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Health Insurance Options for Veterans

America’s approximately 19.1 million veterans have access to more health insurance options than the general public, including:

  • VA health benefits
  • TRICARE plans
  • Specialized plans for specific veteran groups

In addition, veterans have access to civilian health insurance options:

  • Private health insurance plans, like ACA plans and employer-sponsored insurance
  • Medicaid
  • Medicare or Medicare Advantage Plans

Health insurance helps veterans and their families pay for routine care and budget for unpredictable medical costs. However, all of these options can be complicated to navigate, especially when trying to coordinate with VA health benefits.

Learn more about the health insurance options available for veterans, and how to optimize your plans to keep you and your family covered.

Veteran Options At a Glance

VA Health Benefits
TRICARE
Best for
Individual veterans
Veterans with dependents
Option: Pair with TRICARE
Provides coverage for dependents. Covered people can seek care from TRICARE providers as well as VA providers.
N/A
Option: Pair with private health insurance
Provides coverage for dependents. Covered people can seek care from non-VA providers.

VA can bill private health insurance for non-service-connected treatments, potentially reducing veterans’ out-of-pocket costs.
Private insurance is the primary payer. TRICARE can be billed for remaining uncovered amount.
Option: Pair with Medicare or Medicare Advantage
Covered people to seek care from non-VA providers that accept Medicare.

Medicare and VA benefits work independently of each other. The VA does not bill Medicare but may bill Medigap policies for covered services.
Medicare is the primary payer. TRICARE can be billed for any remaining uncovered amount.
Option: Pair with Medicaid
Covered people can seek care from non-VA providers that accept Medicaid. The VA does not bill Medicaid.
Medicaid is the primary payer. TRICARE can be billed for any remaining uncovered amount.

By default, veterans are eligible for health insurance coverage within the VA healthcare system. However, since VA healthcare does not offer coverage for the veteran’s spouse or dependents and has other limitations, it may be beneficial to combine it with other coverage options, such as TRICARE, private health insurance, Medicare, or Medicaid.

Understanding each option and how they work together can help ensure comprehensive coverage. 

VA Health Care System

The VA Health Care System is a Department of Veterans Affairs program that administers medical benefits packages to approximately 19 million veterans. It’s designed to provide veterans with medical, mental health, and support services, focusing on both physical and mental well-being. 

Eligibility Criteria

To access VA healthcare, veterans must meet certain criteria:

  • Active duty / honorable discharge: The individual must have been called to active duty and received an honorable discharge. 
  • Service length: If enlisted after September 7, 1980, a minimum duty requirement of 24 continuous months generally applies.
  • Priority group status: Veterans are divided into 8 categories based on factors such as income level, military service history, and disability rating. Lower-priority veterans could be removed from the program.

Generally, the VA healthcare system does not cover veterans’ families. However, family members of veterans who received a 100% disability rating or died in the line of duty may be eligible to receive care in VA facilities.

Overview of Benefits

The VA does not provide the same set of services for all members. Each veteran receives an individualized medical benefits package based on their priority group and the services their VA primary care provider recommends. 

The VA’s basic health benefits include preventive care, inpatient hospital stays, and urgent or emergency care. Other services that veterans could have coverage for include:

  • Diagnostic tests
  • Rehabilitation therapies
  • Vision care
  • Dental care
  • Prosthetics
  • Medical transportation

VA healthcare does not cover services that are not medically necessary, like cosmetic surgeries. It also does not cover drugs that are not FDA-approved unless you are in a clinical trial.

Limitations to Note

While the VA healthcare system is extensive, it does have some notable limitations. Unlike traditional health insurance, you can only access care at VA hospitals and clinics. This could limit the options for those living far away, or those who need specialist care unavailable within the VA system. Veterans may also experience longer wait times for appointments and treatments at VA clinics than a standard doctor’s office.

VA health care coverage also only covers the individual veteran and does not extend to family members. Eligibility and access to benefits can also fluctuate; veterans with lower priority categorization could lose their benefits during budget constraints or governmental policy changes.

How to Enroll

Since there are no set enrollment periods, veterans who are interested in VA healthcare can apply at any time of year. To apply for VA healthcare, you can complete an application online, by mail, over the phone, or in person at a VA hospital or clinic. The VA generally makes enrollment decisions in less than a week.

