Can veterans use their VA Benefits at urgent care?

Yes. Under the MISSION Act beginning June 6, 2019, veterans can go to a community healthcare provider, including urgent care, but with a few restrictions: The urgent care provider must be part of the VA’s contracted network of community healthcare providers or the veteran may have to pay the full cost of care.VA won’t pay your urgent care bill if you go for preventative care or dental services. The urgent care benefit is not intended to replace a normal doctor.You must be enrolled in VA healthcare and received care through the VA within 24 months to be eligible for the urgent care benefit.Only eligible veterans can use the benefit. Family members cannot use it.You may be charged a copayment for your urgent care visit, based on how many times you’ve gone to urgent care and what your assigned veteran priority group is. Some may pay nothing for the first three visits, then $30 per visit to urgent care for the fourth and subsequent visit in a single calendar year. Others will pay $30 per visit regardless of number of visits. Flu shots at urgent care will never require a copay.There is no limit on the number of times an eligible veteran can access urgent care.Copayments are not paid by the veteran out-of-pocket. The VA will bill you separately.VA also will pay for or fill prescriptions from urgent care, but if the medication is longer than a 14-day supply, the prescription must be submitted and filled by the VA. Some veterans may be required to pay a copay for medication. The Department of Veterans Affairs official site has a warning: “If an eligible Veteran goes to an out-of-network urgent care provider, they may be required to pay the full cost of care.”

Will the VA cover all community urgent care visits?

According to the Department of Veterans Affairs, urgent care options for veterans are available for “non-emergent symptoms” including flu-like symptoms, colds, coughs, wheezing, sore throats, ear pain, bumps, bruises, sprains, painful urination, and minor skin irritations. Additionally, some vaccines, x-rays, some lab testing, and some medications are also covered. If you are concerned about the complexity of your medical history, it is best to seek treatment from your primary care doctor at the VA rather than visiting an urgent care center. The MISSION Act includes an update to the VA benefit policy for urgent care “for the treatment of minor injuries and illnesses, such as colds, sore throats, and minor skin infections.” This is offered “in addition to the opportunity to receive care from a VA provider,” since some same-day services are available at many VA facilities around the country.

What’s the process for accessing urgent care with TRICARE?

While a referral is not necessary for a veteran to access a community urgent care clinic, it is best to contact your nearest VA medical facility to check your eligibility for the urgent care benefits mentioned above. Following your urgent care visit, the clinic must file a claim with he VA in order to be paid and any follow-up medical documents must be sent to the veteran’s home VA medical facility.

Page 2 - VA Urgent Care: Find and book VA Authorized Clinics

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