Each group has its eligibility requirements and you could technically qualify for more than one group.
You should be placed in the group that proves most beneficial. This article is primarily focused on Priority Groups 1 through 5.
Priority Group 1
* Veterans who have service-connected disabilities rated at 50% or more
* Veterans who are granted Individual Unemployability because of their service-connected disabilities
Priority Group 2
* Veterans who have service-connected disabilities rated at 30% or 40%
Priority Group 3
* Former prisoners of war
* Purple Heart recipients
* Veterans discharged for disabilities aggravated or incurred while on active duty
* Veterans who have service-connected disabilities rated at 10% and 20%
* Veterans who have been disabled by treatment or vocational rehabilitation
* Medal of Honor recipients
Priority Group 4
* Veterans receiving the Aid and Attendance or Housebound benefit
* Catastrophically disabled veterans
Priority Group 5
* Veterans who are drawing non-service-connected pensions or who have disabilities rated at 0%
* Veterans who are eligible for Medicaid
An important benefit these groups offer is affordable co-pays.
Co-pays are required for doctor prescriptions and in- and out-patient visits. The co-pays for prescriptions are calculated based on length of supplies and income level.
Additionally, in- and out-patient visits vary because of which Priority Group veterans belong to and if they are being seen by specialty care services or primary care.
Veterans should always check to see if they are being charged for co-pays. If they are, then good questions to ask are: "Should I be charged for co-pays?" or "Am I exempt from co-pays?"
All veterans who are assigned to Priority Group 1 are exempt from co-pays. The reason for the exemption is because veterans assigned to this Priority Group have rated disabilities at 50% or higher.
Veterans who are drawing the Individual Unemployability benefit are also exempt from paying co-pays to include veterans who were prisoners of war. Basically, this covers any veteran assigned to Priority Group 1, Priority Group 4 and veterans who are being treated for their service-connected disabilities.
Sometimes, a typical oversight by the VA may occur when you're service-connected below 50% and placed in a Priority Group where co-pays are mandatory. If at any time your service-connected disability is increased to 50% or higher or you have an injury to the extent of qualifying for being catastrophically disabled, this issue will need to be addressed so you can be reassigned to the right Priority Group.
If you're currently paying co-pays and believe you're eligible for an exemption, it's always in your best interest to speak with a Paralyzed Veterans of America National Service Officer immediately. A medical exam may have to be scheduled and completed for enrollment into the correct Priority Group.
There are instances where travel pay is authorized for veterans who are service-connected at 30% or higher.
Veterans assigned to Priority Group 1 and 2 are eligible for travel reimbursement. If you're rated below 30% and in Priority Group 3, you're eligible for travel if your scheduled appointments are for service-connected disabilities.
Veterans who are receiving the non-service-connected pension and assigned to Priority Group 5 are also eligible for travel. Since you're required to have served during an eligible wartime period to collect the pension, you may still qualify to be under the maximum annual VA Pension Rate (MAPR).
The MAPR for a single veteran with no dependents is $12,868. This amount will vary according to your dependent status. This will also vary if you're receiving Aid and Attendance or Housebound benefits, and if your spouse is a veteran, as well.
For more information, visit benefits.va.gov/pension/current_ rates_veteran_pen.asp or contact your local PVA National Service officer from the roster on page 61.
Charles Tocci is a Paralyzed Veterans of America Veterans Health and Benefits Specialist II.