View 2020 copay rates for VA and VA-approved health care.
You can view the Glossary at www.umr.com or call 1-800-826-9781 to request a copy. Emergency room care $25 Copay per visit True ER. Urgent care $10 Copay per. UMR: DIGNITY HEALTH: 7617 001 - DHMP Nevada EPO Coverage for: Individual + Family. Urgent care $20 Copay per visit $20 Copay per visit Not Covered Deductible Waived. Skilled nursing care $100 Copay per admission 20% Coinsurance. Emergency room care $250 Copay per visit $250 Copay per visit Copay may be waived if admitted. Non-emergency services are not covered. Emergency room service claims for non-emergency services will be denied. Emergency medical transportation 10% Coinsurance 10% Coinsurance None Urgent care $50 Copay per visit 50% Coinsurance None.
Want to see current health care copay rates?
Get rates for the current year
We can help with your questions about debt and other financial concerns
Get the latest information about concerns like managing VA debt, or paying your VA copays or VA-backed home loan during this time.
Go to our coronavirus FAQs
Effective January 1, 2020
Note: Some Veterans don't have to pay copays (they're 'exempt') due to their disability rating, income level, or special eligibility factors.
Urgent care copay rates
(Care for minor illnesses and injuries)
There's no limit to how many times you can use urgent care. To be eligible for urgent care benefits, including through our network of approved community providers, you must:
- Be enrolled in the VA health care system, and
- Have received care from us within the past 24 months (2 years)
You won’t have to pay any copay for a visit where you’re only getting a flu shot, no matter your priority group.
| Priority group | Copay amount for first 3 visits in each calendar year | Copay amount for each additional visit in the same year | |||
|---|---|---|---|---|---|
| Priority group | 1 to 5 | Copay amount for first 3 visits in each calendar year | $0 (no copay) | Copay amount for each additional visit in the same year | $30 |
| Priority group | 6 | Copay amount for first 3 visits in each calendar year | If related to a condition that's covered by a special authority*: $0 (no copay) If not related to a condition covered by a special authority*: $30 each visit | Copay amount for each additional visit in the same year | $30 |
| Priority group | 7 to 8 | Copay amount for first 3 visits in each calendar year | $30 | Copay amount for each additional visit in the same year | $30 |
* Special authorities include conditions related to combat service and exposures (like Agent Orange, active duty at Camp Lejeune, ionizing radiation, Project Shipboard Hazard and Defense (SHAD/Project 112), Southwest Asia Conditions) as well as military sexual trauma, and presumptions applicable to certain Veterans with psychosis and other mental illness.
Outpatient care copay rates
(Primary or specialty care that doesn't require an overnight stay)
If you have a service-connected disability rating of 10% or higher
You won't need to pay a copay for outpatient care.
If you don't have a service-connected disability rating of 10% or higher
You may need to pay a copay for outpatient care for conditions not related to your military service, at the rates listed below.
| Type of outpatient care | Copay amount for each visit or test | ||
|---|---|---|---|
| Type of outpatient care | Primary care services (like a visit to your primary care doctor) | Copay amount for each visit or test | $15 |
| Type of outpatient care | Specialty care services (like a visit to a hearing specialist, eye doctor, surgeon, or cardiologist) | Copay amount for each visit or test | $50 |
| Type of outpatient care | Specialty tests (like an MRI or CT scan) | Copay amount for each visit or test | $50 |
Note: You won’t need to pay any copays for X-rays, lab tests, or preventive tests and services like health screenings or immunizations.
Inpatient care copay rates
(Care that requires you to stay one or more days in a hospital)
If you have a service-connected disability rating of 10% or higher
You won't need to pay a copay for inpatient care.
