VA Form 10-10EZ: How to Complete, Submit, and Update

VA Form 10-10EZ is the application veterans use to enroll in VA health care. You can complete it online at VA.gov, print and mail the PDF to the Health Eligibility Center in Janesville, Wisconsin, or hand it in at any VA medical center. The online version takes about 35 minutes and the VA processes most applications within roughly a week.¹

Who Can Use This Form

You need to have served in the active military, naval, or air service and received something other than a dishonorable discharge. If you enlisted after September 7, 1980, or entered active duty after October 16, 1981, you generally need 24 continuous months of active-duty service, or the full period you were called up for. That minimum is waived if you were discharged for a service-connected disability, a hardship, or an early out, or if you served before those dates.²

Reserves and National Guard members qualify only if they were called to active duty by a federal order and completed the full period. Training-only service doesn’t count. If your discharge was other-than-honorable, bad conduct, or dishonorable, you can still try to qualify by applying for a discharge upgrade or requesting a VA Character of Discharge review before enrolling.²

What to Gather Before You Start

Missing paperwork is the fastest way to stall an application. Pull these together first:

Your DD Form 214 or equivalent separation papers, which show discharge character, active-duty dates, and branch. If you don’t have a copy, request one through the National Archives or VA.gov.³
Social Security numbers for you and any dependents you’ll list.
Insurance cards showing policy numbers and group codes for every plan that covers you, including coverage through a spouse. Listing your insurance does not reduce your VA coverage; the VA uses it to coordinate benefits and bill third-party insurers where applicable.⁴
Previous calendar year gross income figures for you, your spouse, and any dependent children whose income could have paid household expenses: wages, net farm or business income, retirement and pension payments, Social Security, VA disability compensation, interest, dividends, and IRA distributions.⁴
Deductible expenses from that same year: unreimbursed medical and dental costs, prescription drugs, eyeglasses, Medicare premiums, and other health expenses you paid for yourself, your spouse, or anyone you’re legally or morally obligated to support.
A government-issued photo ID if you plan to apply in person.

If you already receive VA benefits, you may not need to attach your DD-214, because the VA can pull your records internally. First-time applicants should include a copy to avoid delays.⁴

Filling Out the Form Section by Section

The paper form has eight sections. The online version asks for the same information with prompts and validation that catch errors before you submit.⁴

Section I: General Information

Your full legal name, date of birth, Social Security number, mailing address, and contact details. Answer every field. Blank entries here are the most common reason applications get returned.

Section II: Military Service Information

Branch, active-duty dates, and discharge character. These entries have to match your DD-214 exactly. If you’re claiming exposure to toxins or burn pits, you can attach a written statement or buddy statements describing the exposure.

Section III: Insurance Information

Every health insurance plan that covers you, including coverage through a spouse. After enrollment, bring your insurance cards to every VA appointment.

Section IV: Dependent Information

Your spouse, even if you live separately, so long as you provided financial support during the previous year. Also unmarried children under 18, unmarried children under 23 who attend school full- or part-time, and children who became permanently unable to support themselves before age 18.

Section V: Employment Information

Current employment status, retirement date if applicable, and employer details.

Section VI: Financial Disclosure

Only veterans without a service-connected disability, or with a 0-percent non-compensable rating, need to complete this section. It determines whether you qualify for enrollment based on income.

Section VII: Previous Year Gross Annual Income

Report the income categories described above for yourself, your spouse, and dependent children.

Section VIII: Previous Year Deductible Expenses

Unreimbursed medical costs, funeral and burial expenses, and educational expenses for dependents. These figures reduce your countable income for the means test, so don’t skip them.

Sign and date the form. Your signature must match the legal name on your identification. An unsigned paper application will be sent back unprocessed.

How to Submit the Application

You have three options once the form is complete.

Online. Go to va.gov/health-care/apply-for-health-care-form-10-10ez and complete the guided application. You’ll get on-screen confirmation when it submits. This is the fastest route.¹

By mail. Print and sign the paper form, then send it to Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207.⁵

In person. Bring the completed form and supporting documents to any VA medical center. Staff can review the application on the spot for completeness, which is worth the trip if you’re unsure whether you filled everything out correctly.

