The short answer
VA Community Care is how VA pays for your care from a provider outside VA. It isn't separate insurance. To use it for routine care, you need to be enrolled in or eligible for VA health care, meet one of six Community Care eligibility rules, and get VA's approval before the appointment. Urgent and emergency care have their own rules.
What is VA Community Care?
It's VA paying a non-VA provider to treat you. The official name is the Veterans Community Care Program. It was created by the MISSION Act and is set out in 38 U.S.C. 1703 and 38 CFR 17.4000 through 17.4040.
Community Care is part of your VA health care, not a separate plan. VA still decides whether you qualify, approves the care, and pays the provider. You don't get a new insurance card or pick from a menu of civilian doctors on your own.
What kinds of care can it cover?
The program covers three broad types of care:
- Hospital care, like an inpatient stay or surgery.
- Medical services, which include outpatient visits, specialists, tests, and outpatient and inpatient mental health and substance use care.
- Extended care services, like home health or adult day care.
What VA will cover is still limited to VA's medical benefits package in 38 CFR 17.38. Community Care changes where you get care. It doesn't add benefits you weren't already eligible for. 38 CFR 17.4025(a) says the program doesn't override other laws that set eligibility for particular services. For example, VA's benefits package excludes in vitro fertilization and cosmetic surgery, so Community Care doesn't cover them either.
Who can use Community Care?
You need two things before a routine appointment, according to VA's eligibility page:
- You're enrolled in VA health care or otherwise eligible for it. The rule calls this being a covered Veteran.
- Your VA health care team approves the care before you get it.
On top of that, you have to meet at least one of six eligibility rules in 38 CFR 17.4010:
- VA doesn't offer the care you need.
- Your state or territory has no full-service VA medical facility.
- You qualified under the old 40-mile Choice rule and still meet its conditions.
- VA can't see you within its wait-time or drive-time standards.
- You and your VA provider agree Community Care is in your best medical interest.
- The VA service line you need has been designated as not meeting VA's quality standards.
Each one is explained in Who Qualifies for VA Community Care?
Is qualifying the same as being approved?
No. This is the most common mix-up. Meeting an eligibility rule means you can ask for outside care. VA still has to approve the specific care, send a referral, and issue an authorization that names the provider, the services, and how long the approval lasts.
Think of it as four steps:
| Step | What it means |
|---|---|
| Eligibility | You meet at least one of the six rules for this care |
| Referral | VA sends your request to a community provider |
| Authorization | VA's approval for a provider, services, and time period |
| Appointment | The provider actually schedules you |
If any step is missing, the appointment may not be covered. See How to Get a VA Community Care Referral.
Do I have to use Community Care if I qualify?
No. 38 CFR 17.4020(a) lets you choose either a VA appointment or Community Care. Many Veterans use both: VA for primary care and a community provider for one specialty, for example.
Is Community Care the same as the Community Care Network?
No. Community Care is the program and its rules. The Community Care Network (CCN) is VA's main group of contracted outside providers. A provider being in CCN doesn't mean VA has approved your visit. See VA Community Care vs. the Community Care Network.
What about urgent and emergency care?
They follow different rules.
- Urgent care: Eligible Veterans can walk into an in-network urgent care clinic without a referral. See VA Community Urgent Care.
- Emergency care: Go to the nearest emergency room. VA should be told within 72 hours. See Non-VA Emergency Care.
- Suicide crisis: VA covers emergency suicide crisis care at no cost, even if you aren't enrolled. See Free Emergency Suicide Crisis Care.
How do I get started?
- Tell your VA care team what care you need.
- Ask whether you qualify for Community Care for that care, and under which rule.
- Tell them if you want Community Care, and name a provider if you have one in mind.
- Wait for the referral and authorization before you schedule. VA says referral preparation can take up to 14 days.
- Read the authorization letter so you know what's approved and for how long.
If you're told no and you think you qualify, ask for the answer in writing. See What to Do If Your Community Care Referral Is Delayed or Stuck.