Health Benefits Copay Rates
Outpatient Services
Basic Care Services |
$15 / visit |
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Services provided by a primary care clinician. |
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Specialty Care Services |
$50 / visit |
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Services provided by a clinical specialist such as surgeon, radiologist, audiologist, optometrist, cardiologist, and specialty tests such as magnetic resonance imagery (MRI), computerized axial tomography (CAT) scan, and nuclear medicine studies. |
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Inpatient Services
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There are two inpatient copay rates, the full rate and the reduced rate. Priority Group 7 and certain other Veterans are responsible for paying 20 percent of VA’s inpatient copay rate. |
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| • Inpatient Copay for the first 90 days of care during a 365-day period. |
$272.80 |
| • Inpatient Copay for each additional 90 days of care during a 365-day period. |
$136.40 |
| • Daily Charge |
$2/day |
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Priority Group 8 and certain other Veterans are responsible for VA’s full inpatient copay rate. |
|
| • Inpatient Copay for the first 90 days of care during a 365-day period. |
$1,364 |
| • Inpatient Copay for each additional 90 days of care during a 365-day period. |
$682 |
| • Daily Charge |
$10/day |
| Veterans living in high cost areas may qualify for a reduced inpatient copay rate. For more information contact VA toll-free at 877-222-VETS (8387). | |
Medications
| Priority Group | Outpatient Medication Tier | Copayment amount | ||
|---|---|---|---|---|
| 2-8 | 1-30 day supply | 31-60 day supply | 61-90 day supply | |
| Tier 1 (preferred Generics) |
$5 | $10 | $15 | |
| Tier 2 (Non-Preferred Generics and some OTCs) |
$8 | $16 | $24 | |
| Tier 3 (Brand Name) |
$11 | $22 | $33 | |
| $700 Medication Copayment Cap | ||||
Veterans in Priority Groups 2-8, are required to pay for each 30-day or less supply of medication for treatment of nonservice-connected condition (unless otherwise exempt).
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• 30-day or less supply for Tier 1 (Preferred Generics) Medications for certain Veterans: |
$5 |
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• 30-day or less supply for Tier 2 (Non-Preferred Generics & some OTCs) Medications for certain Veterans: |
$8 |
|
• 30-day or less supply for Tier 3 (Brand Name) Medications for certain Veterans: |
$11 |
(Veterans in Priority Groups 2 through 8 are limited to $700 annual cap)
