Senators Tammy Duckworth (D-IL) and Susan Collins (R-ME) are introducing the Copay Fairness for Veterans Act, legislation designed to eliminate out-of-pocket costs for preventive health care services provided through the Department of Veterans Affairs.
This bipartisan bill would remove copayments for preventive medications and services, align VA prescription copayment standards with those used in private insurance and TRICARE, and ensure access to all contraceptives approved, granted, or cleared by the Food and Drug Administration without cost-sharing.
“After all they’ve done to serve our nation, it’s unacceptable that Veterans covered by the VA are uniquely singled out and forced to pay out-of-pocket for preventative health care,” Duckworth said. “There’s no reason these copayments should be covered for nearly every ACA patient but not for our heroes. Our bipartisan legislation would eliminate these costs and help ensure VA patients are treated more fairly in the health care market.”
How VA Copays Work and Who Pays Them
The VA health care system operates under its own statutory framework and is not bound by the preventive care coverage requirements imposed on private insurance under the Affordable Care Act. Instead, the Department of Veterans Affairs assigns veterans to priority groups that determine eligibility and cost-sharing obligations.
Veterans are placed into one of eight priority groups based on factors such as service-connected disability ratings, income, and service history.
Those in higher-priority groups, such as veterans with service-connected disabilities rated at 50% or higher, generally do not pay copays. However, veterans in lower-priority categories, particularly Priority Groups 7 and 8, are typically required to pay copays for outpatient visits and prescription drugs.
These copays can apply even to preventive care. For example, a veteran in a lower-priority group may face out-of-pocket costs for cholesterol medications, cancer screenings, or contraceptives, which are services often provided without cost-sharing in other health systems.
The Policy Gap Compared to Other Health Coverage
Under the Affordable Care Act, most private health plans must cover a defined set of preventive services without copayments, coinsurance, or deductibles when delivered in-network.
These services include screenings for conditions such as breast and colorectal cancer, medications to reduce cardiovascular risk, and a broad range of contraceptive options. The policy is designed to remove financial barriers to early detection and treatment.
Because the VA operates outside this framework, those protections do not automatically apply. As a result, veterans receiving care through the VA may be required to pay for preventive services that civilians with private insurance or military retirees using TRICARE receive at no cost.
The discrepancy reflects a structural difference in how federal law governs these systems rather than a difference in clinical standards.
What the Legislation Would Change
The Copay Fairness for Veterans Act would eliminate copayments for preventive services and medications within the VA system, effectively aligning it with private insurance and military retiree coverage.
It would also standardize prescription copayment practices and guarantee that veterans can access any contraceptive approved by the FDA without a copay. Supporters argue these changes would remove financial barriers that often discourage early treatment and routine care.
Estimated Financial Impact
During a Senate Veterans’ Affairs Committee legislative hearing on a prior version of the proposal, the Department of Veterans Affairs provided cost estimates indicating that veterans would retain substantial savings if copays for preventive care were eliminated.
The VA projected that, over ten years, veterans would avoid approximately $49.1 million in outpatient copays and $399 million in medication copayments—roughly $448 million in total out-of-pocket costs.
These figures reflect direct savings to veterans and highlight the scale of the financial burden associated with current copay requirements.
Prior Legislative Efforts Across Congress
Efforts to eliminate preventive care copays within the VA system have developed over several years and across both chambers of Congress.
In 2021, Senators Tammy Duckworth and Susan Collins joined Representative Lauren Underwood to introduce bicameral legislation titled the Veterans Preventive Health Coverage Fairness Act, targeting the same issue. That proposal sought to eliminate copays for preventive services and medications and align VA prescription cost-sharing with private-sector and military retiree standards.
Underwood has continued to pursue the issue in the House. In 2025, she testified before the House Veterans’ Affairs Committee on legislation with a similar objective, emphasizing the need to eliminate copays for preventive services recommended by federal health authorities such as the US Preventive Services Task Force, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration.
Although those earlier efforts did not become law, they established a consistent legislative record and policy rationale supporting the current proposal.
The issue has also received acknowledgment from executive leadership. During his confirmation process, VA Secretary Doug Collins indicated a willingness to work with lawmakers on preventive care copays, stating that the preventive aspect of health care is “very important.”
The Underlying Problem the Bill Targets
At its core, the legislation addresses a structural inconsistency in federal health policy. Veterans receiving care through the VA may be required to pay for preventive services that are treated as cost-free in nearly every other major coverage system in the United States.
Supporters argue that this gap is not just a question of parity, but of access. Research has found that patients are less likely to use preventive services when they face out-of-pocket costs, which can make it harder to detect health problems early, when treatment is often more effective and, in many cases, less costly.
For veterans in means-tested priority groups, even relatively small copayments can influence health care decisions. Those costs can discourage routine screenings, delay the use of preventive medications, and reduce follow-through on recommended care.
In practical terms, that can mean conditions that might have been managed early instead progress into more serious and complex health issues requiring more intensive treatment.
By eliminating copays for preventive care, the Copay Fairness for Veterans Act seeks to remove those barriers and align VA health benefits with the broader shift in U.S. health policy toward emphasizing prevention and early intervention.
