VA Community Care: Getting Care Outside VA

VA Community Care lets eligible veterans receive care from approved non-VA providers when VA cannot provide the needed care directly, nearby, soon enough, or in a way that meets certain access or quality standards.

Community Care can be a strong option, but it is not automatic private care. In most situations, veterans must be enrolled in or eligible for VA health care and must have approval from their VA health care team before getting care from a community provider, except for certain urgent or emergency care situations.

The most important rule is simple: do not schedule routine care outside VA until VA has approved the referral and authorization. Urgent care, emergency care, and travel reimbursement follow different rules.

Community Care is health care paid for by VA but delivered by approved community providers outside a VA medical facility. VA uses Community Care when VA cannot provide the needed care directly or when the veteran qualifies under specific eligibility rules — access, wait time, drive time, provider availability, quality standards, or medical best interest.

Community Care is coordinated through VA's Community Care Network (CCN). It is still VA-coordinated care. It is not the same as choosing any civilian provider and assuming VA will pay.

Talk with your VA primary care provider, specialist, or care team about the care you need. Ask whether Community Care may apply based on the type of care, distance, wait time, medical need, provider availability, best medical interest, or access and quality concerns.

Start with VA before scheduling anything outside VA for routine care.

You can search for an in-network community provider yourself or ask your VA health care team to help. A provider saying they "take VA" is not enough by itself. Before scheduling routine care, confirm VA has approved the referral and that the provider is part of the approved process.

After you have the referral, you can schedule the appointment yourself or ask VA to schedule it. If you schedule it yourself, tell your VA health care team within 14 days so they can put the appointment in your chart and coordinate with the community provider.

If VA does not have the appointment information, the process can break down.

VA urgent care is for minor, non-life-threatening illnesses and injuries that need attention soon — strep throat, sprains, skin infections, ear infections, minor cuts, colds or flu-like symptoms, and similar issues.

For eligible veterans, no referral is required before using urgent care, but the provider must be in VA's Community Care Network. To use the benefit, the veteran must be enrolled in VA health care and must have received care from VA or an in-network provider within the past 24 months. Family members cannot use the veteran's urgent care benefit.

Do not pay a copay at the time of the urgent care visit. If a VA copay applies, VA will bill you later. For priority groups 1–5, VA's current copay page lists the first three urgent care visits per calendar year at $0, with additional visits generally $30. Priority group 6 depends on whether the visit is related to a condition covered by special authority. Priority groups 7–8 are generally $30 per visit.

For a medical emergency, go to the nearest emergency department. VA says emergency departments should treat the veteran immediately and should not wait for VA approval. VA may pay for the care depending on eligibility and circumstances.

VA must be notified within 72 hours of when emergency care starts. VA prefers the provider notify VA, but the veteran or someone acting on their behalf can also notify VA. Urgent care facilities do not qualify as emergency departments.

Emergency care, urgent care, and routine Community Care are three different paths. Do not assume the rules are the same.

Community Care does not always mean there will be no cost. Copays may still apply depending on priority group, disability rating, income, special eligibility, type of care, and whether the care is related to a service-connected condition.

Veterans with a service-connected rating of 10% or higher generally do not pay a copay for outpatient care. Do not pay the community provider at the time of care unless VA specifically tells you to. VA normally bills any VA copay separately. If you receive a bill from a community provider, do not ignore it — contact VA, the provider, or your local VA Community Care office.

Beneficiary Travel is about whether VA may reimburse eligible veterans or caregivers for travel to and from approved appointments. Some travel requires preapproval, and reimbursement claims should generally be filed within 30 days of the appointment.

If someone mentions a "medical destination," travel pay, lodging, or transportation support, do not assume that means Community Care has been approved. Ask VA which process applies: Community Care authorization, urgent care benefit, emergency care notification, or Beneficiary Travel.