The Veterans Health Administration offers first-class health care to eligible veterans. Enrollment in VA health care fulfills the Affordable Care Act (ACA) coverage requirement, so there is no need for an add-on insurance plan.
While the VA is at the core of health care for veterans – including veterans with disabilities or low income – civilian health care also plays a vital part in your overall care. In fact, a recent report (2020) by the National Center for Veterans Analysis and Statistics showed that less than half of all veterans used any VA services or benefits in 2017.
That means at least half of all veterans used some other health care—a private insurance plan, Tricare, Medicare or Medicaid—for at least some of their care.
What Does VA Health Care Cover?
The Department of Veterans Affairs health care benefits packages may include:
- Outpatient and inpatient preventive, primary and specialty care, mental health care, prescriptions, home health care, extended care and geriatrics, and access to prosthetics and medical equipment, including hearing aids and eyeglasses
- Women veterans can get prenatal care, maternity coverage, breast and cervical cancer screenings, and primary care.
- Vets and their family members can also visit community-based centers to receive outpatient and inpatient counseling, referral, and outreach services at no cost. (You may, however, pay small copays for prescriptions and some medical treatments).
Other services the VA covers:
- Screening tests
- health care assessments and education programs
- Dental care (if eligible)
- Hospice, respite care, or palliative care
- Rehabilitative services
- Bereavement counseling
- Reconstructive surgery, excluding non-medical cosmetic surgery
- Pregnancy and delivery services. Veterans must pay for all care after birth.
Services the VA does not cover:
- Abortions and abortion counseling
- Cosmetic surgery, unless medically necessary as determined by the VA
- Gender alteration or sexual trauma counseling
- Drugs and medical devices not approved by the FDA
- Spa and health club memberships
- In-vitro fertilization
- Services not ordered by licensed professionals
- Private-duty nursing
- Emergency care in non-VA facilities
How the VA works with Tricare
TRICARE is a health care platform for uniformed active-duty service members, retired service members, reservists, members of the National Guard, survivors of fallen service members, and military-dependent family members.
The Affordable Care Act (ACA) Most Tricare plans to meet the minimum essential coverage (MEC) requirements for the Affordable Care Act.
However, if you are switching to new Tricare coverage or losing your current Tricare eligibility, review your options to avoid any penalties for not meeting MEC requirements.
Active duty service members, military retirees and their families who have Tricare Select meet ACA’s minimum requirements. Service members who qualify for Tricare For Life and have a Medicare Part B plan also meet minimum requirements.
Every VA facility has a Tricare point of contact (POC) and an established check-in process. When you register for a service, be sure to tell the VA provider that you are using your Tricare benefit.
If you don’t, you may be charged higher out-of-pocket costs or payment may be denied.
VA Health Care for Tricare Beneficiaries
For primary care services, some VA facilities will see Tricare beneficiaries. Prior to making an appointment, check with your regional contractor to see if you can enroll with a VA Tricare provider.
Keep in mind that primary care with Tricare and the VA are separate, and you can’t use both. That means that eligible beneficiaries can choose to use either their VA or Tricare benefits for each separate treatment of care.
Supplemental insurance pays after TRICARE pays its share of the bill. In other words, Tricare reimburses you for medical expenses paid out-of-pocket to civilian providers.
Tricare Referrals for VA Health Care
If you want to obtain specialty care at a VA facility and you’re enrolled in Tricare Prime, you must have a referral. If you’re enrolled in Tricare Select, a referral is usually not required, but prior authorization might be required for some services.
VA Prescriptions for Tricare Beneficiaries
Prescription drug coverage is available to all Tricare beneficiaries through the Tricare Pharmacy Program. You can get your prescriptions filled at any Tricare retail network pharmacy, military pharmacies, non-network pharmacies and through Tricare Pharmacy Home Delivery. If you have a non-covered drug, you may have to pay the full cost of the prescription out-of-pocket.
Also, by law, the VA must bill private health insurance providers first for medical care and prescriptions you receive for non-service-connected conditions. So, if you are an enrolled vet, you can update your health insurance information by using the online Health Benefits Renewal (10-10-EZR) form at www.vets.gov/health care/apply/.
If you only qualify for premium-based coverage, you must obtain one of the options below or purchase other qualifying health coverage to meet the minimum requirement.
Tricare Plans that meet minimum coverage requirements include:
- TRICARE for Life
- TRICARE Prime
- US Family Health Plan
- TRICARE Young Adult
- TRICARE Prime Remote
- TRICARE Reserve Select
- TRICARE Retired Reserve
- TRICARE Prime Overseas
- TRICARE Standard and Extra
- TRICARE Standard Overseas
- TRICARE Prime Remote Overseas
- Continued Health Care Benefit Program
- Transitional Assistance Management Program
How VA Health Care Works with Civilian Health Insurance
If you have other health care coverage, like private or civilian insurance plans—Tricare, Medicare or Medicaid—you can still receive your VA health care benefits together with these plans.
However, if you are a veteran who is not enrolled in VA benefits, you can get civilian coverage through the Health Insurance Marketplace.
Plans vary by price, quality and benefits. Plus, your VA benefits can co-exist alongside civilian health care.
Veterans applying for VA medical care must provide information about other health insurance coverage, including if you’re covered under your spouse’s health care insurance coverage or coverage provided by your current job.
Creditable Coverage for Medicare Part D
If you are enrolled in the VA health care system, you already have creditable coverage for Medicare Part D. However, your family members can not receive creditable coverage since only veterans can enroll in the VA health care system.
The Civilian Health and Medical Program (CHAMPVA)
The Civilian Health and Medical Program (CHAMPVA) may provide health care benefits for eligible VA beneficiaries. With this program, the VA shares the cost of covered health care services performed by a primary physician.
However, to receive benefits, your beneficiaries can not be entitled to health care under another health insurance plan, such as Medicare, Medicaid or Tricare. This program also fulfills the minimum essential coverage requirement for the Affordable Care Act (ACA).
Beneficiaries who are eligible for health care under the CHAMPVA program must be spouses or children of:
- Veterans (living or deceased) who have received a 100% permanent and total (“P&T”) rating from the VA for a service-related disability.
- Veterans who died in the line of duty or from a service-connected disability.
- Veterans who died while serving but cannot enroll in CHAMPVA or are not eligible for Tricare
Moreover, if a surviving spouse remarries before turning 55, they will lose their CHAMPVA benefits.
VA Health Care FAQs
If you get accepted for VA health care, should you give up your civilian or other health care?
If you give up other health care coverage when authorized for VA coverage, you’ll likely save money on premiums. However, there are risks.
The VA doesn’t typically provide care for your family members. Also, if you cancel your current Medicare Part B plan, you can’t reclaim this coverage until January of the following year. Plus, you might have to pay a penalty when you reinstate coverage.
Can you use your Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA) to help defer the cost of VA care for non-service-related conditions?
The VA will bill High-Deductible health care Plans (HDHPs) such as HRAs and HSAs for non-service-related conditions. Also, if you have an HDHP tied to your HSA, you can use your HSA plan to help pay VA copays.
Does the VA need your permission to bill your other insurance if related to a sensitive diagnosis?
The VA is required by law (the VA MISSION Act of 2018) to bill any other health insurance provider if the care you receive is related to a sensitive diagnosis, such as HIV testing and drug or alcohol abuse, without the need to obtain your permission.