VA Will Now Let You Go to Civilian Urgent Care Doctors

Got a sore throat or a sprained ankle and don't want to go to a Department of Veterans Affairs hospital? Got sick at 8:00 on a Friday night and don’t want to wait until Monday to see a VA doctor? A new VA program may be for you.

As of June 6, 2019, the VA offers medical care to eligible veterans at selected civilian urgent care facilities nationwide.

This is an expansion of the VA's Mission Act, which itself was an expansion of the Veterans Choice Act. The Choice Act was passed in 2014 as the result of highly publicized problems with veterans not being able to get appointments at VA hospitals in a timely manner.

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Under this new expanded program, veterans are eligible to get limited urgent care from civilian doctors regardless of how close they are to a VA facility.

Eligibility

If you are enrolled in the VA health care system and have received VA medical care within the last 24 months, you should be eligible for this program. However, you should contact your local VA medical facility before visiting a civilian urgent care provider. Only certain services and providers are covered under this new benefit. If you visit a provider that isn't part of the program, or you get medical treatment that isn't covered under this program, you may end up paying out-of-pocket.

You don't have to go to a civilian doctor if you don't want to. The VA says that most of its locations, including hospitals and community-based outpatient clinics, offer same-day services for most situations.

You should contact your local medical office to check your eligibility. Or you can call (866) 606-8198. You can also find civilian community-care locations near you at https://www.va.gov/find-locations/.

Payments

One way this program differs from regular VA medical care is that you may have to make a co-payment to see the civilian doctor. The amount depends on your VA Priority Group and how many times you visit civilian doctors each year. Typically, you get three free visits each year.

Co-Payments for Office Visits

• Priority Groups 1-5. There is no co-payment for the first three visits during a calendar year. For all subsequent visits, the co-payment is $30.
• Priority Group 6. If the visit is for medical treatment related to combat and chemical exposures such as Agent Orange; contaminated water at Camp Lejeune, NC; Gulf War Syndrome, etc., as well as some mental illnesses, there is no co-pay for the first three visits during a calendar year. For all subsequent visits, the co-payment is $30. If the visit is not related to these conditions, the co-payment is $30 per visit, for all visits.
• Priority Groups 7-8. The co-payment is $30 per visit.

There is no co-payment for any Priority Group for flu shots.

Co-Payments for Prescriptions

If you get a prescription from an urgent care center, you should fill it at a VA network pharmacy. If you go to an out-of-network pharmacy, you will have to pay the full price at the drug store and then file a claim with the VA to get your money back.

If you are given a prescription for what the VA considers routine or maintenance drugs (such as blood pressure or cholesterol drugs), you will have to get those filled by the VA.

Some veterans may be required to make a co-payment for medication. Prices are based on your Priority Group, as well as the type of drugs prescribed. For details, see https://www.va.gov/COMMUNITYCARE/revenue_ops/copays.asp.

When the benefit starts, you will be able to contact the VA Health Resource Center for questions related to urgent care co-payments at 1-877-222-VETS (8387).

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