HEALTHCAREVA program

VA Community Care (MISSION Act)

Allows enrolled veterans to receive care from approved non-VA community providers when VA cannot provide timely or geographically accessible care. Veterans remain responsible for applicable copayments.

Available to enrolled veterans meeting access or wait time standards

View on VA.gov

Step-by-step guide

What VA checks before community care

Enrollment in VA health careCommunity care is for veterans enrolled in VA health care, or who get VA care without enrolling, for example at a 50% rating.
One of the community care conditionsVA does not offer the service at any VA facility; your state has no full-service VA medical facility; you and your VA provider agree it is in your best medical interest; a VA service line falls short of VA's quality standards; or VA cannot offer a VA appointment that meets its access standards. For primary care, mental health care, and some extended care, the standards are an appointment within 20 days of the request and a 30 minute average drive. For specialty care they are 28 days and a 60 minute average drive.
A referral from your VA care teamAsk your VA care team for a referral. VA reviews the request, confirms it with you, and prepares the referral. You can name a provider in the network, or VA refers you to one.

Source: 38 CFR 17.4005 (opens in new tab); VA.gov: community care outside VA (opens in new tab); 38 CFR 17.4010(a) (opens in new tab); 38 CFR 17.4040(a) (opens in new tab); 38 CFR 17.4020(b) (opens in new tab); VA.gov: community care referrals and appointments (opens in new tab); VA.gov: community care for veterans (opens in new tab)

Which kind of care do you need?

Care from a community provider with a referral
VA pays a provider in its community care network when VA cannot give you the care you need, under set conditions. Your VA care team must approve the care before you get it. You can still choose care at a VA facility.
Source: 38 CFR 17.4010(a) (opens in new tab); 38 CFR 17.4040(a) (opens in new tab); 38 CFR 17.4020(b) (opens in new tab); VA.gov: community care outside VA (opens in new tab); VA.gov: community care referrals and appointments (opens in new tab)
Urgent care in VA network
For minor illnesses and injuries that are not life threatening, you can go to an in-network urgent care center or walk-in clinic without a referral. If your life or health is in danger, call 911 or go to the nearest emergency room.
1. Enrolled, and seen in the past 24 monthsVA.gov lists two things: enrollment in VA health care, and care from VA or an in-network provider in the past 24 months. Family members cannot use this benefit.
Source: 38 CFR 17.4600(c)(1) (opens in new tab); VA.gov: urgent care at VA or in-network providers (opens in new tab)

What to gather, and what it shows VA

Documents for this benefit: what each is, what it shows VA, and how VA gets it
Document	What it shows	How VA gets it	Have it?
VA health care enrollment The VA letter that confirms your enrollment, or your Veteran Health Identification Card.	That you are enrolled in VA health care	VA mails the letter after you apply with VA Form 10-10EZ. Ask for the card online or at a VA medical center.	Yes
Authorization letter The letter VA sends after you schedule. It has an authorization number, the approved provider, the care covered, and how long the approval lasts.	That VA approved this community care	VA sends it after the appointment is scheduled. Keep it for every visit.	Yes
Other health insurance Details of any other health plan that covers you.	Coverage VA must know about before it authorizes care	Give the details to VA before the care is authorized, and tell VA within 60 days if the plan changes.	Yes
Urgent care billing card and photo ID A government-issued photo ID and a copy of VA's urgent care billing information card, printed or on your phone.	Who to call to check your urgent care benefit	Download the card from the VA.gov urgent care page. Show it at the clinic and say you are using your VA urgent care benefit.	Yes

VA shares your records with the community provider. BeneVets does not ask for copies of them.

Steps, in order

Ask your VA provider
Tell your VA care team the care you need and ask whether community care applies. You can search for an in-network provider yourself, or ask the team to find one.
Source: VA.gov: community care referrals and appointments (opens in new tab); 38 CFR 17.4010(a) (opens in new tab)
Get the referral
Ask your VA care team for a referral to the community provider. VA checks the request against the conditions, contacts you to confirm, and prepares the referral.
Source: VA.gov: community care referrals and appointments (opens in new tab); 38 CFR 17.4020(b) (opens in new tab)
Schedule with the community provider
Schedule the appointment yourself, or ask your VA care team to do it. If you schedule it yourself, tell your VA care team so they can work with the provider. Keep the authorization letter VA sends.
Source: VA.gov: community care referrals and appointments (opens in new tab)
Go to the appointment
VA shares your records with the provider. Bring copies of any images, like a CT scan or MRI, that the provider asks for. Care your authorization letter does not list is not covered; for more care, you or the provider can ask for a new referral.
Source: VA.gov: community care referrals and appointments (opens in new tab)
Use in-network urgent care
Confirm the clinic is in the VA network; out-of-network urgent care can leave you with the full cost. Fill out the intake form, say you are using your VA urgent care benefit, and do not pay a copay at the visit.
Source: VA.gov: urgent care at VA or in-network providers (opens in new tab); 38 CFR 17.4600(c)(1) (opens in new tab)
Handle billing questions
Do not pay the community provider a copay. VA bills any copay later. If you disagree with a VA copay bill or cannot pay it, VA.gov explains disputes and financial hardship options.
Source: 38 CFR 17.108(c)(4) (opens in new tab); VA.gov: urgent care at VA or in-network providers (opens in new tab); VA.gov: VA financial hardship assistance (opens in new tab)

Good to know

Copays follow the VA rules

Community care carries the same copays as care at VA, and veterans who pay no VA copays pay none here. You pay nothing at the visit; VA bills any copay later. VA may also bill your other health insurance for care not related to service.

Source: 38 CFR 17.108(c)(4) (opens in new tab); 38 CFR 17.108(d) (opens in new tab); VA.gov: community care for veterans (opens in new tab)

Urgent care copays

Urgent care has its own copay rule. Priority groups 1 to 5 pay none for the first 3 visits each calendar year. Groups 7 and 8 pay a copay each visit. Group 6 depends on whether the visit is for a condition VA covers under a special authority.

Source: 38 CFR 17.4600(d) (opens in new tab); VA.gov: current VA health care copay rates (opens in new tab)

Appeals go to clinical appeals

If VA denies a request for community care, you can appeal through VA's clinical appeals process. These decisions cannot go to the Board of Veterans' Appeals.

Source: 38 CFR 17.4010(d) (opens in new tab); VA.gov: community care outside VA (opens in new tab)

Free help with the health care application

Free help: an accredited VSO can file this with you. Find one near you in the BeneVets VSO directory at /vso-directory. A VSO can help with the VA health care application that community care depends on.

Source: VA.gov: accredited representatives (opens in new tab); VA.gov: how to apply for VA health care (opens in new tab)

BeneVets is informational and is not an accredited representative. Free help: an accredited VSO can work through VA benefits with you at no cost. Find an accredited VSO near you