TRICARE

TRICARE is a health insurance program for members of the U.S. military, providing health insurance for approximately 9.6 million active-duty personnel, veterans, and their family members. TRICARE coverage extends beyond the VA healthcare system, offering care from military hospitals and clinics as well as through an extensive network of civilian healthcare providers. 

While VA benefits are reserved for veterans, TRICARE covers a broader beneficiary base. It supports a seamless transition from active duty to veteran status and provides access to medical services for various healthcare needs.

Eligibility Criteria

Two groups of people are eligible for TRICARE: sponsors and family members. Sponsors are eligible for TRICARE based on their military service, including:

  • Active duty service members
  • Active duty National Guard or Reserve members
  • Retired service members or Reserve members

Some veterans may not be eligible for TRICARE as sponsors. Unlike the VA healthcare system, TRICARE does not generally cover veterans who separated from active duty before retirement.

Family members may be eligible for a TRICARE plan based on their sponsors’ military status. Eligible family members may include children, spouses, and unmarried former spouses. 

Overview of Benefits

There are several TRICARE plans, including TRICARE Prime, TRICARE Select, and TRICARE For Life. In general, TRICARE plans offer coverage for medically necessary services, such as:

  • Primary care
  • Preventive care
  • Hospital care
  • Tests and X-rays
  • Pregnancy-related care
  • Eligible prescription drugs

Covered benefits may vary between plans depending on your current military status. For example, TRICARE Prime covers glasses or contacts for active duty service members, but this benefit is not offered to family members or retired service members. 

How to Enroll

Enrolling in TRICARE is mandatory for active duty service members and optional for other eligible people. Veterans who want to enroll in TRICARE can submit an application by mail, fax, phone, or online.

Special Considerations for Specific Groups of Veterans

Some groups of veterans, such as those who are disabled or need coverage for dependents, may have access to special programs and benefits. Understanding these options can help ensure comprehensive care when selecting health insurance for veterans. 

Veterans with Disabilities

Veterans with disabilities from service-connected injuries or conditions can access specialized healthcare programs through the VA. The programs address the unique challenges and requirements associated with service-connected health issues. 

In addition to standard VA healthcare benefits, disabled veterans may be eligible for rehabilitation, prosthetic services, and home healthcare. Priority for these services is typically given based on the disability rating, which reflects the severity of the service-connected condition.

Veterans with Dependents

While VA benefits primarily cover the veteran, programs like the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) offer coverage for dependents of veterans who:

  • Are permanently and totally disabled due to a service-connected condition
  • Died in the line of duty
  • Were disabled as a result of VA healthcare

TRICARE also extends its coverage to family members of active duty personnel, retired service members, and certain veterans who meet specific eligibility criteria. These programs help ensure the families of those who have served have access to necessary healthcare services.

General Health Insurance Options

It is important to note that veterans are not limited to TRICARE or VA coverage for health insurance. You can also consider the wide range of civilian health insurance options, including:

  • Private health insurance
  • Medicare
  • Medicaid

Most plans can work with TRICARE or VA health benefits, allowing you to coordinate your coverage.

Private Health Insurance

Private health insurance offers veterans an alternative or supplemental option to VA and TRICARE benefits. You can enroll in a private plan through the Health Insurance Marketplace or employer-sponsored programs. Unlike VA and TRICARE, private health insurance plans are available to the general public and feature a broader range of health care services and providers.

Private health insurance can be valuable for veterans seeking services or specialists unavailable through the VA or TRICARE networks. It may also offer coverage during travel or in areas where VA facilities are inaccessible.

There are several types of private health insurance plans, each with different coverage, cost-sharing mechanisms, and levels of flexibility. Common options include:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Point of Service (POS)
  • High Deductible Health Plans (HDHPs)
  • Stand-alone dental and vision insurance

How Private Health Insurance Works With VA Benefits

Veterans can combine VA benefits with private health insurance, offering a broader range of healthcare coverage. With both coverages in place, the VA can bill private insurers for medical care, supplies, and prescriptions used to treat illnesses or injuries unrelated to military service, also known as non-service-connected conditions. 

