The Better Veteran
Maximize Your Benefits. Optimize Your Life.
October 15, 2026
Quick favor if you use Gmail. If this landed in Promotions, drag it to Primary and hit reply with one word. Gmail pays attention to both, and it's the easiest way to make sure the next one finds you.
Unfortunately, no, the subject line is not a euphemism of me saying the VA is f*cking me. No new tool this week. By the time this lands I'm on a table at the VA, and I spent yesterday drinking the stuff they give you, which is a sentence I'll let you fill in yourself.
Here's why I'm telling you. This isn't the routine screening you get at 45. My VA primary care doc ordered it because of symptoms, and I'm not rated for anything in my gut. No IBS that regularly warrants this, nothing on my decision letters that has anything to do with a colonoscopy. The VA is doing a full diagnostic procedure, with anesthesia and a pathologist on standby, for a condition it has never service-connected, and my bill is $0.
Not because I'm 100%. Anyone at 10% gets the same bill.
It’s worth reiterating that any compensable rating, 10% or higher, removes every VA inpatient and outpatient copay, for every condition, rated or not. A knee rated 10% in 2019 pays for a colonoscopy in 2026. I wrote about this in August when I built the VA Healthcare Navigator. This week I'm the example. Never tell me I don’t practice what I preach.
VA's own copay page, 2026 rates. One sentence, and it's the whole rule.
What the same hour costs everywhere else
I pulled the numbers before the prep kicked in. Same procedure, ordered for the same reason, five other ways to pay for it.
No insurance. The average cash price at 1,984 U.S. hospitals is $2,331. Published list prices run from $810 to $7,414 depending on the building. Anesthesia and the lab work on anything they remove are billed on top.
Employer plan. The routine screening is $0 by law, and that mostly holds: in a study of 333,000 insured adults the average out-of-pocket was $79 on a $2,125 procedure. The catch is the fine print. If you've had polyps before, or you went in because of symptoms, it gets coded as diagnostic and your deductible and coinsurance apply, up to the full price. And until 2022, one in eight people with an in-network doctor and an in-network facility still got a bill from an out-of-network anesthesiologist or pathologist. Median surprise bill: $418.
Medicare. $0 for the screening. The moment they find and remove a polyp it stops being a screening, and you owe 15% to the doctor and 15% to the facility. On a $2,125 procedure that's about $319, decided while you're asleep.
TRICARE, retired. $0 for the screening on Prime and Select. A diagnostic one is $79 on Prime, 20% or $125 on Select depending on your group.
VA. $0 for the screening, for every enrolled veteran. $0 for everything after it if you hold a rating of 10% or more. No network, no deductible, no coding question, no anesthesiologist you didn't pick.
Same procedure, six bills. Mine is the bottom row. Every figure is sourced in the footer of the chart.
The honest version of the comparison is this. If you have a good employer plan, the routine screening is also $0, and I'm not going to pretend otherwise. But mine isn't a routine screening. It's diagnostic, which on every plan above is the version that costs money. What the VA doesn't have is the list of ways a $0 procedure turns into a $319 or $418 or $2,125 one. I've never had to ask the VA whether the anesthesiologist was in network. There isn't one.
And that's before the part everyone forgets: what you pay all year just to hold the card, before a single appointment.
The average worker pays $6,850 a year toward a family plan before they've seen a doctor. VA health care has no premium and no enrollment fee, at any rating.
Where the VA stops charging, rating by rating
People hear "VA health care is free" and "the VA charges copays" and both are true, depending on one number. Here is the whole ladder. Every rung holds for as long as you hold the rating.
Enrolled, no rating. Already a lot for nothing: routine screenings, lab work, X-rays, EKGs, your first three mental health visits each year, video visits from home, C&P exams, the PACT Act toxic exposure screening. Everything else: $15 for a primary care visit, $50 for a specialty visit or a specialty test like an MRI. My colonoscopy would have been a $50 specialty copay. A hospital stay runs $1,736 for the first 90 days at the full rate, or a fifth of that if your income puts you in the reduced group. Prescriptions are $5 to $11 per 30-day fill, capped at $700 a year.
0% service-connected. Care for that condition is $0. Everything else as above.
10% or higher. Every care copay is gone except urgent care after your third visit of the year. Primary care, specialty, surgery, hospital stays, for any condition. This is the rung that paid for my colonoscopy. Prescriptions for your rated conditions are $0; prescriptions for anything else still carry the $5 to $11 copay with the $700 cap.
