A veteran receives treatment at the VA Pacific Islands Health Care System. (Courtesy photo)
Jennifer S. Gutowski, MHA, FACHE
Director, VA Pacific Islands Health Care System
HONOLULU -- The director gives information about priority groups at the VA Pacific Islands Health Care System. She explains what are the priority groups and how they affect you.
Do you know what Veteran Priority Group you’re in?
Today’s Veterans have a comprehensive medical benefits package, which VA administers through an annual patient enrollment system. The enrollment system is based on priority groups to ensure health care benefits are readily available to all enrolled Veterans. Complementing the expansion of benefits and improved access is our ongoing commitment to providing the very best in quality health care service to our patients when they are needed during that enrollment period, regardless of the treatment program or the location.
The first step is to be enrolled into the VA Health Care System. You may be able to get VA health care benefits if you served in the active military and did not receive a dishonorable discharge and served 24-continuous months on active duty. If you qualify for VA Health Care, each Veteran’s medical benefits package is unique. All Veterans receive coverage for most care and services, but only some will qualify for added benefits like dental care.
If you are found ineligible for care at the Veterans Health Administration, you can file for disability compensation by completing a VA Form 21-526EZ, “Application for Disability Compensation and Related Compensation Benefits” with the Veterans Benefits Administration.
The Department of Veterans Affairs assigns Enrollment Priority Groups (1-8) with 1 being the highest priority. Priority groups have been established to manage the provision of care to all enrolled Veterans. Upon application, each Veteran will be placed into the highest priority group for which they are eligible based upon verification of the information provided in theVA Form 10-10EZ, “Application for Health Benefits.” The full list of your covered benefits depends on your “Priority group”.
Veterams Affairs will assign service members a priority group when they leave active duty. Above, Soldiers from the Desmond T.Doss Health Clinic on Schofield Barracks escort a simulated casualty to during a mass casualty drill in 2018. (U.S. Army photo by Ramee Opperude)
Once you are registered for VA health care and you know your service connection percentage VHA can identify your priority group. You can call the Call Center at 1(800) 214-1306 and talk to a clinic Medical Support Assistant (MSA), Enrollment and Eligibility staff member, a Nurse and/or a provider who has access to Computerized Patient Records System (CPRS) and Veterans Health Information Systems and Technology Architecture (VISTA) can look up your priority group.
When you apply for VA health care, you’ll be assigned 1 of 8 priority groups. This system helps to make sure that Veterans who need immediate care can get signed up quickly.
Your priority group may affect how soon we sign you up for health care benefits. It may also affect how much (if anything) you’ll have to pay toward the cost of your care.
Learn more about health benefit copay rates at https://www.va.gov/HEALTHBENEFITS/cost/copay_rates.asp.
Your priority group will be based on these things:
* Your military service history, and
* Your disability rating, and
* Your income level, and
* Whether or not you qualify for Medicaid, and
* Other benefits you may be receiving (like pension benefits).
We assign Veterans with service-connected disabilities the highest priority. We assign the lowest priority to Veterans who earn a higher income and who don’t have any service-connected disabilities qualifying them for disability compensation (monthly payments).
This is important for the newUrgent Care benefit. Once you have enrolled, your eligibility will be verified. Based on your specific eligibility status, you will be assigned a Priority Group. The Priority Groups range from 1-8 with 1 being the highest priority. Based on your eligibility and income, you may have to pay copay for treatment and some may not be eligible for enrollment.
You may be eligible for more than one Priority Group. In that case, VA will always place you in the highest Priority Group that you are eligible for.
Depending on your Priority Group, the VA may reimburse you for travel costs from your home to a medical facility.
Priority Group 1
•Veterans with service-connected disabilities rated 50% or higher.
•Veterans determined by VA to be unemployable due to service-connected conditions.
Priority Group 2
•Veterans with service-connected disabilities rated 30% - 40%.
Priority Group 3
•Veterans who are former Prisoners of War (POWs).
•Veterans awarded a Purple Heart.
•Veterans whose were discharged for a disability.
•Veterans with service-connected disabilities rated 10% - 20%.
•Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”
•Veterans awarded the Medal Of Honor.
Priority Group 4
•Veterans who are receiving aid and attendance or housebound benefits.
•Veterans who have been determined by VA to be catastrophically disabled.
Priority Group 5
•Nonservice-connected veterans and non-compensable service-connected Veterans rated 0% disabled by VA with annual income below the VA’s and geographically (based on your resident zip code) adjusted income limits. •Veterans receiving VA pension benefits.
•Veterans eligible for Medicaid programs.
Priority Group 6
•Veterans with service-connected disabilities rated 0%.
•Veterans exposed to Ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki.
•Project 112/SHAD participants.
•Veterans who served in Vietnam between Jan. 9,1962 and May 7, 1975.
•Veterans of the Persian Gulf War who served between Aug. 2, 1990 and Nov. 11, 1998.
•Veterans who served on active duty at Camp Lejeune for not fewer than 30 days beginning Aug. 1, 1953 and ending Dec. 31, 1987.
•Combat veterans who were discharged on or after Jan. 28, 2003, are eligible for enhanced benefits for 5 years after discharge.
Priority Group 7
•Veterans with gross household income below certain limits and who agree to pay copays.
Priority Group 8
•Veterans with gross household income above certain limits and who agree to pay copays.
For more information on the MISSION Act, visit https://www.missionact.va.gov/.