If the private insurer does not cover the full cost, the veteran is not responsible for additional balances beyond the copayment amount. However, they may have a required copayment. Typically, payments made to the VA by private insurers offset the veteran’s copayment amount on a dollar-for-dollar basis, reducing out-of-pocket costs.

Medicare and Medicare Advantage

Medicare is a federal health insurance program for people 65 and older, as well as those under 65 with eligible disabilities, ALS, and End-Stage Renal Disease. Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). 

Original Medicare does not have a network of providers. Instead, covered individuals may seek services from any healthcare provider or facility that accepts Medicare. 

Medicare Advantage is an alternative to Original Medicare offered by private insurance companies. It offers comprehensive coverage and may result in lower out-of-pocket costs when compared to Original Medicare. However, Medicare Advantage Plans often require covered individuals to use healthcare providers and facilities within the plan’s network. 

Eligibility Criteria

Veterans are eligible for Medicare if they are 65 or older, have received Social Security Disability Insurance for 24 months, or have ALS or End-Stage Renal Disease, regardless of age. Some veterans might be automatically enrolled in Medicare once they meet the eligibility criteria, while others may need to sign up. 

Overview of Benefits

Original Medicare Part A includes coverage for inpatient hospital stays, short-term nursing home care, hospice care, and home health care. Part B covers medically necessary or preventive services, such as doctor visits and lab tests. 

Medicare Advantage, also known as Part C, includes Part A and Part B coverage and generally also includes Part D drug coverage. Some plans may also offer benefits that Original Medicare does not, such as dental, hearing, vision care, and wellness benefits.

How Medicare Works with VA Benefits

Veterans can have both Medicare and VA benefits, but the two do not work together. Medicare does not pay for services provided at VA facilities, and VA benefits do not pay for Medicare deductibles, copayments, or coinsurance. However, if you have a Medigap policy, the VA may bill it for covered services.

Having both VA benefits and Medicare coverage can increase healthcare options. While VA benefits cover care exclusively in VA facilities, veterans can use Medicare in non-VA settings as long as the healthcare providers accept Medicare.  

Medicaid

Medicaid is a public health insurance program for low-income individuals and families. As of May 2022, it covers 81.9 million people nationwide. It’s designed to provide comprehensive health care to the most vulnerable populations. While the federal government sets basic guidelines, each state administers its own Medicaid program. For this reason, costs, coverage, eligibility criteria, and benefits can vary.

Eligibility Criteria

Medicaid eligibility is determined based on income, family size, and other factors, with specific criteria varying by state. In many states, individuals and families earning up to 138% of the Federal Poverty Level (FPL) may qualify, though this threshold can differ in states that have chosen to expand Medicaid coverage. Other eligibility categories include pregnant women, children, elderly adults, and individuals with certain disabilities.

Veterans may be eligible for Medicaid benefits based on their income and family size, independent of their VA benefits status. Generally, individuals covered by Medicaid are required to get care in their own state to receive coverage.  

Overview of Benefits

In each state, Medicaid covers a set of federally mandated benefits, such as hospital services, physician services, and laboratory services. Additionally, states may choose to offer certain optional benefits, such as prescription drug coverage, physical therapy, and dental care. 

How Medicaid Works with VA Benefits

Combining Medicaid with VA benefits can create more comprehensive coverage. While VA healthcare facilities do not bill Medicaid for services, veterans can use Medicaid for medical treatment outside the VA system, enhancing access to care.

Pairing VA Benefits with Other Health Coverage

VA benefits can provide critical coverage for veterans, yet it typically does not cover all medical and family needs. Adding other health coverage can enhance medical care options for veterans, their spouses, and dependents, providing access to doctors and hospitals outside the VA and coverage for non-service-connected medical issues.  

What to Consider

When considering whether to combine VA benefits with other health coverage, there are several factors to consider, including:

  • Coverage needs: Determine if you need individual coverage or need to cover a spouse and/or dependents. 
  • Accessibility: Consider whether VA facilities or preferred healthcare providers are conveniently located nearby. 
  • Healthcare requirements: Assess your specific healthcare needs, including any regular treatments, medications, or specialized care.
  • Future plans: Think about any upcoming life changes, such as retirement, that could affect your eligibility for certain health plans.

