When Does the VA Cover Care at Non-VA Facilities?

The Department of Veterans Affairs doesn’t require you to get all your care at VA medical centers. Under the right circumstances, the VA will cover appointments with community doctors, emergency room visits at civilian hospitals, and walk-in care at urgent care clinics. But the rules vary depending on what type of care you need. Here’s when the VA picks up the tab for non-VA care.

Community Care: When the VA Sends You Outside

The MISSION Act, short for Maintaining Internal Systems and Strengthening Integrated Outside Networks, lets enrolled veterans get care from non-VA providers when they meet specific conditions. This is called Community Care, and it requires authorization from the VA before scheduling appointments.

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You qualify for Community Care if you meet at least one of these six conditions:

• Best medical interest: You and your VA provider agree that seeing a community doctor is in your best medical interest. As of May 2025, this decision no longer requires a second VA doctor to review it, speeding up the process.
• Service not available: The VA doesn’t offer the care you need or can’t provide it at a quality level that meets their standards.
• Wait time: The VA can’t schedule you within 20 days for primary care, mental health care or extended care, or within 28 days for specialty care.
• Drive time: The average drive to the nearest VA facility is more than 30 minutes for primary care or mental health care, or more than 60 minutes for specialty care.
• Location: You live in Alaska, Hawaii, New Hampshire, Guam, American Samoa, the Northern Mariana Islands or the U.S. Virgin Islands, which have no full-service VA facility.
• Grandfathered distance: You qualified under the old Veterans Choice Program’s 40-mile rule as of June 6, 2018, and live in Alaska, Montana, North Dakota, South Dakota or Wyoming.

The VA schedules most community care appointments for you, though in some cases, you can schedule your own. Either way, you need authorization before you go. Without it, you’ll get stuck with the bill.

Copays for community care work the same as they do at VA facilities. Veterans with service-connected conditions or certain priority groups don’t pay copays. Everyone else pays based on their priority group and the type of care.

Emergency Care: The 72-Hour Rule

If you need emergency care, don’t wait for VA approval. Call 911 or go to the nearest emergency room. The VA covers emergency care at non-VA hospitals under certain conditions, but you need to follow the notification rule.

The hospital or you must notify the VA within 72 hours of when emergency treatment starts. The VA prefers the hospital makes the call, but it doesn’t, you or someone acting on your behalf can report it through the VA’s emergency care reporting portal or by calling your local VA facility.

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Missing the 72-hour notification doesn’t automatically kill your claim, but it makes coverage harder to get. The VA will then evaluate whether your care qualifies as unauthorized emergency treatment, which has stricter requirements.

For the VA to cover emergency care, several conditions must be met:

• You’re enrolled in VA health care and received care at a VA or in-network facility within the past 24 months.
• The care happened at a hospital emergency department, not an urgent care clinic.
• A reasonable person would have thought delaying care could be life-threatening.
• You tried to get other insurance to pay first (if you have other coverage).
• The VA received proper notification.

The VA typically covers care only through stabilization. Once you’re stable, the hospital should contact the VA about transferring you to a VA facility. If you refuse transfer, the VA stops paying.

For service-connected conditions or veterans rated permanently and totally disabled, coverage rules are more generous. The VA covers emergency care for these conditions even without the 72-hour notification.

Urgent Care: No Referral Needed

Veterans can walk into in-network urgent care clinics without prior authorization for minor injuries and illnesses such as strep throat, sprained muscles, ear infections and urinary tract infections. This is the easiest path to non-VA care because you don’t need anyone’s permission first.

To use urgent care, you need to be enrolled in VA health care and have received care from the VA or an in-network provider within the past 24 months. The clinic must be part of the VA’s network. Going out of network means you pay the full cost yourself.

Copays for urgent care depend on your priority group and how many times you visit:

• Priority Groups 1-5: First three visits free, then $30 for each additional visit.
• Priority Group 6: First three visits free if related to service-connected conditions or special authorities. Otherwise, $30 per visit.
• Priority Groups 7-8: $30 per visit.

Don’t pay anything at the urgent care clinic. The VA bills you later. If the clinic tries to collect payment upfront, call your VA medical center.

Urgent care clinics can write prescriptions for up to 14 days (7 days for opioids), which you can fill at an in-network pharmacy or at the VA. There’s no limit to how many times you can use urgent care in a year.

What You Can’t Get Without Authorization

Most non-emergency care at non-VA facilities requires the VA’s approval before you schedule. This includes routine appointments, specialist consultations, procedures and diagnostic tests that aren’t part of urgent care.

If you schedule care with a non-VA provider without authorization and it doesn’t qualify as emergency or urgent care, you’ll pay for it yourself. The VA won’t reimburse you after the fact.

When in doubt, contact your VA care team first. They can tell you whether you need authorization and help you get it if you do.

The Bottom Line

The VA covers non-VA care in three main situations:

• Community care with prior authorization
• Emergency care with 72-hour notification
• Urgent care at in-network clinics

The first requires planning ahead, the second requires fast notification, and the third just requires showing up at the right clinic.

For life-threatening emergencies, always go to the nearest emergency room and worry about notification later. For everything else, check with your VA care team to make sure the VA will cover it before you schedule.

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