VA Health Care’s 8 Priority Groups: Why a 10 Percent Rating Erases Your Copay
10 min read · Last updated September 17, 2026
Reviewed for accuracy by Steven Sun · See our Editorial Standards
- A service-connected disability rating of 10% or higher moves a veteran into Priority Group 1, 2, or 3 and eliminates copays for outpatient primary and specialty care entirely, per VA’s own copay-rates page.
- Only Priority Group 1, reserved for a rating of 50% or more, a VA finding that a veteran cannot work because of a service-connected disability, or the Medal of Honor, also eliminates prescription copays. Groups 2 through 8 can still owe $5 to $33 per prescription depending on the medication tier and days of supply.
- Priority Groups 7 and 8 are the two income-tested tiers, sorted using the Geographic Means Test (GMT), which compares household income against limits that change by ZIP code and household size.
- Medication copays are capped at $700 per calendar year for any veteran who owes them, no matter how many prescriptions are filled after that point in the year.
VA sorts every veteran enrolled in VA health care into one of 8 priority groups using disability rating, catastrophic disability status, former prisoner-of-war status, and household income measured against the Geographic Means Test. A rating of 10% or higher clears outpatient copays entirely, but it takes a 50% rating, a finding of individual unemployability, or the Medal of Honor to clear prescription copays too.
In this article
- What a VA health care priority group actually decides
- How VA sorts you into 1 of 8 groups
- What changes your copay bill, group by group
- What moves you into a different group
- How to enroll and find your own group
A veteran gets a disability rating decision back from VA raising his combined rating from 0% to 10%. He does not think about it again until his next VA primary care appointment, when the front desk tells him the $15 copay he paid at his last visit does not apply anymore. The rating decision changed his monthly compensation check. It also quietly moved him into a different VA health care priority group, the eight-tier system that decides what he pays every time he uses VA medical care afterward, a completely separate mechanism from the disability claim that just approved his rating.
What a VA health care priority group actually decides
Filing a disability claim, sitting for a claim and pension (C&P) exam, and getting a rating decision are about VA disability compensation, the monthly payment VA owes for a service-connected condition. Enrolling in VA health care and being placed into a priority group is separate. It governs whether a veteran gets treated at a VA medical center, how quickly VA schedules that care when Congress has funded only a limited number of enrollment slots for the year, and what copay, if any, the veteran owes for a visit or prescription.
A veteran needs no disability rating to enroll in VA health care. A veteran with a 100% combined rating still applies for VA health care separately and gets placed into a priority group like everyone else. The two systems overlap only because VA reuses the same rating percentage as one sorting criterion among several, which is why a rating change can ripple into a health care bill even though the claim itself was never about health coverage.
How VA sorts you into 1 of 8 groups
VA’s own priority groups page lays out the qualifying criteria for each of the 8 groups, from highest priority to lowest:
- Priority Group 1: a service-connected disability rated 50% or more disabling, a service-connected disability that VA has determined makes the veteran unable to work, or receipt of the Medal of Honor.
- Priority Group 2: a service-connected disability rated 30% or 40% disabling. Veterans whose separate conditions combine to land in this range can see how VA does that math in our combined ratings guide.
- Priority Group 3: a former prisoner of war (POW), a Purple Heart recipient, a veteran discharged for a disability caused by or worsened by active-duty service, or a service-connected disability rated 10% or 20% disabling.
- Priority Group 4: a veteran receiving VA aid and attendance or housebound benefits, or a VA determination of being catastrophically disabled.
- Priority Group 5: no service-connected disability, or a non-compensable 0% service-connected disability, combined with household income below VA’s adjusted income limits for the veteran’s ZIP code; or receipt of VA pension benefits; or Medicaid eligibility.
- Priority Group 6: a compensable 0% service-connected disability, certain service eras (World War II, the Persian Gulf War, or 30 days of active duty at Camp Lejeune between 1953 and 1987), combat service after November 11, 1998 with discharge on or after October 1, 2013 (with 10 years of enhanced eligibility from discharge), or a qualifying toxic exposure. The Promise to Address Comprehensive Toxics (PACT) Act expanded who falls into this last category; see our PACT Act guide for the exposure list.
- Priority Group 7: gross household income below the Geographic Means Test limit for where the veteran lives, and agreement to pay copays.
- Priority Group 8: gross household income above both VA’s national income limit and the Geographic Means Test limit, and agreement to pay copays.
The same VA guidance resolves overlap directly: “if you qualify for more than one priority group, we’ll assign you to the highest one.” A veteran with a 20% rating who also has income low enough for Priority Group 5 still lands in Priority Group 3, because 3 outranks 5.
What changes your copay bill, group by group
VA’s current copay rates page states the actual rule plainly: a veteran with a service-connected disability rating of 10% or higher owes no copay for outpatient care, meaning a routine primary care visit or a specialist appointment. Without that rating, a veteran may owe $15 for a primary care visit and $50 for a specialty care visit or test, for care unrelated to military service. X-rays, lab work, and preventive screenings carry no copay for anyone.
