The short answer
No copay at the visit. Community Care providers shouldn't collect anything from you. VA figures out any copay later and bills you, and it can't be more than you'd owe for the same care at VA. Many Veterans owe nothing, including those rated 10% or more, for outpatient and inpatient care.
Do I pay anything at a Community Care appointment?
No. Under 38 CFR 17.108(c)(4), the copay for Community Care is $0 at the time of service. VA decides later whether you owe anything and sends you a bill. The provider shouldn't ask you for a copay. See What a Community Care Provider Can Bill You For.
How much could VA bill me later?
No more than you'd owe for the same care at VA. The rule caps the Community Care copay at the VA amount. For 2026, from VA's copay rates:
| Type of care | 2026 copay, if you owe one |
|---|---|
| Primary care visit | $15 |
| Specialty care visit | $50 |
| Specialty tests, like MRI or CT | $50 |
| Urgent care | $0 for the first 3 visits a year in Priority Groups 1 to 5, then $30 |
| Medications | $5 to $11 per 30-day supply, $700 annual cap |
| Inpatient care | Depends on priority group |
Same-day rule: if you have several visits in a day, you pay at most one copay, the specialty amount if any visit was specialty care.
Who doesn't pay copays?
Your priority group sets most of this. In general:
- Rated 10% or more service connected: no outpatient or inpatient copays.
- Priority Group 1: no medication copays.
- Care for a service-connected condition: no copay, whatever your rating.
- Income below VA limits: you may qualify for free or reduced-cost care.
What care never has a copay?
Under 38 CFR 17.108(e), no matter your priority group, including when delivered through Community Care:
- counseling and care for military sexual trauma;
- readjustment counseling and related mental health services;
- mental health peer support services;
- emergent suicide crisis care;
- care for exposure-related conditions under 38 U.S.C. 1710(e), like certain combat or toxic exposure care;
- C&P exams;
- lab tests, flat X-rays, and EKGs;
- preventive screenings and immunizations;
- smoking cessation and weight management counseling;
- hospice care;
- in-home video telehealth; and
- visits only for education on opioid overdose reversal medication.
Veterans getting care under the psychosis and mental illness presumption don't pay copays for that care.
When will the bill come?
After the provider's claim is processed, which can take a while. VA sends a monthly statement for any copays. If you have questions about a specific charge, call the number on the statement.
What if I can't afford the bill?
VA has options, according to its financial help page. Act within 30 days of the bill to avoid late fees and interest.
- Waiver or compromise: Ask VA to forgive part or all of the debt, or settle for a smaller lump sum. Use VA Form 5655, the Financial Status Report, with a letter explaining your situation.
- Repayment plan: Pay monthly with VA Form 10-323. VA usually wants it paid within 3 years.
- Hardship determination: If your income dropped, VA Form 10-10HS asks VA to exempt you from future copays for the rest of the calendar year. It doesn't cover medication copays.
You can also ask VA to review your priority group if your income or disability rating has changed.