how we assess and verify your income to help determine if you’re eligible for VA health care and whether you’ll need to pay copays for certain types of care, tests, and medications. Find out what maternity care and services we cover. You can also check the copay that you may be responsible for based on your priority group. Last updated: December 29, 2025