If you need help at any point, call the VA at 877-222-8387, Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.⁶

What Happens After You Submit

The VA processes most health care applications within about a week.¹ Once you’re approved, expect this sequence:

A welcome call from a VA representative to help schedule your first appointment and answer benefits questions.⁷
Your Veterans Health Benefits Handbook by mail, spelling out the benefits, copays, and other details tied to your assigned priority group.
Your Veteran Health Identification Card (VHIC) for checking in at appointments and using VA pharmacies. Request it online or in person at your nearest VA medical center after the welcome call.⁸
A first appointment notice by mail, if you requested one on the application.

Enrollment stays active as long as you continue to meet eligibility requirements. There’s no annual renewal. One thing to keep in mind: to use VA-funded urgent care at community providers, you have to have received VA or in-network care within the past 24 months, so don’t let years pass between visits if you want that option open.⁹

How Your Priority Group and Copays Are Set

After processing your application, the VA assigns you to one of eight priority groups based mainly on your disability rating, income, and certain service history factors. Your group determines how quickly you’re enrolled and how much you pay in copays.¹⁰

Group 1: service-connected disability rated 50 percent or higher, an unemployability determination, or Medal of Honor recipients.
Group 2: service-connected disability rated 30 or 40 percent.
Group 3: former POWs, Purple Heart recipients, veterans discharged for a service-connected disability, or a 10- or 20-percent rating.
Group 4: veterans receiving VA aid and attendance or housebound benefits, or determined catastrophically disabled.
Group 5: no service-connected disability (or 0-percent non-compensable) with income below adjusted geographic limits, VA pension recipients, or those eligible for Medicaid.
Group 6: compensable 0-percent service-connected disability, Project 112/SHAD participants, certain WWII and Gulf War-era veterans, combat veterans discharged after October 1, 2013, and veterans with qualifying toxic exposure under the PACT Act.
Group 7: income below geographic limits, doesn’t qualify for a higher group, agrees to pay copays.
Group 8: income above geographic limits, agrees to pay copays, meets other enrollment criteria.

Veterans in Groups 1 through 6 generally pay no copays for most care. In Groups 7 and 8, outpatient copays are $15 per primary care visit and $50 per specialty care visit. Inpatient copays differ: Group 7 veterans pay $347.20 for the first 90 days of a hospital stay plus $2 per day; Group 8 veterans pay $1,736 for the first 90 days plus $10 per day.¹¹ Income limits change annually and vary by zip code; check yours at va.gov/health-care/income-limits.¹²

If you were exposed to burn pits, Agent Orange, radiation, or other toxic substances during service, the PACT Act lets you enroll without first applying for disability benefits, as long as you meet the basic service and discharge requirements. Reporting exposure in Section II can affect your group placement, and the eligibility expansion that took full effect in March 2024 opened enrollment to veterans who didn’t qualify before. If you were turned down previously, it’s worth reapplying.¹³

Updating Your Information Later

Once you’re enrolled, do not file a new 10-10EZ to update your records. Use VA Form 10-10EZR whenever your personal information, insurance, income, or military service history changes.¹⁴ This matters because a drop in income, an added dependent, a new disability rating, or newly documented toxic exposure can move you into a higher priority group and lower your copays. You can submit the 10-10EZR online, by phone at 877-222-8387, by mail to the same Janesville address, or in person at a VA health facility.⁵

1
Veterans Affairs. Apply For VA Health Care
2
Veterans Affairs. Eligibility For VA Health Care
3
National Archives. DD Form 214 Discharge Papers and Separation Documents
4
Department of Veterans Affairs. VA Form 10-10EZ – Health Benefits Application
5
Veterans Affairs. Update Health Care Info VA Form 10-10EZR
6
Veterans Affairs. How To Apply For VA Health Care
7
Veterans Affairs. After You Apply For Health Care Benefits
8
Veterans Affairs. Get A Veteran Health Identification Card (VHIC)
9
U.S. Department of Veterans Affairs. Getting Urgent Care At VA Or In-Network Community Providers
10
Veterans Affairs. VA Priority Groups
11
Veterans Affairs. Current VA Health Care Copay Rates
12
Veterans Affairs. Income Limits and Your VA Health Care
13
Veterans Affairs. The PACT Act and Your VA Benefits
14
Veterans Affairs. About VA Form 10-10EZR