After VA processes your health care application, it assigns you to one of eight priority groups. The group controls two things: whether VA is currently enrolling veterans like you at all, and how much you pay when you get care.
Everything below was pulled from VA.gov and from Title 38 of the Code of Federal Regulations on September 6, 2026. The copay figures are VA’s published rates effective January 1, 2026, and the copay amounts themselves are codified in 38 CFR 17.108 and 17.110, which match VA’s rate page exactly.
What Puts You in Each Group
VA bases the assignment on your service history, your disability rating, your income, whether you qualify for Medicaid, and whether you receive other VA benefits such as a pension. If you qualify for more than one group, VA puts you in the highest one.
| Priority group | Who lands here |
|---|---|
| 1 | Service-connected rating of 50% or more, or rated unemployable because of a service-connected disability, or awarded the Medal of Honor |
| 2 | Service-connected rating of 30% or 40% |
| 3 | Former prisoners of war, Purple Heart recipients, discharged for a disability caused or worsened by active duty, rated 10% or 20%, or special eligibility under 38 U.S.C. 1151 |
| 4 | Receiving VA aid and attendance or housebound benefits, or determined by VA to be catastrophically disabled |
| 5 | No service-connected rating or a non-compensable 0% rating, plus income below the adjusted limits for your ZIP; or receiving a VA pension; or eligible for Medicaid |
| 6 | Compensable 0% rating, Project 112/SHAD, World War II service, Persian Gulf War service, 30+ days at Camp Lejeune between 1953 and 1987, recent combat theater service (10-year enhanced window), or toxic exposure categories including Agent Orange, burn pits, ionizing radiation and TERA |
| 7 | Gross household income below the geographically adjusted limit (GMT) for where you live, and you agree to pay copays |
| 8 | Gross household income above both the national and geographic limits, and you agree to pay copays |
Group 8 is the one with fine print. VA splits it into subpriority groups a through g, and only subgroups a, b, c and d are eligible for enrollment. Subgroups e and g are not, though a veteran in subgroup e remains eligible for care for the service-connected condition itself. The dividing lines are enrollment date (before January 16, 2003, or on or after June 15, 2009) and whether income exceeds the limits by 10% or less.
What Each Group Pays: 2026 Copay Rates
Outpatient care
If you have a service-connected disability rated 10% or higher, you pay nothing for outpatient care. If you do not, the rates below apply to care for conditions unrelated to your service.
| Type of outpatient care | Copay per visit or test |
|---|---|
| Primary care visit | $15 |
| Specialty care visit (audiology, optometry, surgery, cardiology) | $50 |
| Specialty tests (MRI, CT scan) | $50 |
| X-rays, lab tests, preventive screenings and immunizations | $0 |
38 CFR 17.108(c) adds a rule VA’s rate page does not spell out: if you have multiple primary care encounters on one day, you owe one primary care copay. If you have both primary and specialty encounters the same day, you owe one specialty copay, not both.
Urgent care
The urgent care benefit requires enrollment plus a VA or in-network visit within the past 24 months. There is no limit on the number of visits.
| Priority group | First 3 visits per calendar year | Each additional visit that year |
|---|---|---|
| 1 to 5 | $0 | $30 |
| 6 (special-authority condition) | $0 | $0 |
| 6 (not special authority) | $30 | $30 |
| 7 to 8 | $30 | $30 |
A flu shot alone carries no copay at any priority group. VA also tells veterans not to pay the community provider at the time of the visit; if a copay is owed, VA bills you afterward. For comparison, a self-pay urgent care visit outside this benefit runs far more than $30.
Inpatient care
Nobody with a service-connected rating of 10% or higher pays an inpatient copay. Priority group 7 pays a reduced rate that 38 CFR 17.108(b)(3) sets at 20% of the full amount; group 8 pays the full rate.
| Length of stay in a 365-day period | Priority group 7 (reduced) | Priority group 8 (full) |
|---|---|---|
| First 90 days | $347.20 plus $2 per day | $1,736 plus $10 per day |
| Each additional 90 days | $173.60 plus $2 per day | $868 plus $10 per day |
The $1,736 figure is not arbitrary. Under 38 CFR 17.108(b)(2), VA ties the inpatient copay to the Medicare Part A inpatient deductible, with half that amount for each subsequent 90-day block. A reduced rate may also be available in high-cost areas regardless of priority group. Set against a cash hospital stay, even the group 8 rate is a fraction of billed charges.
