Priority Groups Table

The number of Veterans who can be enrolled in the health care program is determined by the amount of money Congress gives VA each year. Since funds are limited, VA set up Priority Groups to make sure that certain groups of Veterans are able to be enrolled before others.

Once you apply for enrollment, 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 for enrollment. Some Veterans may have to agree to pay copay to be placed in certain Priority Groups.

You may be eligible for more than one Enrollment Priority Group. In that case, VA will always place you in the highest Priority Group that you are eligible for. Under the Medical Benefits Package, the same services are generally available to all enrolled Veterans.VA determines your eligibility for VA’s comprehensive medical benefits package through our patient enrollment system, which is based on Priority Groups from 1 through 8.

Priority Group 1

• Have a service-connected disability that we’ve rated as 50% or more disabling, or
• Have a service-connected disability that we’ve concluded makes you unable to work (also called unemployable), or
• Received the Medal of Honor (MOH)

Priority Group 2

• We may assign you to priority group 2 if you have a service-connected disability that we’ve rated as 30% or 40% disabling.

Priority Group 3

• Are a former prisoner of war (POW), or
• Received the Purple Heart medal, or
• Were discharged for a disability that was caused by—or got worse because of—your active-duty service, or
• Have a service-connected disability that we’ve rated as 10% or 20% disabling, or
• Were awarded special eligibility classification under Title 38, U.S.C § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”

Priority Group 4

• Are receiving VA aid and attendance or housebound benefits, or
• Have received a VA determination of being catastrophically disabled

Priority Group 5

• Don’t have a service-connected disability, or you have a non-compensable service-connected disability that we’ve rated as 0% disabling, and you have an annual income level that’s below our adjusted income limits (based on your resident zip code), or
• Are receiving VA pension benefits, or
• Are eligible for Medicaid programs

Priority Group 6

• Have a compensable service-connected disability that we’ve rated as 0% disabling, or
• Were exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki, or
• Participated in Project 112/SHAD, or
• Served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, or
• Served in the Persian Gulf War between August 2, 1990, and November 11, 1998, or
• Served on active duty at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987
• We may also assign you to priority group 6 if you meet all of the requirements listed below. You:
• Are currently or newly enrolled in VA health care, and
• Served in a theater of combat operations after November 11, 1998, or were discharged from active duty on or after January 28, 2003, and
• Were discharged less than 5 years ago

 
Note: As a returning combat Veteran, you’re eligible for these enhanced benefits for 5 years after discharge. At the end of this enhanced enrollment period, we’ll assign you to the highest priority group you qualify for at that time.

Priority Group 7

• Veterans with incomes below the geographic means test (GMT) income thresholds and who agree to pay the applicable copayment.

Priority Group 8
Veterans with gross household incomes above the VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copays
You may be eligible for VA health care benefits if we place you in one of these subpriority groups:

Subpriority group a
All of these must be true. You:

• Have a non-compensable service-connected condition that we’ve rated as 0% disabling, and
• Enrolled in the VA health care program before January 16, 2003, and
• Have remained enrolled since that date and/or were placed in this subpriority group because your eligibility status changed

Subpriority group b
All of these must be true. You:

• Have a non-compensable service-connected condition that we’ve rated as 0% disabling, and
• Enrolled in the VA health care program on or after June 15, 2009, and
• Have income that exceeds current VA or geographical limits by 10% or less

Subpriority group c

• All of these must be true. You:
• Don’t have a service-connected condition, and
• Enrolled in the VA health care program as of January 16, 2003, and
• Have remained enrolled since that date and/or were placed in this subpriority group because your eligibility status changed

Subpriority group d
All of these must be true. You:

• Don’t have a service-connected condition, and
• Enrolled in the VA health care program on or after June 15, 2009, and
• Have income that exceeds current VA or geographical limits by 10% or less

You’re not eligible for VA health care benefits if we place you in one of these subpriority groups:

Subpriority group e
All of these must be true. You:

• Have a non-compensable service-connected condition that we’ve rated as 0% disabling, and
• Don’t meet the criteria for subpriority group a or b above

Note: You’re eligible for care for your service-connected condition only.

Subpriority group g

• All of these must be true. You:
• Don’t have a service-connected condition, and
• Don’t meet the criteria for subpriority group c or d above