See It In Action

To better understand how paired coverage works together, consider a scenario where a veteran is evaluating healthcare options for his family. While he can access VA benefits, the coverage does not extend to his spouse and children, so he enrolls in a family healthcare plan through the ACA Marketplace.

This strategic move allows him to manage his healthcare through VA facilities at no additional cost while allowing him and his family to seek treatment at non-VA hospitals, clinics, and doctor’s offices. This dual approach helps ensure the entire family has access to a wide range of healthcare services, from preventive care to emergency interventions.

Making an Informed Decision

When comparing healthcare coverage options and how they work with VA benefits, veterans may benefit from seeking assistance. The following resources are available to help you make informed decisions and coordinate your care. 

  • Professional counseling services: Helps veterans understand their benefits and coverage options, providing guidance tailored to individual needs.
  • Financial advisors: Assist veterans in assessing the financial implications of health insurance decisions, ensuring choices align with long-term financial health.
  • Licensed agents or brokers: Specialize in navigating the details of various health plans, including TRICARE, Medicare, and private insurance, to identify the coverage solutions most likely to meet your needs and goals.
  • HealthCare.gov: Provides comprehensive information on Marketplace insurance plans, subsidies, and enrollment periods.
  • My HealtheVet (VA’s health portal): Provides access to health care management online, including appointment scheduling and health record reviews.
  • eBenefits portal: A joint VA and Department of Defense (DoD) website that allows veterans and their beneficiaries to manage their benefits and health care, providing access to VA health care eligibility, enrollment status, and information on VA and TRICARE benefits.
  • VA Mobile: Offers various apps designed to provide health care services to veterans. Apps like VA Online Scheduling allow veterans to schedule, view, and cancel appointments at VA facilities. VA Video Connect enables veterans to consult their healthcare providers via secure video sessions.
  • TRICARE Online (TOL): Allows TRICARE beneficiaries to manage their health care, including making appointments, accessing lab results, and renewing prescriptions. It’s particularly useful for active duty service members, retirees, and their families looking to compare TRICARE plans and benefits.

Putting It All Together

Veterans can choose from several health insurance options to complement their VA benefits, offering coverage to immediate family members and allowing covered individuals to seek healthcare services outside the VA system. TRICARE, Medicare, Medicaid, and private insurance each offer different benefits that can enhance overall healthcare coverage. 

When evaluating health insurance for veterans and the options available, it’s important to consider factors such as their health needs, family coverage requirements, and access to VA facilities. A range of resources are available to help veterans compare and coordinate healthcare plans, including professional counseling services, financial advisors, and licensed agents or brokers, as well as several official websites and mobile apps. These tools can help you make informed decisions regarding your healthcare coverage. 

Frequently Asked Questions

Yes. Veterans who served in the National Guard or Reserves may qualify for VA health benefits if they were called to active duty (other than for training) and completed the full period for which they were called or ordered. Eligibility for TRICARE is generally determined based on whether they retired from the National Guard or Reserves and their age.

Veterans with a service-connected disability rating are eligible for VA healthcare. The rating can affect their priority group placement within the VA system, with higher disability ratings generally resulting in more benefits and lower out-of-pocket costs.

VA health insurance plans cover various mental health services, including counseling, therapy, and medications. TRICARE also offers mental health services, including outpatient, inpatient, and telehealth options. Private insurance plans, including those through the ACA, are required to provide mental health and substance use disorder benefits.

Yes. The VA offers comprehensive care that includes reproductive health, maternity care, and other services specifically geared to the needs of female veterans. TRICARE and private insurance plans also offer coverage for women’s health services.

Veterans living overseas have access to the VA’s Foreign Medical Program (FMP), which provides coverage for treatment related to a service-connected disability to those living or traveling abroad. The TRICARE Overseas Program (TOP) also offers coverage for active duty service members, retirees, and their families residing outside the U.S.

If a veteran experiences a lapse in health insurance coverage, the first step may be to explore whether VA benefits are available. Next, determine whether a Special Enrollment Peroid applies for access to the ACA Marketplace. Short-term health insurance plans can also serve as a temporary solution until securing more permanent coverage is possible.

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