If you’re in priority group 7 or 8
You'll pay either our full copay rate or reduced copay rate. If you live in a high-cost area, you may qualify for a reduced inpatient copay rate no matter what priority group you're in. To find out if you qualify for a reduced inpatient copay rate, call us toll-free at 877-222-8387. We're here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.
| Length of stay | Copay amount | ||
|---|---|---|---|
| Length of stay | First 90 days of care during a 365-day period | Copay amount | $281.60 copay + $2 charge per day |
| Length of stay | Each additional 90 days of care during a 365-day period | Copay amount | $140.80 copay + $2 charge per day |
Note: You may be in priority group 7 and qualify for these rates if you don't meet eligibility requirements for priority groups 1 through 6, but you have a gross household income below our income limits for where you live and you agree to pay copays.
| Length of stay | Copay amount | ||
|---|---|---|---|
| Length of stay | First 90 days of care during a 365-day period | Copay amount | $1,408 copay + $10 charge per day |
| Length of stay | Each additional 90 days of care during a 365-day period | Copay amount | $704 copay + $10 charge per day |
Note: You may be in priority group 8 and qualify for these rates if you don't meet eligibility requirements for priority groups 1 through 6, and you have a gross household income above our income limits for where you live, agree to pay copays, and meet other specific enrollment and service-connected eligibility criteria.
Medication copay rates
If you’re in priority group 1
You won’t pay a copay for any medications.
Note: You may be in priority group 1 if we've rated your service-connected disability at 50% or more disabling, if we've determined that you can't work because of your service-connected disability (called unemployable), or if you've received the Medal of Honor.
If you’re in priority groups 2 through 8
You'll pay a copay for:
- Medications your health care provider prescribes to treat non-service-connected conditions, and
- Over-the-counter medications (like aspirin, cough syrup, or vitamins) that you get from a VA pharmacy. You may want to consider buying your over-the-counter medications on your own.
Note: The cost for any medications you receive while staying in a VA or other approved hospital or health facility are covered by your inpatient care copay.
The amount you’ll pay for these medications will depend on the “tier” of the medication and the amount of medication you’re getting, which we determine by days of supply. Once you’ve paid $700 in medication copays within a calendar year (January 1 to December 31), you won’t have to pay any more that year—even if you still get more medications. This is called a copay cap.
| Outpatient medication tier | 1-30 day supply | 31-60 day supply | 61-90 day supply | ||||
|---|---|---|---|---|---|---|---|
| Outpatient medication tier | Tier 1 (preferred generic prescription medicines) | 1-30 day supply | $5 | 31-60 day supply | $10 | 61-90 day supply | $15 |
| Outpatient medication tier | Tier 2 (non-preferred generic prescription medicines and some over-the-counter medicines) | 1-30 day supply | $8 | 31-60 day supply | $16 | 61-90 day supply | $24 |
| Outpatient medication tier | Tier 3 (brand-name prescription medicines) | 1-30 day supply | $11 | 31-60 day supply | $22 | 61-90 day supply | $33 |
If you have a service-connected rating of 40% or less and your income falls at or below the national income limits for receiving free medications, you may want to provide your income information to us to determine if you qualify for free medications.
Geriatric and extended care copay rates
You won't need to pay a copay for geriatric care (also called elder care) or extended care (also called long-term care) for the first 21 days of care in a 12-month period. Starting on the 22nd day of care, we'll base your copays on 2 factors:
- The level of care you're receiving, and
- The financial information you provide on your Application for Extended Care Services (VA Form 10-10EC).
| Level of care | Types of care included | Copay amount for each day of care | |||
|---|---|---|---|---|---|
| Level of care | Inpatient care | Types of care included |
| Copay amount for each day of care | Up to $97 |
| Level of care | Outpatient care | Types of care included |
| Copay amount for each day of care | Up to $15 |
| Level of care | Domiciliary care for homeless Veterans | Types of care included |
| Copay amount for each day of care | Up to $5 |
Services that don't require a copay
You won't need to pay a copay for any of the services listed below, no matter what your disability rating is or what priority group you're in.
- Laboratory (lab) tests
- Electrocardiograms (EKGs or ECGs) to check for heart disease or other heart problems
- VA health initiatives that are open to the public (like health fairs)
Other information you may need
Pay your copay bill
Find out how to pay your copay bill—and what to do if you disagree with the charges or are having trouble making payments.