Medications
Priority group 1 pays nothing for any medication. Groups 2 through 8 pay by tier, and the copay applies only to drugs for non-service-connected conditions plus over-the-counter products dispensed by a VA pharmacy.
| Medication tier | 1 to 30 day supply | 31 to 60 days | 61 to 90 days |
|---|---|---|---|
| Tier 0 (no-copay prescription and OTC) | $0 | $0 | $0 |
| Tier 1 (preferred generic) | $5 | $10 | $15 |
| Tier 2 (non-preferred generic, some OTC) | $8 | $16 | $24 |
| Tier 3 (brand name) | $11 | $22 | $33 |
Medication copays are capped at $700 per calendar year under 38 CFR 17.110(b)(5). Once you hit it, the rest of the year is free. The full picture, including mail order and how the tiers compare to cash prices, is in VA pharmacy costs.
Geriatric and extended care
The first 21 days of care in a 12-month period are free. From day 22, copays are based on the level of care and on the financial information you provide on VA Form 10-10EC: up to $97 per day for inpatient community living center care or overnight respite, up to $15 per day for adult day health care or daily respite, and up to $5 per day for domiciliary care for homeless veterans. VA sets the 2026 community spouse resource allowance at $162,660. If you are comparing this against the private market, see how to pay for a nursing home.
The Three Things That Actually Decide Your Copay
Priority group alone does not determine what you pay. Three factors interact.
Service-connected status. 38 CFR 17.108(d) exempts any veteran with a compensable service-connected disability from inpatient and outpatient copays, along with former POWs, Purple Heart recipients, World War II veterans, veterans discharged for a line-of-duty disability, and veterans VA determines cannot defray the cost of care. This is the exemption that does the most work, and it kicks in well before the 50% mark.
What the care is for. Care for a service-connected condition is free regardless of rating percentage or group. So are claim exams, readjustment counseling, care related to military sexual trauma, care for combat-theater veterans who served after November 11, 1998, smoking cessation and weight loss programs, lab tests, EKGs, and care delivered as part of a VA research project.
The income test. Groups 5, 7 and 8 are assigned by income, and income also drives free-medication eligibility for veterans rated 40% or less.
The Income Numbers
VA runs two thresholds. The national income limit is uniform across the country. The geographically adjusted limit (GMT) is set by ZIP code and can be far higher.
Using VA’s income limits tool for the 2026 income year, a veteran with no dependents faces a national limit of $43,335 and a maximum annual pension rate of $17,441. Add one dependent and the national limit rises to $52,000. The GMT swings hard by location: for the same veteran with no dependents it was $54,150 in a San Antonio ZIP and $90,750 in a Manhattan ZIP.
Income at or below the national limit generally points to priority group 5 and, for veterans rated 40% or less, to free medications. Income above the national limit but below the local GMT points to group 7 and the reduced inpatient rate. Income above both points to group 8.
VA counts gross household income, which includes a spouse’s income, and it verifies through IRS and Social Security data. If your income drops mid-year, you can ask VA to redetermine rather than waiting for the annual cycle.
Who Pays Nothing at All
Putting the exemptions together, you owe no VA copays if any of these describe you:
- You are in priority group 1 (rated 50% or higher, unemployable, or Medal of Honor).
- You have any compensable service-connected rating, for inpatient and outpatient care.
- You are a former prisoner of war, a Purple Heart recipient, or a World War II veteran.
- VA has determined you are catastrophically disabled, for medications under 38 CFR 17.110(c)(9).
- Your income does not exceed the maximum annual VA pension rate, for medications.
- The care is for a service-connected condition, whatever your rating.
If you are rated 40% or less and your income sits below the national limit for free medications, submitting your income information to VA is the single highest-value paperwork task on this list, because it converts a $700-a-year medication ceiling into zero.
The Bottom Line
VA health care is not free for everyone, but the ceiling is low. Even a group 8 veteran with no service connection tops out at $15 per primary care visit, $50 per specialty visit or scan, $30 per urgent care visit after the first three, and $700 a year in drug copays, with labs, X-rays and preventive care at no charge.
The two adjacent benefits worth claiming are mileage reimbursement, covered in VA travel pay, and prescription costs, covered in VA pharmacy costs. Veterans’ family members are on a separate program, CHAMPVA, which has its own deductible and cost share.