If you lost your job or if you have a sudden decrease in income or an increase in out-of-pocket family health care expenses, we can help. Read this page to find out how to request help with current VA copay bills or an exemption from future copays.
You can request either of the 2 financial hardship assistance options on this page, depending on your situation. To avoid late charges, including interest and other fees, you’ll need to take action within 30 days of receiving your bill.
If you don’t think you can pay your copay bills, you can request help.
You can request one of these types of debt relief:
If we accept part or all of your request, you won’t have to pay the amount of the balance we agree to relieve.
You can request debt relief for copay bills online now.
You can also request debt relief by mail or in person.
Fill out a Financial Status Report (VA Form 5655).
Write a letter describing the financial issues that make it hard for you to pay your copay debt. If you want to request a hearing to help explain your financial issues, include this request in your letter.
Submit your completed form and supporting letter to the business office or health administration office at your nearest VA medical center.
If you can’t pay your copay bills all at once, you can set up a monthly repayment plan at any time. We’ll review your proposed payment plan based on the amount of money you owe and your ability to pay within a reasonable time. We usually require you to pay off the full debt within 3 years.
To set up a repayment plan, fill out an Agreement to Pay Indebtedness (VA Form 1100).
In paragraph 1A, tell us how much you can pay each month.
Then submit your completed form and any other needed documentation to us. You can send these by mail, or bring them in person, to the business office or health administration office at your nearest VA medical center.
After we approve your repayment plan, you can begin sending your monthly payments. If you receive a coupon book with your approved repayment plan, please send payments to the address on the coupon. You can also make a payment by mail or in person at your VA medical center’s revenue office.
Repayment plans don’t include new charges you may receive after submitting your proposed plan. If you submit your plan and then receive a bill with new charges, submit a new VA Form 1100 for the new charges.
If you keep receiving new charges, call us at 866-400-1238 (TTY: 711) every 90 days to request a new repayment plan. We’re here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.
You may be eligible for a hardship determination, which would qualify you for a copay exemption. This means we’ll assign you to a higher priority group, and you won’t have to pay any VA copays for the rest of the calendar year.
To request a VA hardship determination and copay exemption:
Fill out a Request for Hardship Determination (VA Form 10-10HS).
Write a letter explaining why you’re requesting a hardship determination.
The letter should describe the financial issues that make it hard for you to pay your copays.
Submit your completed form and letter to us.
You can send these by mail, or bring them in person, to the business office or health administration office at your nearest VA medical center.
Note: A hardship copay exemption doesn’t apply to copays for pharmacy medications.
If you need more information or help with filling out your forms, call us at 866-400-1238 (TTY: 711). We’re here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.