Your health care costs
Learn how we assess and verify your income to help determine if you're eligible for VA health care and whether you'll need to pay copays for certain types of care, tests, and medications.
Copayments for maternity care (PDF)
We cover maternity care for eligible Veterans through arrangements with community providers. Download this fact sheet to find out more about copays.
View 2020 copay rates for VA and VA-approved health care.
Want to see current health care copay rates?
Get rates for the current year
We can help with your questions about debt and other financial concerns
Get the latest information about concerns like managing VA debt, or paying your VA copays or VA-backed home loan during this time.
Go to our coronavirus FAQs
Effective January 1, 2020
Note: Some Veterans don't have to pay copays (they're 'exempt') due to their disability rating, income level, or special eligibility factors.
Urgent care copay rates
(Care for minor illnesses and injuries)
There's no limit to how many times you can use urgent care. To be eligible for urgent care benefits, including through our network of approved community providers, you must:
- Be enrolled in the VA health care system, and
- Have received care from us within the past 24 months (2 years)
You won’t have to pay any copay for a visit where you’re only getting a flu shot, no matter your priority group.
| Priority group | Copay amount for first 3 visits in each calendar year | Copay amount for each additional visit in the same year | |||
|---|---|---|---|---|---|
| Priority group | 1 to 5 | Copay amount for first 3 visits in each calendar year | $0 (no copay) | Copay amount for each additional visit in the same year | $30 |
| Priority group | 6 | Copay amount for first 3 visits in each calendar year | If related to a condition that's covered by a special authority*: $0 (no copay) If not related to a condition covered by a special authority*: $30 each visit | Copay amount for each additional visit in the same year | $30 |
| Priority group | 7 to 8 | Copay amount for first 3 visits in each calendar year | $30 | Copay amount for each additional visit in the same year | $30 |
* Special authorities include conditions related to combat service and exposures (like Agent Orange, active duty at Camp Lejeune, ionizing radiation, Project Shipboard Hazard and Defense (SHAD/Project 112), Southwest Asia Conditions) as well as military sexual trauma, and presumptions applicable to certain Veterans with psychosis and other mental illness.
Outpatient care copay rates
(Primary or specialty care that doesn't require an overnight stay)
If you have a service-connected disability rating of 10% or higher
You won't need to pay a copay for outpatient care.
Umr Medical Benefits Umr
If you don't have a service-connected disability rating of 10% or higher
You may need to pay a copay for outpatient care for conditions not related to your military service, at the rates listed below.
| Type of outpatient care | Copay amount for each visit or test | ||
|---|---|---|---|
| Type of outpatient care | Primary care services (like a visit to your primary care doctor) | Copay amount for each visit or test | $15 |
| Type of outpatient care | Specialty care services (like a visit to a hearing specialist, eye doctor, surgeon, or cardiologist) | Copay amount for each visit or test | $50 |
| Type of outpatient care | Specialty tests (like an MRI or CT scan) | Copay amount for each visit or test | $50 |
Note: You won’t need to pay any copays for X-rays, lab tests, or preventive tests and services like health screenings or immunizations.
Inpatient care copay rates
(Care that requires you to stay one or more days in a hospital)
If you have a service-connected disability rating of 10% or higher
You won't need to pay a copay for inpatient care.
If you’re in priority group 7 or 8
You'll pay either our full copay rate or reduced copay rate. If you live in a high-cost area, you may qualify for a reduced inpatient copay rate no matter what priority group you're in. To find out if you qualify for a reduced inpatient copay rate, call us toll-free at 877-222-8387. We're here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.
| Length of stay | Copay amount | ||
|---|---|---|---|
| Length of stay | First 90 days of care during a 365-day period | Copay amount | $281.60 copay + $2 charge per day |
| Length of stay | Each additional 90 days of care during a 365-day period | Copay amount | $140.80 copay + $2 charge per day |
Note: You may be in priority group 7 and qualify for these rates if you don't meet eligibility requirements for priority groups 1 through 6, but you have a gross household income below our income limits for where you live and you agree to pay copays.
| Length of stay | Copay amount | ||
|---|---|---|---|
| Length of stay | First 90 days of care during a 365-day period | Copay amount | $1,408 copay + $10 charge per day |
| Length of stay | Each additional 90 days of care during a 365-day period | Copay amount | $704 copay + $10 charge per day |
Note: You may be in priority group 8 and qualify for these rates if you don't meet eligibility requirements for priority groups 1 through 6, and you have a gross household income above our income limits for where you live, agree to pay copays, and meet other specific enrollment and service-connected eligibility criteria.
