Last week, VA implemented changes to community care under the VA MISSION Act. The changes included expanded eligibility for community care and a new urgent care benefit. As part of our outreach and engagement efforts, we collected the top questions received from Veterans and provided answers to each one below. Our goal is to make it easier to access the care you have earned.
General health care
When can I receive community care?Eligibility for community care depends on your individual health care needs or circumstances. You should discuss community care eligibility with your VA care team to determine if you are eligible. This video provides a quick overview of Veteran community care.
Can I get dental care through the MISSION Act?Eligibility for dental services has not changed under the MISSION Act. You should talk to your VA care team about eligibility for dental services. Click here for more information about dental care.
How does a community provider know I am eligible to receive community care?If your VA care team has determined that you are eligible for community care and you chose a community provider, VA will send the provider a referral and authorization prior to you receiving care. You must receive approval from VA prior to obtaining care from a community provider in most circumstances.
I was authorized for community care under the Choice program. What happens now? The Choice program expired on June 6, 2019, and specific Choice eligibility for community care is no longer being used. If you were eligible for community care under Choice, you should speak with your VA care team or a VA staff member at your local VA medical facility about updated eligibility for community care. This video also provides a quick primer regarding community care eligibility under the new Veteran community care program.
How do I become eligible for the urgent care benefit?You must be enrolled in VA health care and have received care through VA from either a VA or community provider within the past 24 months to be eligible for the urgent care benefit.
What is the difference between urgent care and emergency care?Urgent care consists of medical services provided for minor illnesses or injuries that are not life-threatening such as strep throat, pink eye, or influenza. Emergency care consists of inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health such as severe chest pain, seizures or loss of awareness, heavy uncontrollable bleeding, or moderate to severe burns.
Do I have to pay a copayment if I receive urgent care that relates to my service-connected condition?Copayments for urgent care are different from other VA medical copayments. Copayments for urgent care depend on your assigned priority group and the number of times you visit any urgent care provider in a calendar year. Visit the Urgent Care webpage for more information about copayments.
How do I get prescription medication related to an urgent care visit? VA will pay for or fill prescriptions for urgent care. For urgent care prescription medication longer than a 14-day supply, the prescription must be submitted to VA to be filled. For urgent prescriptions written by an urgent care provider, you can fill a 14-day supply of medication at a contracted pharmacy within the VA network, in VA, or at a noncontracted pharmacy. If a noncontracted pharmacy is used, you must pay for the prescription and then file a claim for reimbursement with your local VA medical facility.
Click here for detailed information on community care and urgent care.