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Veterans Affairs (VA) Care Options

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VA Health Care Overview

All Veterans receive coverage for most health care services such as regular checkups with your primary care provider, appointments with specialists, medical equipment, prosthetics, and prescriptions, but only some will qualify for added benefits like dental care. The full list of your covered benefits depends on:

  • Your priority group, and​
  • The advice of your VA primary care provider, and​
  • The medical standards for treating any health conditions you may have

More information

For more information on VA eligibility and priority groups visit:​​
https://www.va.gov/health-care/eligibility/

Where to Receive Care

VA Health Care provides medical care and services for veterans in two main ways:

1

VA Care Locations

May also be referred to as Veterans Health Administration (VHA)

  • When you sign up for VA health care, you become part of the country’s largest integrated health care system – with more than 1,200 care locations serving nearly 9 million Veterans each year.​
  • VA care locations in this network may include VA medical centers, VA community-based outpatient clinics, vet centers, VA community living Centers, or your own home (if needed).

2

Community Care Network​

  • Community Care is a VA program that provides care for veterans from providers in their local community, outside of the Veterans Health Administration care locations. ​
  • There are a few steps to get started before receiving care from a community provider to avoid being billed for the care, which are covered in more detail below.

Community Care Deeper Dive

The first step is to meet with your VA physician and discuss your care and treatment options. In order for a veteran to receive care through the VA Community Care Network, a VA staff member must determine if at least one of the following criteria is met:

It is in the Veteran’s best medical interest, as determined by the VA provider.​

A service is needed that is not available at a VA medical facility.​

Veteran lives in a US state or territory without a full-service VA medical facility.​

Veteran qualifies under the “Grandfather” provision related to distance eligibility for the Veterans Choice Program.​

VA cannot provide care within certain designated access standards.

  • For average drive time to a specific VA medical facility, the access standards are 30-minute average drive time for primary care, mental health care, and noninstitutional extended care services or a 60-minute drive for specialty care.​
  • For appointment wait times at a specific VA medical facility, the access standards are 20 days for primary and mental health care, and noninstitutional extended care services or 28 days for specialty care.

Veteran needs care from a VA medical service that VA determines is not providing care that complies with VA’s quality standards.

The Next Step if You Qualify

  • Your VA Physician will refer your care to the appropriate provider, either TriWest or Optum (see the map below to determine coverage based on your location).​
  • The provider will make your appointments and contact you. You may also be eligible for self-service appointment scheduling.
  • If you have a referral and have not heard from either provider, contact the VA to ensure your referral is correct and has been issued.

Optum Covers regions 1, 2, and 3

https://vacommunitycare.com/

TRIWEST Covers regions 4 and 5

https://www.triwest.com/

VA Community Care Contact Center

1-877-881-7618

Example of a Veteran’s journey through the VA Community Care Network​

Eligibility

1

Veteran seeks care from VA. ​

2

VA determines, based on specified community care criteria, that veteran receives care from a facility in the community care network​

Appointments​

3

VA engages community care provider to accept referral and method of delivery (referral packet includes medical record)​

4

Once referral is accepted, either VA schedules appointment with community care provider or veteran schedules appointment​

Getting Care​

5

Veteran receives care from community care provider​

6

Provider sends medical record to VA.​

Billing

7

Provider bills Optum or TriWest for the care.​

What About Prescription Medicine?​

  • For prescription medication, the prescription should be sent to and filled by the nearest VA pharmacy​
  • Immediate need prescriptions may be filled (up to a 14-day supply with no refills) at a VA pharmacy OR a retail pharmacy participating in the network. ​
  • A prescription for more than a 14-day supply must be filled by VA

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Disclaimer: The information on this site is intended for U.S. residents only and is provided purely for educational purposes. Health, legal, regulatory, insurance, or financial related-information provided here is not comprehensive and is not intended to provide individual guidance or replace discussions with a healthcare provider, attorney, or other experts. All decisions must be made with your advisers considering your unique situation. © Triage Cancer & Pfizer Inc. 2024 

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