Real‑world examples of Veterans Affairs healthcare enrollment form examples

Before we talk about rules or eligibility, let’s walk through real examples of veterans affairs healthcare enrollment form examples that mirror what people are actually doing in 2024–2025.

Think of VA Form 10‑10EZ as the front door to VA health care. You can complete it online, by mail, or in person, but the questions are the same. The best examples are the ones that show how different life situations change what you write down.

Example of a recently separated OEF/OIF veteran with no disability rating

Picture a 28‑year‑old Army veteran who separated 10 months ago after serving in Afghanistan. No VA disability rating yet, working full‑time, single, no dependents.

On VA Form 10‑10EZ:

• Personal and military service sections are straightforward: they list their dates of active duty, branch, and separation date.
• Combat service is marked “Yes” and the Afghanistan deployment dates are entered. This can impact priority group placement.
• Income section is completed with last calendar year’s wages from their W‑2. No Social Security, no pension, no investments.
• Health insurance section: they check that they have employer‑sponsored coverage and provide the policy details.

This is one of the cleanest examples of veterans affairs healthcare enrollment form examples: no dependents, no disability rating, and simple income. The VA will likely place this veteran in a mid‑range priority group, but they still get enrolled and can be seen at VA facilities, often with low or no copays for certain services.

Example of a veteran with 70% service‑connected disability rating

Now take a 62‑year‑old Marine Corps veteran who has a 70% service‑connected disability rating from VA.

On the 10‑10EZ:

• In the service‑connected disability area, they clearly indicate they have a VA rating and list the percentage.
• Because of that rating, they do not have to report income to qualify for enrollment. Many veterans don’t realize this and overcomplicate the form.
• They still fill in basic personal and service information, but the income and asset sections can be left blank without affecting eligibility.

This is one of the best examples of how the form works in a veteran’s favor. The disability rating drives priority group assignment, not income. For a 70% rating, the veteran will typically land in Priority Group 1 or 2, which means no enrollment fee and very favorable copay rules.

Example of a low‑income veteran with no service‑connected disability

Consider a 55‑year‑old Navy veteran, no service‑connected rating, working part‑time with variable income, married, one dependent child at home.

On the 10‑10EZ:

• They carefully complete the household income section: part‑time wages, spouse’s income, and any small side‑gig income.
• They list family size correctly: three people in the household.
• They indicate they have no private health insurance and are not enrolled in Medicare yet.

Here, the VA compares their reported income and family size to the VA National Income Thresholds for the current year. These thresholds are updated annually and published at VA.gov. In 2024–2025, many low‑income veterans qualify for Priority Group 5, which often means no copays for primary care and mental health visits.

This is one of the most important examples of veterans affairs healthcare enrollment form examples for people who assume they “make too much” or “don’t qualify.” The form is the way VA runs the math.

Example of a National Guard member with recent federal activation

A 35‑year‑old National Guard member was federally activated for 12 months, returned home last year, and is now back to civilian work.

On VA Form 10‑10EZ:

• They list active duty periods that count as federal service (Title 10 orders) in the service section.
• They answer combat service based on whether they deployed to a designated combat zone.
• They provide current civilian income and note any TRICARE coverage if still eligible.

This example of VA healthcare enrollment shows how Guard and Reserve members must be precise about activation orders. Only certain types of service count toward VA health care eligibility. The form captures those dates and status changes.

The best examples include Guard/Reserve cases because they highlight why you should keep copies of orders and DD214s handy when you sit down with the form.

Example of a veteran already on Medicare

A 70‑year‑old Air Force veteran with no disability rating, but fully enrolled in Medicare Part A and B.

On the 10‑10EZ:

• They list Medicare in the health insurance section, including their Medicare number and Part A/Part B start dates.
• They report retirement income, Social Security benefits, and any pension.
• They may qualify for a middle or lower priority group depending on income, but Medicare coverage does not block VA enrollment.

In this scenario, VA care can work alongside Medicare, which is a point the form quietly captures. The VA has guidance on how VA and Medicare interact at VA.gov. This is one of the most common examples of veterans affairs healthcare enrollment form examples for older veterans.

