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The VA Community Care program allows eligible veterans to receive health care from approved non-VA providers in their community when certain access standards are not met. Established under the VA MISSION Act of 2018 (which replaced the earlier Veterans Choice Program), community care is designed to ensure that veterans can receive timely, convenient care even when VA facilities cannot meet their needs. This is not a separate insurance program. It is an extension of your VA health care benefits that allows you to see community providers at VA expense.
There are six criteria for community care eligibility, and you only need to meet one. First, if a VA medical facility does not offer the service you need, you may be eligible for community care. Second, if the VA cannot provide the care within its designated access standards (20 days for primary care and mental health, 28 days for specialty care from the date of request), community care may be authorized. Third, if you live beyond the designated drive time standards (30 minutes for primary care and mental health, 60 minutes for specialty care), you may qualify. Fourth, if it is in your best medical interest, as determined by your VA provider. Fifth, if the VA and community care provider agree that it would be in your best interest. Sixth, if you live in a state or territory without a full-service VA medical facility.
The referral process for community care typically begins with your VA care team. When your VA provider determines that you need a service that meets one of the community care eligibility criteria, they will submit a referral for community care. The VA community care office then schedules your appointment with an approved community provider. In some cases, you may be able to request a specific community provider, though the VA must confirm they are in the network and can see you within the access standards. For urgent care (not emergency care), you can go directly to an approved community urgent care provider without a referral.
The community care provider network is managed by a third-party administrator under contract with the VA. As of 2026, the community care network covers most of the country. You can search for approved community providers through the VA facility locator on VA.gov or by calling your VA medical center community care office. Not every local provider participates in the VA community care network, so it is important to verify before scheduling an appointment. Seeing an out-of-network provider without prior authorization typically means the VA will not cover the cost.
When you receive care through the community care program, the VA pays the community provider directly. You should not receive bills for authorized community care services (except for applicable copays based on your priority group). If you do receive a bill from a community provider for authorized care, contact your VA medical center community care office immediately. In some cases, billing errors occur because the provider did not submit the claim correctly to the VA. Your VA community care office can help resolve these issues.
Copays for community care follow the same rules as copays for care received at VA facilities. Veterans in Priority Groups 1 through 3 generally pay no copays. Veterans in higher priority groups may owe copays based on the type of care received. For community urgent care visits specifically, there is a copay structure for non-service-connected care that varies by priority group. Service-connected care received through community care generally has no copay regardless of priority group.
Dental care through the community care program is available for veterans who meet the dental eligibility requirements described in the dental eligibility classes. If you are eligible for VA dental care and the VA dental clinic cannot see you within the access standards, community care for dental services may be authorized. This follows the same referral and authorization process as other community care services. VADIP (the VA Dental Insurance Program) is separate from community care and operates as a purchased insurance product.
Scheduling and coordination are important aspects of community care that veterans should understand. When community care is authorized, you may receive a call from the VA or the community care contractor to schedule your appointment. Respond promptly, as authorization letters typically have a time limit (usually 60 to 90 days). After your appointment, the community provider should send your medical records and results back to the VA. If this does not happen automatically, ask the community provider to send records to your VA care team. Maintaining continuity of care between VA and community providers ensures that your VA care team has a complete picture of your health.
If you believe you qualify for community care but your request is denied, you have the right to appeal. The first step is to discuss the decision with your VA care team to understand the reasoning. In some cases, additional information or a revised request can resolve the issue. If you disagree with the decision, you can file a formal complaint through the VA patient advocate at your medical center. Understanding your rights under the MISSION Act and being proactive about communication with your VA care team are the best ways to ensure you receive the care you need.
Disclaimer: This article is for educational and informational purposes only. It does not constitute legal, medical, or VA claims advice. VA regulations, fee structures, and enforcement actions are subject to change. Always verify current requirements at VA.gov or consult with an accredited VSO, attorney, or claims agent before making decisions about your benefits.
Written by Claim Recon Editorial