30% or higher. The VA starts paying you to show up: 41.5 cents a mile to any VA appointment, any condition, after a small deductible. Everything above still holds.
50% or higher, or TDIU. Priority Group 1. The prescription copays end too, rated condition or not. At this rung the system is $0, full stop, with one exception: urgent care after your third visit of the year.
100% schedular, or TDIU. Comprehensive dental, which is the benefit everyone assumes exists at every rating and doesn't.
100% Permanent & Total. CHAMPVA. Your spouse and kids get VA-paid health care with a $3,000 annual family cap. This is the rung my family lives on. It's why $1.6 million in NICU bills cost us $3,000.
The ladder on one page. Save it, or send it to the veteran who keeps saying the VA charges for everything.
So if you're sitting at 60% and wondering whether the VA will handle a surgery for something it never rated, the answer is yes, at $0, and it has been since you crossed 10%. The thing a higher rating buys you in the hospital is not the surgery. It's the prescriptions, the mileage, the dental, and your family.
If you want to see exactly where you stand, priority group, copays, mileage, dental, CHAMPVA, the VA Healthcare Navigator lays it out for your rating in about a minute.
The Navigator at a 10% rating. Visits and hospital care $0 for any condition, with the regulation cited on the card.
The number that actually bothered me
VA's own colorectal screening program says 68.4% of veterans in the system are up to date. That leaves nearly 1 million enrolled veterans who aren't. Enrolled. Already in. Card in the wallet. Haven't done the one thing that catches this early.
And it doesn't even have to be the scope. VA has mailed over 100,000 at-home kits. You ask your primary care provider, they send a kit to your house, you send it back, done for the year. If it comes back positive, then you get the colonoscopy, still at $0.
So, four asks, in order of how long they take:
Not in the VA system yet? Sign up at VA.gov. Last time I did this it took ten seconds and I had a card the next day. No rating required.
In the system but no PCP visit this year? Book one. Annual visit, $0 at 10% or higher, $15 if you have no rating. Ask what screenings you're due for. At 45 the answer includes this one.
Over 45 and never been screened? Ask for the kit or the scope. The kit is a mailbox.
Symptoms you've been sitting on because you weren't sure the VA would touch something it never rated? It will. That's this whole issue. Tell your PCP.
This spot used to hold an ad. It holds this instead, and this week there's actual news in it.
Since August I've been doing six-month Transition Planning with veterans one-on-one, and a lot of the people who book the intro call don't need six months. They need one thing. A decision letter read by someone who's been through it. A VR&E meeting with a date on the calendar. An MEB packet due in three weeks.
So I opened two more ways to work with me:
File Review. You send one set of documents (decision letter and denials, your VR&E paperwork, an MEB packet, a DD-214 for a first claim). I spend about 90 minutes alone with it and send back a written review: the gaps, counted, the order to fix them, which form is next and what it has to say. Email questions answered for two weeks after. It credits in full toward anything bigger within 60 days.
One Fight. Ninety days on one workstream with a date: a BDD filing, a VR&E counselor meeting, a rating increase, a first claim. Playbook, worksheet, your statements edited, a rehearsal, a day-of cheat sheet, and a read-back call after the decision. The clock only runs while there's work to do; time waiting on VA never counts against you.
Transition Planning. The full six months and the living map, for the people whose situation has four moving parts.
The intro call is still free and it's still where I figure out which one fits you. First come, first served.
Three shapes, one free call to pick the right one.
One thing I want to know
Hit reply with one number: the year of your last VA primary care visit. If the answer is "never," reply with that. I read every one, and I'll write next week's issue for whichever answer comes up most.
I asked the Benefits Assistant on the Toolbox page my own question before I wrote this. Same answer, same regulation. Ask it yours.
Talk soon,
Zak
P.S. If you're not sure what you're entitled to at the VA, or anywhere else, the Quiz takes two minutes and routes you to the right tool for your rating, your state, and your family. It's at the top of the Toolbox.
Stay informed. Stay empowered. -- The Better Veteran
Nothing here is legal, tax, medical, or financial advice. Every figure traces to a government source or a named study as of October 15, 2026, and the tools are educational estimates; confirm your own case with the VA, your plan, or an accredited VSO. The Better Veteran has no affiliation with the VA. One-on-one transition planning is educational guidance. The newsletter and every tool stay free.