Example of a veteran applying for VA health care and disability at the same time

A 40‑year‑old Army veteran is filing a new disability claim with VA and, at the same time, wants to enroll in VA health care.

On the 10‑10EZ:

• They check the box indicating they have applied for disability compensation but have no rating yet.
• They complete the income section in full, because until the rating is granted, income rules still apply.
• Once the disability claim is decided, VA may automatically update their priority group without requiring a new 10‑10EZ.

This is a good example of how the enrollment form and disability claims process run in parallel. Many veterans assume they must wait for a rating before enrolling; this example shows that is not the case.

Example of a veteran enrolling online through VA.gov

In 2024–2025, many veterans skip paper entirely and complete the 10‑10EZ online at VA.gov.

In the online version:

• Required fields are clearly marked, and some sections auto‑populate if the veteran signs in with Login.gov or ID.me.
• The form will skip or gray out certain income questions if the veteran is already service‑connected at a qualifying level.
• Veterans can upload supporting documents electronically, which is especially helpful for Guard/Reserve service records.

This digital path is one of the most practical examples of veterans affairs healthcare enrollment form examples today. The questions are the same as the paper 10‑10EZ, but the interface reduces errors and missing information.

Breaking down the key sections using real examples

Seeing examples is helpful, but it also pays to understand how each major section of the form behaves in real life. Here’s how those earlier examples of veterans affairs healthcare enrollment form examples map onto specific parts of VA Form 10‑10EZ.

Personal and contact information

This part is straightforward but still trips people up when addresses or phone numbers change.

In the best examples, veterans:

• Use an address where they actually receive mail. VA still sends some notices on paper.
• Provide both a mobile number and email, which speeds up follow‑up questions.
• Use the same spelling of their name that appears on their DD214 and other VA records.

A small mismatch here can slow processing if VA has to reconcile identity information across systems.

Military service information

This section is where the Guard/Reserve example shines. You’ll typically see:

• Active duty start and end dates that match DD214s.
• Branch of service and character of discharge.
• Indication of combat service, Purple Heart, or POW status when applicable.

Why it matters:

• Combat service and awards can influence priority group and eligibility for certain programs, including mental health services.
• Some time‑limited eligibility windows (for example, recently separated combat veterans) are triggered by the dates entered here.

Financial and household information

The income section is where examples of veterans affairs healthcare enrollment form examples really start to diverge.

In the low‑income veteran example:

• Household size and combined income determine whether they fall below VA’s national or geographic income thresholds.
• VA uses these numbers to assign Priority Group 5 when income is under the limit, leading to more favorable cost‑sharing.

In the 70% service‑connected example:

• The veteran can skip this section entirely because their rating places them in a higher priority group regardless of income.

VA updates income thresholds yearly. The 2024–2025 figures are posted on VA’s official site, and they typically track changes in the federal poverty guidelines published by HHS.

Health insurance and other coverage

Across the Medicare, employer‑coverage, and no‑insurance examples, you see three patterns:

• Veterans with employer insurance list the plan name, group number, and policy number.
• Veterans with Medicare enter Part A and B details.
• Veterans with no other coverage simply check the appropriate box.

VA uses this data to:

• Coordinate benefits with other insurers.
• Bill private insurance when appropriate (which does not usually affect the veteran’s copays).

The CDC and NIH both emphasize the importance of coordinated care for chronic conditions; VA’s insurance questions are part of making that possible. For general background on why multiple‑payer coordination matters in chronic disease management, you can see resources at CDC.gov and NIH.gov.

2024–2025 trends affecting VA healthcare enrollment forms

The form itself (VA Form 10‑10EZ) hasn’t radically changed, but the context around it has.

Increased online enrollment and digital records

More veterans are applying online rather than mailing paper forms. This trend has a few practical impacts:

• Fewer incomplete applications, because the online tool flags missing required fields.
• Faster decisions when VA can automatically verify service information via existing databases.
• Easier updates when a veteran’s income or family situation changes.

