A state veteran healthcare copay schedule is a published list showing how much a veteran owes out of pocket for specific medical services through VA healthcare or state-level veteran programs. The amount depends on the veteran's priority group, income level, disability rating, and the type of care received. Knowing your copay schedule helps you budget for medical costs and avoid surprise bills.

How Is the VA Copay Schedule Determined?

The VA assigns every enrolled veteran to a priority group, numbered 1 through 8. This group determines whether you pay copays for inpatient care, outpatient visits, prescriptions, and long-term services. Veterans with a service-connected disability rated 50% or higher generally pay no copays. Veterans in lower priority groups with higher incomes pay the most.

The federal VA copay schedule applies nationwide, but some states add their own programs that reduce or waive copays for certain services. For example, state veteran homes and state-funded health programs may have their own cost-sharing rules separate from the VA. This means your total copay responsibility can vary depending on where you live and which programs you use.

What Are the Current VA Copay Rates?

As of the most recent VA schedule, here are the general copay categories:

Inpatient Care Copays

  • Priority Groups 1–6: No copay for inpatient care related to a service-connected condition. For non-service-connected care, the first 90 days in a 365-day period carry a per-diem charge (currently $1,454.40 for the first 90 days, with a $10 charge per day after that).
  • Priority Groups 7–8: Copays apply for non-service-connected inpatient care at the same or reduced rates depending on income thresholds.

Outpatient Care Copays

  • Primary care visit: $15 per visit for most priority groups
  • Specialty care visit: $50 per visit
  • Urgent care: $30 per visit at VA-authorized urgent care facilities
  • Telehealth visits: $15 for primary care, $50 for specialty telehealth

Prescription Copays

  • 30-day supply (Tier 1): $5 per prescription
  • 60- or 90-day supply: $10 or $15, respectively
  • Medications not on the VA formulary: $11 per 30-day supply
  • Annual cap: $700 per calendar year for Priority Groups 2–6

These rates change periodically. Always check the current VA copay schedule at va.gov/health-care/copay-rates for the latest figures.

Do All Veterans Pay Copays?

No. Many veterans are exempt from copays entirely. You do not pay copays if you:

  • Have a service-connected disability rated 50% or higher
  • Are receiving care for a service-connected condition (any rating)
  • Are a former POW
  • Received a Purple Heart
  • Were exposed to Agent Orange or other toxic substances during qualifying service
  • Are in Priority Group 1 based on income and disability
  • Are receiving VA pension benefits

If you are unsure about your exemption status, check your VA enrollment letter or contact your local VA health facility. Many veterans who qualify for exemptions never realize it and end up paying copays they owe nothing on.

How Do State Programs Affect Veteran Copays?

Several states operate their own veteran healthcare programs that go beyond federal VA benefits. These state programs may cover copays, offer supplemental insurance, or provide services the VA does not cover at all. For veterans who need help with healthcare benefits available in their state, these programs can meaningfully reduce out-of-pocket costs.

For instance, some states fund veteran home care services with reduced or zero copays for qualifying veterans. If you or a family member needs in-home assistance, you can learn more about home healthcare aide services for veterans that may be available through state programs at little or no cost.

States may also cover services like acupuncture or speech therapy that have limited or no VA coverage in some regions. Veterans seeking acupuncture coverage by state or speech pathology services through state programs may find that copays differ significantly from standard VA rates or that the state absorbs the cost entirely.

What Happens If You Don't Pay Your VA Copay?

VA copays are real debts. If you do not pay, the VA will send you a billing statement, then a series of follow-up notices. After 90 days of non-payment, the VA may refer your balance to the U.S. Department of the Treasury for collection. This can affect your credit and may result in garnishment of certain federal payments.

However, the VA offers payment plans and financial hardship waivers. If your income has dropped or you are experiencing a financial crisis, you can apply for a copay waiver through your local VA Revenue Office. You will need to provide documentation of your income and expenses. The VA processes these requests on a case-by-case basis.

How Can You Reduce or Eliminate Your Copays?

There are several strategies to lower your copay burden:

  1. Request a priority group review. If your financial situation has changed or you believe you were assigned the wrong group, ask the VA to reevaluate. Priority Group 5–8 veterans with lower incomes may qualify for a higher priority group with reduced copays.
  2. Apply for a copay hardship waiver. Submit VA Form 10-10HS to request copay relief due to financial hardship.
  3. Check for state-level assistance. Many states have programs that pay or offset VA copays for eligible veterans. Contact your state Department of Veterans Affairs office.
  4. Use VA telehealth when possible. Some telehealth services carry lower copays than in-person visits.
  5. Enroll in the VA Medication Copay Cap. Once you hit $700 in prescription copays in a calendar year, you should not be billed more. Track your spending to make sure this cap is applied correctly.
  6. Combine VA care with TRICARE or Medicare. Veterans eligible for both VA care and other federal programs may have different cost-sharing rules that work in their favor.

What Are Common Mistakes Veterans Make With Copays?

A few recurring errors cost veterans money or cause confusion:

  • Assuming copays apply to all visits equally. Primary care copays are much lower than specialty care. Scheduling routine concerns through primary care instead of going directly to a specialist can save money.
  • Not tracking prescription copays. Veterans sometimes pay the annual $700 cap and then keep paying. If you have hit the cap, contact the VA pharmacy billing office.
  • Ignoring billing statements. VA copay statements are easy to miss, especially if you receive them by mail. Sign up for VA.gov notifications to track balances online.
  • Forgetting to update income information. If your income drops, your priority group and copay obligations may change. Update your financial information annually with the VA.
  • Not knowing about state benefits. Veterans often look only at federal VA coverage and miss state-level programs that cover or reduce copays. If you recently moved or were recently discharged and transitioning to state healthcare programs, review what your new state offers.

How Do You Look Up Your Specific Copay Amounts?

You can find your copay information in three places:

  1. VA.gov: Log into your account and review billing statements under the "My Health" section.
  2. Your VA enrollment letter: This confirms your priority group, which determines your copay schedule.
  3. Call the VA Health Resource Center: Dial 1-866-400-1238 to speak with a billing representative who can explain your specific charges.

You can also visit your local VA medical center's billing office in person. Bring your VA ID card and any recent billing statements.

Do Copays Apply to Emergency Care?

If you receive emergency care at a non-VA facility, the VA may cover the cost, but copays still apply based on your priority group and whether the condition is service-connected. You must notify the VA within 72 hours of the emergency admission for the claim to be processed. Failure to notify the VA in time is one of the most common reasons veterans get stuck with full emergency bills.

For urgent care visits at VA-authorized community providers, a $30 copay applies for Priority Groups 1–6 for the first three visits per calendar year. After that, the copay structure may change.

Next step: Review your VA enrollment priority group today. If you are Priority Group 5 or above, check whether your income qualifies you for a group change or a hardship waiver. Then contact your state's Department of Veterans Affairs to ask about state-specific copay assistance programs that could save you money this year.