Medications work differently. Only Priority Group 1 pays no copay for any medication. Veterans in Priority Groups 2 through 8 may owe a copay for prescriptions treating conditions that are not service-connected, and for over-the-counter medications picked up at a VA pharmacy. Those copays run by tier and days of supply: $5 for a 30-day supply of a Tier 1 generic, $8 for Tier 2, and $11 for Tier 3 brand-name drugs, roughly doubling at 60 days and tripling at 90. No veteran who owes medication copays pays more than $700 total in a calendar year.
| Priority Group | Primary basis for placement | General copay treatment |
|---|---|---|
| 1 | 50%+ rating, unable to work due to service-connected disability, or Medal of Honor | No copay for any VA care, including medications |
| 2 | 30% or 40% service-connected rating | No outpatient or inpatient copay; may owe medication copay for non-service-connected prescriptions |
| 3 | 10% or 20% rating, former POW, Purple Heart, or discharged for a service-caused disability | No outpatient or inpatient copay for veterans whose rating already clears 10%; may owe medication copay for non-service-connected prescriptions |
| 4 | Aid and attendance, housebound benefits, or catastrophic disability determination | Varies with underlying rating; medication copay can still apply below a 10% rating |
| 5 | 0% or no rating with income below VA’s limit, VA pension, or Medicaid eligibility | No copay for non-service-connected outpatient or inpatient care; medication copay depends on a separate income test |
| 6 | 0% compensable rating, specific service eras, or qualifying toxic exposure | No copay for care tied to the qualifying condition; unrelated care and medications may carry a copay |
| 7 | Household income below the Geographic Means Test limit, agrees to pay copays | Owes outpatient and medication copays at standard rates; may qualify for a reduced inpatient rate |
| 8 | Household income above VA’s national and Geographic Means Test limits, agrees to pay copays | Owes full outpatient, inpatient, and medication copay rates |
What moves you into a different group
A priority group is not permanent. VA re-sorts a veteran whenever the underlying facts change. A new or increased disability rating decision is the most common trigger: a veteran whose rating rises from a non-compensable 0% to a compensable 10% moves from an income-tested group into a rating-based one, and the outpatient copay ends the same way it does in the opening example above.
Income changes work the other direction. VA calculates a means-tested veteran’s priority group from the prior year’s household income, so a job loss, a retirement, or a new dependent can shift a veteran between Priority Groups 5, 7, and 8 once VA has updated information on file. VA Form 10-10EZR is built for exactly this: submitting updated household financial information lets VA determine whether a veteran will “need to pay a copay for non-service-connected care or prescription medicines.” The same form also collects updated military service and toxic-exposure history, which VA states plainly helps decide “if we’ll place you in a higher priority group,” and that placement “may affect how much (if anything) you’ll have to pay toward the cost of your care.”
A new toxic-exposure determination, a Purple Heart award processed after enrollment, or a change in former prisoner-of-war status can also move a veteran into a higher group. None of this happens automatically. VA acts on what a veteran reports, so a veteran whose circumstances changed months ago but never filed the update can still be paying a copay a current rating or income level would have erased.
How to enroll and find your own group
A veteran who has never enrolled applies with VA Form 10-10EZ, online through VA.gov, by mail, by phone, or in person at a VA medical center. VA typically processes an online application within about a week, and the confirmation states the assigned priority group directly.
An already-enrolled veteran can confirm or update a current priority group through a VA.gov account, VA’s health benefits line, or any VA medical center enrollment office. Report a change in income, rating, or exposure history rather than assume VA applies it automatically, since the group only changes once VA has the updated facts to act on.
Frequently asked questions
Do I need a service-connected disability rating to enroll in VA health care? No. A veteran with no rating at all, or a 0% rating, can still enroll in VA health care. Placement depends on several factors together, including rating, income, and service history, and a veteran without a rating is typically sorted by income into Priority Group 5, 6, 7, or 8 instead.
What happens to my priority group if my disability rating changes? VA re-evaluates your priority group whenever a new rating decision is issued. A rating that rises to 10% or higher can move you into Priority Group 1, 2, or 3 and eliminate your outpatient copay, while a rating that stays below that threshold generally leaves an income-tested placement unchanged.
Does being placed in Priority Group 8 mean I cannot get VA health care? No. Priority Group 8 is still an enrolled group, not a denial. It means your household income exceeds both VA’s national and geographically adjusted limits and you agreed to pay the standard copay rates for the outpatient, inpatient, and medication care you use.
Are veterans in every priority group charged the same medication copay? No. Only Priority Group 1 owes no medication copay at all. Veterans in Priority Groups 2 through 8 can owe $5 to $33 per prescription depending on the drug’s tier and days of supply, capped at $700 total per calendar year, and some may also qualify for free medications under a separate income test tied to a rating of 40% or less.
How does the Geographic Means Test decide my income limit? The Geographic Means Test compares your reported household income, including your spouse’s and dependents’ income, against a limit VA sets for your specific ZIP code and household size. The limit changes by location because the cost of living does, which is why two veterans with identical income can land in different priority groups depending on where they live.
