When the VA can't provide timely care, veterans can get treatment from private providers through the Community Care program. Here's how it works.
Not every veteran lives near a VA medical center, and not every VA facility can provide every type of care in a timely manner. The VA Community Care program allows eligible veterans to receive healthcare from approved private providers when the VA can't meet certain access standards. Understanding when and how you can use Community Care can prevent delays in getting the treatment you need.
You may be eligible for Community Care if the VA cannot provide the care you need, if the VA cannot meet access standards for timeliness (generally 20 days for primary care and 28 days for specialty care), if you live more than a certain drive time from the nearest VA facility that offers the service you need (30 minutes for primary care, 60 minutes for specialty care), or if it's in your best medical interest as determined by your VA provider.
The process starts with your VA provider. They'll submit a referral for Community Care, and the VA will authorize treatment with an approved private provider. You don't get to simply go to any doctor and send the VA the bill — the referral and authorization must happen first, except in genuine emergencies. The VA coordinates with a third-party network administrator to find available providers in your area.
Emergency care is a separate situation. If you have a medical emergency, go to the nearest emergency room — don't try to get to a VA facility if it's not the closest option. The VA can cover emergency care at non-VA facilities under certain conditions: you must be enrolled in VA healthcare, the care must be for a condition that a reasonable person would consider an emergency, and a VA facility must not have been reasonably available. There are time limits for notifying the VA after emergency treatment, so contact the VA as soon as possible after an emergency room visit.
The MISSION Act expanded Community Care access standards and streamlined the process. Under current rules, the VA will also consider whether community care would better serve the veteran based on factors like the nature of the care needed, the frequency of required visits, and the veteran's preference. Your VA care team should discuss Community Care options with you during treatment planning.
One important detail: when using Community Care, you may still have copays depending on your priority group, just as you would at a VA facility. The copays are the same as what you'd pay at the VA — your out-of-pocket costs don't increase just because you're seeing a private provider through the program.