That’s why newer examples of veterans affairs healthcare enrollment form examples often describe the online portal instead of a physical packet of paperwork.

Greater awareness of mental health and toxic exposure care

Since the PACT Act and related policy changes, more veterans with potential toxic exposures or mental health needs are being encouraged to enroll in VA care, even if they’re not sure about disability ratings yet.

In practice, this means:

• More examples of veterans filing 10‑10EZ forms before or alongside disability claims.
• More attention to combat service and deployment locations in the service section.

For background on how VA health care intersects with mental health and long‑term disease risk, sites like Mayo Clinic and WebMD offer accessible overviews of conditions commonly treated in VA systems, such as PTSD, COPD, and cardiovascular disease.

Income thresholds and cost‑of‑living changes

As inflation and wages shift, VA’s income thresholds adjust. That means some veterans who didn’t qualify based on income a few years ago might now fall under the line.

The low‑income veteran example above is not static. In 2024–2025, their same wages and household size could produce a different outcome than they would have in 2019, simply because the thresholds moved. This is one reason it’s worth submitting a new 10‑10EZ if your financial situation changes.

Practical tips drawn from the best real examples

Looking across all these examples of veterans affairs healthcare enrollment form examples, a few practical patterns show up:

• Veterans with 50%+ service‑connected ratings often over‑complicate the income section. In many cases, they don’t need to.
• Veterans with Guard/Reserve service sometimes under‑report qualifying federal activation periods. That can cost them eligibility.
• Veterans who think they “make too much” frequently discover, after filling out the form, that their family size and updated thresholds put them inside VA’s income window.
• Veterans with Medicare or employer coverage sometimes skip VA enrollment, assuming they can’t have both. The examples above show that’s not the case.

If you’re unsure which example of VA healthcare enrollment fits you best, it’s worth talking to a VA enrollment specialist at your nearest VA medical center or a county veterans service officer. They work with these forms every day and can walk through your situation line by line.

FAQ: examples of VA healthcare enrollment questions veterans ask

Q: Can you show more examples of veterans affairs healthcare enrollment form examples for someone with dependents?
A: A common case is a veteran with a spouse and two children, no service‑connected rating, and moderate income. On the 10‑10EZ, they list all four household members, total combined income, and any private insurance for each person. VA then compares that total to the income threshold for a four‑person household. This can place them in a lower priority group than a single veteran with the same income, which is why accurate dependent information matters.

Q: What is an example of when I can skip the income section?
A: Veterans with certain service‑connected ratings (often 50% or higher) or those receiving VA pension benefits can usually leave the income fields blank without affecting enrollment. The 70% service‑connected example above is a textbook case. If the form or online tool allows you to move forward without income after you indicate your rating, that’s a good signal you’re in this category.

Q: Are there examples of veterans who have both VA health care and private insurance?
A: Yes. Many working‑age veterans keep employer‑sponsored coverage for family members while using VA for specific services, such as mental health or specialty care. In their 10‑10EZ, they list the private plan, group number, and policyholder info. VA may bill the private plan for certain treatments, but this typically doesn’t increase the veteran’s out‑of‑pocket costs.

Q: Do I need a disability rating before I submit VA Form 10‑10EZ?
A: No. The example of the 40‑year‑old veteran filing a disability claim and enrolling in VA health care at the same time shows this clearly. You can apply for health care first, and your priority group may later be updated automatically when your disability claim is decided.

Q: Where can I see an official example of the current VA healthcare enrollment form?
A: The most reliable source is VA’s own site. You can view or download VA Form 10‑10EZ and its instructions directly from VA.gov. That page always hosts the latest version of the form and is the best reference to compare against any examples you see online.

The bottom line: real examples of veterans affairs healthcare enrollment form examples show that the form is less about trick questions and more about accurately describing your service, your household, and your existing coverage. Once you’ve seen how veterans in different situations handle the same questions, your own 10‑10EZ stops looking like a bureaucratic maze and starts looking like what it really is: a structured way to open the door to care you’ve already earned.