Health care and health insurance are complex for most people, but for veterans even more so. Veterans have different and unique health care options that make decision-making even more challenging. If you or a loved one has served in the military, it’s important to be aware of recent health care changes and the range of health coverage options available to veterans.
VA health care is the most widely known health benefit for veterans, made available
by the Department of Veterans Affairs.
Of the more than 21 million veterans in the United States, around nine million are enrolled in
VA, and over five million accessed VA care last year.
However, the VA is only one of many options available to veterans and their families seeking access to
health care and health insurance.
- VA Health Care
VA health care, put simply, provides health care services exclusively for veterans. Health services are mostly provided in VA medical facilities, although there is a regional option through Patient-Centered Community Care (PC3). VA benefits may be received in conjunction with other health insurance or as stand-alone coverage. Enrollment in VA is optional and can be terminated or reinstated. It is generally available to veterans of any age who were honorably discharged from active military service after at least two years, and reserve members who completed the full period for which they were called or ordered to active duty. Costs vary depending on years of service, income, and the nature of the care. All service-related care is free within the VA system.
TRICARE is health insurance provided by the Department of Defense for active duty personnel and their families. Tricare is available to active duty service members, military retirees (those who completed 20 years of service), and their dependents. It may be used in conjunction with other health insurance or as stand-alone coverage. To enroll, veterans must also be registered in the Defense Enrollment Eligibility Reporting System (DEERS). Veterans may enroll in Medicare or Medicaid while also receiving VA or TRICARE, but co-operation between the programs varies.
- Employment-Based Insurance
Veterans in the civilian workforce are able to access insurance offered through their employer the way any other employee would. Employment-based insurance is the largest source of coverage for veterans under age 65. Veterans are able -- but not required -- to receive both employment-based coverage and VA benefits. For veterans who have both private employment-based insurance and VA, the VA can bill private insurance for the care they receive at VA facilities.
- State Health Care Exchanges
Exchanges are new health insurance marketplaces in each state. Veterans will be able to purchase a health care plan through one of the health care exchanges. However, an individual must be completely uninsured in order to qualify for a lower-cost marketplace plan. Enrollment in the VA Health Plan makes veterans ineligible for subsidies in the Exchange. In order to qualify for a subsidy or discount, a veteran must end enrollment in the VA plan and experience a gap in coverage between terminating VA benefits and enrolling in a marketplace plan. Should a veteran wish to return to VA benefits in the future, eligibility may change. Enrollment in the VA plan does not affect the ability of a veteran’s family to receive Exchange subsidies if they otherwise qualify. The next open enrollment period in the Exchange will begin in November of 2015.
Medicaid is the largest source of medical and health-related services for people with low incomes (typically up to $12,000/$16,105 per year for an individual) in the United States. Eligibility varies by state. Medicaid is free or low-cost (for co-pays), depending on income. Medicaid does not cover any health services at VA facilities, but for those with both Medicaid and TRICARE, Medicaid acts as the secondary payer. Unlike most other sources of insurance, Medicaid has no open enrollment period, which means veterans can enroll at any time.
Medicare is health insurance provided by the federal government to individuals age 65 and older, as well as some adults with disabilities. All U.S. citizens and permanent residents 65 and older are eligible. To ensure the lowest monthly premiums, Veterans must enroll within three months before or after their 65th birthday. Medicare and TRICARE work together – there is a branch of TRICARE called “TRICARE for Life” that becomes available when you enroll in Medicare Parts A and B (basic Medicare). Medicare becomes your primary insurance, and TRICARE pays for any coinsurance and deductible. Medicare and VA benefits, however, do not work together. Medicare does not pay for any care received at VA facilities, but it will cover care at a non-VA facility.
Health Care Resources for Female Veterans
Between VA and TRICARE, female Veterans have access to all essential services. Standard primary care is covered: health evaluation and treatment, disease prevention, nutrition counseling, substance abuse counseling, etc. Mental health assistance is available as well. Mood disorders, post-traumatic stress disorder, domestic violence, sexual trauma, and post-deployment readjustment are some of the mental health issues that can be evaluated through VA care. TRICARE covers mental health services, though they define this coverage in terms of the method of assistance (acute inpatient care, applied behavior analysis, psychotherapy, psychological testing, residential treatment, and partial hospitalization are all covered).
Beyond that, there are gender-specific services available. VA and TRICARE cover Pap smears, mammograms, birth control, HPV vaccine, preconception counseling, and menopausal support. Specialty care includes reproductive health care: maternity, tubal ligation, and others. Infertility treatment, while provided by VA, is limited through TRICARE (though it is covered if connected to a service-related injury or ailment). By law, VA centers are prohibited from providing abortion services and in-vitro fertilization, though TRICARE covers abortions under extreme circumstances
Frequently Asked Questions
Does VA care only cover service-connected conditions?
No. Veterans can receive care for any injury or condition. Non-service-connected conditions may require a copay depending on income and eligibility factors.
What is military retirement?
Active duty members may retire after 20 years of service. Reservists must reach age 60 and accrue 20 years of service in order to retire. Medical retirement is also available if an active duty member becomes disabled as a result of an injury or condition connected to his or her service.
Are veterans with military coverage eligible to purchase a Marketplace plan?
Yes, veterans with VA care or TRICARE can buy a Marketplace plan. However, military coverage is considered to meet the health care law’s standard for minimum essential coverage, so veterans are ineligible to receive subsidies for a lower-cost plan.
Can veterans who are enrolled in the VA health care program purchase a lower-cost Marketplace plan for their families?
Yes. VA-enrolled veterans themselves do not have access to Marketplace subsidies, but their dependents do, based on family income.
Can veterans terminate their VA coverage in order to purchase a subsidized Marketplace plan?
Yes. However, a word of caution: one must be completely uninsured in order to qualify for a lower-cost Marketplace plan. There will be a gap in coverage between terminating VA benefits and enrolling in a Marketplace plan. Additionally, should a veteran wish to return to VA benefits in the future, factors of eligibility may change.
How do Medicare and Medicaid work with veterans’ benefits?
Veterans may enroll in Medicare or Medicaid while also receiving VA or TRICARE, but cooperation between the programs varies.
- Medicare and TRICARE work together – there is a branch of TRICARE called “TRICARE for Life” that becomes available when you enroll in Medicare parts A and B. Medicare becomes your primary insurance, and TRICARE pays for the coinsurance and deductible.
- Medicare and VA benefits, however, do not work together. Medicare does not pay for any care received at VA facilities.
- Medicaid and TRICARE work together. Medicaid acts as the secondary payer for those enrolled in both.
- Medicaid and VA benefits do not work together. Medicaid does not pay for any care at VA facilities.
What are the eligibility factors for free VA care?
Veterans who have the following eligibility factors are exempt from all inpatient and outpatient copays:
- Former Prisoner of War status
- 50% or more compensable military service-connected disabilities
- Catastrophic Disability status
The following services are exempt from inpatient and outpatient copays, although still may be subject to extended care copays:
- Care for a service-connected condition
- Counseling and care for military sexual trauma
- Health risk examinations
- Smoking cessation and weight reduction services
- Readjustment counseling
- Laboratory and electrocardiograms
- Hospice care
- Care potentially related to combat service for Veterans that served in a theater of combat operations after November 11, 1998