VA offers an urgent care benefit that provides eligible Veterans
with greater choice and access to timely, high-quality care.
Urgent care providers treat minor injuries and illnesses,
including flu-like symptoms (such as coughs and colds),
sprains, sore throats, and bumps and bruises.
For example, if
you’re an eligible Veteran and one day you wake up with
flu-like symptoms, you can go to an urgent care provider that is
part of VA’s contracted network of community providers for
treatment.
The benefit supplements care that Veterans
may also have access to at a VA medical facility.
To be eligible
for urgent care, Veterans must be enrolled in the VA health
care system and have received care through VA from either a VA
provider or community provider paid for by the VA within the
past 24 months.
To check their eligibility, Veterans can
contact their local VA medical facility by phone or in person.
Eligible Veterans do not need to get prior authorization from VA
to visit an urgent care provider in VA’s contracted network of
community providers.
VA can only pay for care under this benefit
if the Veteran is eligible, the services are covered under this
benefit and the provider is part of VA’s contracted network
of community providers.
If a Veteran goes to an
out-of-network urgent care provider, they may be
responsible for the full cost of care.
To find an available
urgent care provider in VA’s contracted network of community
providers, Veterans can use VA’s facility locator on VA.gov or
contact their local VA medical facility.
Veterans must notify
the urgent care provider that they are using their VA benefit
for the visit, and the provider will verify their eligibility.
Please note the following about urgent care: Urgent care is not
an adequate replacement for emergency care.
If a Veteran has
a medical emergency, like chest pain or a large broken bone, or
needs immediate help due to an accident or injury, they should
call 9-1-1 or go to an emergency department
immediately.
Urgent care is not an adequate replacement for
preventive health care, disease prevention, or management of
chronic or long-term conditions.
Veterans should work with their
primary care provider for these types of care.
If a Veteran goes
to an urgent care provider and receives services that are not
covered by this benefit, they may be responsible for the full
cost of care.
Veterans may be charged a VA copayment for
urgent care that is different from other VA medical
copayments.
VA copayments for urgent care depend on the
Veteran’s assigned priority group and the number of times
they visit an in-network urgent care provider in a calendar
year.
For Priority Groups 1-5, there is no copayment for the
first three visits during a calendar year.
For the fourth or
more visit in a calendar year, the copayment is $30.
For
Priority Group 6, there is no copayment for the first three
visits during a calendar year if the visit is related to special
authority or exposure.
For the fourth visit and all subsequent
visits in a calendar year, the copayment is $30.
If the visit
is not related to special authority or exposure, the
copayment is $30 per visit, regardless of which visit it is.
For Priority Groups 7-8, the copayment is $30 per visit.
For
Priority Groups 1-8, there is no copayment for a flu shot-only
visit.
Visits consisting only of a flu shot do not count as a
visit for the number of visits in a calendar year for eligible
Veterans.
In addition, please note that copayment charges are
billed separately by VA as part of VA’s billing process and
there is no limit to the number of times an eligible Veteran can
go to an urgent care provider.
For prescription medication of a
14 day or fewer supply written by an urgent care provider,
Veterans can either fill the prescription at a contracted
pharmacy in the VA network, at VA, or at a non-contracted
pharmacy.
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.
If a non-contracted pharmacy is
used, Veterans must pay for the prescription and then file a
claim for reimbursement with their local VA medical facility.
To learn more about urgent care, please contact your local VA
medical facility or visit VA.gov.