Medication copay rates
If you’re in priority group 1
You won’t pay a copay for any medications.
Note: You may be in priority group 1 if we've rated your service-connected disability at 50% or more disabling, if we've determined that you can't work because of your service-connected disability (called unemployable), or if you've received the Medal of Honor.
If you’re in priority groups 2 through 8
You'll pay a copay for:
- Medications your health care provider prescribes to treat non-service-connected conditions, and
- Over-the-counter medications (like aspirin, cough syrup, or vitamins) that you get from a VA pharmacy. You may want to consider buying your over-the-counter medications on your own.
Note: The cost for any medications you receive while staying in a VA or other approved hospital or health facility are covered by your inpatient care copay.
The amount you’ll pay for these medications will depend on the “tier” of the medication and the amount of medication you’re getting, which we determine by days of supply. Once you’ve paid $700 in medication copays within a calendar year (January 1 to December 31), you won’t have to pay any more that year—even if you still get more medications. This is called a copay cap.
| Outpatient medication tier | 1-30 day supply | 31-60 day supply | 61-90 day supply | ||||
|---|---|---|---|---|---|---|---|
| Outpatient medication tier | Tier 1 (preferred generic prescription medicines) | 1-30 day supply | $5 | 31-60 day supply | $10 | 61-90 day supply | $15 |
| Outpatient medication tier | Tier 2 (non-preferred generic prescription medicines and some over-the-counter medicines) | 1-30 day supply | $8 | 31-60 day supply | $16 | 61-90 day supply | $24 |
| Outpatient medication tier | Tier 3 (brand-name prescription medicines) | 1-30 day supply | $11 | 31-60 day supply | $22 | 61-90 day supply | $33 |
If you have a service-connected rating of 40% or less and your income falls at or below the national income limits for receiving free medications, you may want to provide your income information to us to determine if you qualify for free medications.
Geriatric and extended care copay rates
You won't need to pay a copay for geriatric care (also called elder care) or extended care (also called long-term care) for the first 21 days of care in a 12-month period. Starting on the 22nd day of care, we'll base your copays on 2 factors:
- The level of care you're receiving, and
- The financial information you provide on your Application for Extended Care Services (VA Form 10-10EC).
Does Umr Cover Er Visits
| Level of care | Types of care included | Copay amount for each day of care | |||
|---|---|---|---|---|---|
| Level of care | Inpatient care | Types of care included |
| Copay amount for each day of care | Up to $97 |
| Level of care | Outpatient care | Types of care included |
| Copay amount for each day of care | Up to $15 |
| Level of care | Domiciliary care for homeless Veterans | Types of care included |
| Copay amount for each day of care | Up to $5 |
Services that don't require a copay
You won't need to pay a copay for any of the services listed below, no matter what your disability rating is or what priority group you're in.
- Laboratory (lab) tests
- Electrocardiograms (EKGs or ECGs) to check for heart disease or other heart problems
- VA health initiatives that are open to the public (like health fairs)
Umr Urgent Care Centers
Other information you may need
Pay your copay bill
Find out how to pay your copay bill—and what to do if you disagree with the charges or are having trouble making payments.
Your health care costs
Learn how we assess and verify your income to help determine if you're eligible for VA health care and whether you'll need to pay copays for certain types of care, tests, and medications.
Copayments for maternity care (PDF)
We cover maternity care for eligible Veterans through arrangements with community providers. Download this fact sheet to find out more about copays.