VA Copay Rates 2026 vs. Medicare Costs: What Florida Veterans Actually Pay

Veterans often ask us whether they'd save money by skipping Medicare, because VA copays can be so low. They can be. But VA copays pay for VA care, and the real question is what happens when you need care outside the VA. Here are the 2026 VA rates, straight from VA.gov, next to what Medicare costs.

Who pays VA copays at all?

Many veterans pay nothing. VA says some veterans are exempt because of their disability rating, income level, or special eligibility factors. You won't pay a copay for care related to a service-connected disability. With a service-connected rating of 10% or higher, you won't pay a copay for outpatient or inpatient care. And you won't pay for X-rays, lab tests, or preventive services like screenings and immunizations. Veterans in priority group 1, which includes a service-connected rating of 50% or more, unemployability due to a service-connected disability, or the Medal of Honor, don't pay for any medications.

2026 VA copay rates (effective January 1, 2026)

Outpatient care without a 10%+ service-connected rating

Type of care	Copay per visit or test
Primary care (for example, your primary care doctor)	$15
Specialty care (for example, a cardiologist or surgeon)	$50
Specialty tests (for example, MRI or CT scan)	$50

Urgent care

Priority group	First 3 visits in a calendar year	Each additional visit
1 to 5	$0	$30
6	$0 if related to a special-authority condition, otherwise $30	$30
7 to 8	$30	$30

To use urgent care benefits you must be enrolled in VA health care and have received care from VA within the past 24 months.

Outpatient medications (priority groups 2 through 8)

Tier	1 to 30 days	31 to 60 days	61 to 90 days
Tier 1 (preferred generics)	$5	$10	$15
Tier 2 (non-preferred generics, some over-the-counter)	$8	$16	$24
Tier 3 (brand-name)	$11	$22	$33

VA also caps medication copays: once you've been charged $700 in a calendar year, you pay no more medication copays that year.

Inpatient care (priority groups 7 and 8, non-service-connected care)

The full inpatient rate for priority group 8 is $1,736 for the first 90 days of care in a 365-day period plus $10 per day, then $868 plus $10 per day for each additional 90 days. Priority group 7 pays a reduced rate: $347.20 plus $2 per day, then $173.60 plus $2 per day. Veterans with a service-connected rating of 10% or higher pay no inpatient copay.

What does Medicare cost?

In 2026, the standard Part B premium is $202.90 a month with a $283 annual deductible, and typically 20% coinsurance after that. Part A has no premium for most people, but a hospital stay carries a $1,736 deductible per benefit period. Medicare Advantage plans can have a $0 plan premium, with copays that vary by plan. More detail in our Medicare enrollment and costs guide.

So is Medicare worth it if my VA copays are low?

It's the wrong comparison, because the two cover different places. VA copays buy you care at VA facilities. They don't buy you care at a non-VA doctor or hospital. VA says its health care doesn't cover the cost of care from non-VA providers outside its community care network, so Medicare is what covers that care. The better questions are:

• How often do I get care outside the VA, today and realistically over the next ten years?
• What would a hospital stay or emergency away from home cost me with no Medicare?
• Can I get Medicare at a cost that makes it a reasonable safety net? A low-cost Medicare Advantage plan, some with a Part B premium reduction, is often how veterans answer that.

Your priority group and copays can change as your income or disability rating changes, so check yours at VA.gov or by calling 877-222-8387.