To fill out VA Form 10-10EZ, work through it in the order it’s printed: personal identifiers, military service history, insurance, and finances. Have your DD-214, private insurance card, and last year’s tax return next to you before you start. You can complete the form online at VA.gov, print and mail it to the Health Eligibility Center in Janesville, Wisconsin, or hand it to staff at any VA medical center. The information you enter determines whether the VA enrolls you, which priority group you land in, and whether you owe copayments.
Confirm You’re Eligible Before You Start
The form is only useful if you qualify to enroll. You need active service in the military, naval, air, or space service and a discharge under conditions other than dishonorable.1Office of the Law Revision Counsel. 38 USC 101 – Definitions A dishonorable discharge stops the application.
If you enlisted after September 7, 1980, or entered active duty as an officer after October 16, 1981, you generally need at least 24 continuous months of active service. Two exceptions: veterans discharged early because of a service-connected disability, and those who completed the full period for which they were called to active duty.2eCFR. 38 CFR 3.12a – Minimum Active-Duty Service Requirement
Reserve and National Guard members qualify if they were called to active duty by a federal order and completed the full period of that activation.3Veterans Affairs. Eligibility for VA Health Care Keep the orders or the DD-214 that documents the federal activation within reach; the VA will verify it.
What to Gather Before You Open the Form
Pull these items together first. Missing information is the most common reason applications stall.
- Full legal name, Social Security number, and date of birth.
- DD-214 or other separation paperwork, showing branch, entry date, discharge date, and character of discharge. Attaching a copy speeds processing if you don’t already receive VA benefits.4Department of Veterans Affairs. VA Form 10-10EZ
- Health insurance details: name, address, and policy number for any private coverage you or your spouse carry. The VA is required to bill your private insurer for care related to non-service-connected conditions, so this is not optional.5Veterans Affairs. VA Health Care and Other Insurance
- Last calendar year’s gross household income: wages, Social Security benefits, retirement pay, interest, and dividends. Your most recent tax return makes this easier.
Filling In Your Military Service
Copy the service dates, branch, and discharge characterization directly from your DD-214. Don’t paraphrase or round dates. If you already receive VA benefits, the system can cross-reference your service record, but including a copy of the DD-214 with a paper application removes a common source of delay.4Department of Veterans Affairs. VA Form 10-10EZ Reserve and Guard applicants relying on a federal activation should attach those orders.
Filling In the Financial Section
This is the section that trips people up, and it’s the one that decides whether you receive cost-free care, qualify for travel reimbursement, or owe copayments. Underreporting risks a later adjustment; skipping the section entirely can drop you into a lower priority group with higher out-of-pocket costs.
Enter gross household income for the previous calendar year. That means your earnings, your spouse’s earnings, Social Security payments, retirement or pension income, and investment income like interest and dividends. You don’t submit tax returns with the form, but the VA verifies what you reported through a data match with the IRS and the Social Security Administration.6U.S. Department of Veterans Affairs. Income Verification (IV) Frequently Asked Questions Discrepancies generate follow-up correspondence.
Deductible expenses reduce your reportable income and can move you into a more favorable priority group. List non-reimbursed medical expenses you or your spouse paid: medical and dental care, medications, eyeglasses, Medicare premiums, and other health care costs for dependents you support. Burial expenses for a spouse or dependent count as well.7Department of Veterans Affairs. VA Form 10-10EZR – Health Benefits Update Form Do not list anything you expect insurance to reimburse. Educational costs such as tuition and books are not deductible on this form, despite what some third-party guides suggest.
One shortcut: if you have a service-connected disability rated 50% or higher or you receive a VA pension, you can skip the financial assessment. It won’t change your priority placement.
Filling In the Insurance Section
Enter every private insurance policy that covers you or your spouse. Enrolling in VA health care does not replace private insurance, and holding private insurance does not disqualify you from the VA. The two systems run alongside each other. When the VA treats you for a condition unrelated to your military service, it bills your private insurer.5Veterans Affairs. VA Health Care and Other Insurance
Listing your coverage has an upside for you. Charges the VA submits to your insurer may count toward your plan’s annual deductible, and you’re never billed for the balance between what the VA charged and what your insurer paid beyond your normal VA copay. If you have a high-deductible health plan linked to a Health Savings Account, HSA funds can cover any VA copayments for non-service-connected care.5Veterans Affairs. VA Health Care and Other Insurance
How to Submit the Completed Form
You have three ways to send it in.
- Online is the fastest. Sign in to VA.gov with a Login.gov or ID.me account and complete the form through the authenticated portal. Some fields pre-fill from your VA profile, and you get a digital confirmation on submission.8Veterans Affairs. Apply for VA Health Care
- By mail: download and print the PDF from VA.gov, fill it out, and mail it to Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207.9Veterans Affairs. How to Apply for VA Health Care
- In person: bring the completed form to any VA medical center or clinic. Staff can help you finish it on the spot.
Whichever route you choose, the VA sends a confirmation once the application enters the system. Processing usually takes a week or two. Missing financial data and an unclear discharge characterization are the two most common reasons applications stall.
What Happens After You Submit
The VA assigns you to one of eight priority groups. Groups 1 through 4 cover veterans with service-connected disabilities, former prisoners of war, Purple Heart recipients, Medal of Honor recipients, and catastrophically disabled veterans. Groups 5 through 8 are driven largely by the income numbers you reported: Group 5 for veterans below the national income threshold, Group 7 for those above the national threshold but below a separate geographic-based limit who agree to copayments, and Group 8 for those above the geographic threshold who agree to copayments.10Office of the Law Revision Counsel. 38 USC 1705 – Management of Health Care: Patient Enrollment System This is why the financial section carries so much weight for veterans without a compensable disability rating.
Veterans with a service-connected disability rated 10% or higher generally owe nothing for outpatient or inpatient visits. Preventive screenings, immunizations, routine lab work, and standard x-rays carry no copayment for anyone. Veterans in Groups 7 and 8, along with Group 5 veterans seeking care for non-service-connected conditions, can expect copayments for primary care, specialty care, and prescriptions.
Once enrolled and after your welcome call, you can request a Veteran Health Identification Card. Apply in person at your VA medical center with the enrollment coordinator, or online through AccessVA, with a current government-issued photo ID. The card arrives by mail within 7 to 14 days for U.S. residents.11Veterans Affairs. Get a Veteran Health Identification Card (VHIC) Submit only one request; duplicates cause delays.
Enrolled veterans can also claim travel reimbursement for trips to VA medical appointments if they have a service-connected disability rated 30% or higher, receive a VA pension, or have income below the maximum annual VA pension rate.12Veterans Affairs. File and Manage Travel Reimbursement Claims The financial data from your 10-10EZ feeds this determination too.
Updating Your Information Later
Enrollment doesn’t expire, so you don’t fill out the 10-10EZ again each year. But changes in income, insurance, or dependent status can affect your priority group, copay obligations, and travel pay eligibility. Report those changes on Form 10-10EZR, the Health Benefits Update Form, available online at VA.gov or at any VA facility.13Veterans Affairs. Update Health Care Info VA Form 10-10EZR
An income drop or a rise in medical expenses can move you into a higher priority group and reduce or eliminate copays. Veterans rated 50% or higher for a service-connected disability and those receiving a VA pension do not need to submit financial updates; their priority status is set regardless of income.14Veterans Affairs. VA Form 10-10EZR – Health Benefits Update Form