Phil Moeller: How Medicare works with Veterans Affairs (VA) health benefits

There are nearly 6 million veterans enrolled in both Veterans Affairs (VA) healthcare and Medicare as of 2025.¹ However, there are also challenges and barriers to using these benefits together effectively. Making sure the two health benefit programs work in tandem, and are not at odds with each other, requires knowledge and planning.

The Veterans Administration recommends that veterans enroll in Medicare as soon as they’re eligible.² Its informational website emphasizes these reasons:

• In most circumstances, the VA provides care for only the veteran and not for family members.

• Medicare Part B (coverage for doctors and outpatient services) covers care outside the VA system that many vets and family members may need. If you don’t get Part B when first eligible, you may not be able to get it back until January of the following year. You may also have to pay a penalty to get your coverage back (called reinstating your coverage). This penalty gets bigger each year you delay signing up and may not go away.

• A Medicare plan can provide access to coverage outside of the VA syste — so you have more options to choose from.

• Signing up for Medicare Part D (coverage for prescription drugs), means you may also be able to get medicine from non-VA doctors.

Even with Medicare, it can make sense to first look for care already covered at a VA facility or a non-VA facility that the VA has approved for your care.

Only 20% of VA users depend completely on VA benefits for their healthcare.³ The other 80% also have:

• 45%: One or more types of Medicare
• 26%: The military’s TRICARE coverage
• 44%: Private health insurance³

TRICARE for Life⁴ offers supplemental benefits to veterans that are like private Medicare Supplement policies that are purchased by many people with original Medicare – Parts A and B – to cover approved medical claims not fully paid by original Medicare. Coverage does not include family members. There is no enrollment fee for qualifying vets already paying applicable Part A and B premiums.

Here’s a guide showing how TRICARE works with Medicare:

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Medicare + TRICARE

Medicare pays

• Approved charges

TRICARE pays

• Remaining approved charges

You pay

• $0

When both types of coverage work together, most out-of-pocket costs are covered.

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Medicare Only

Medicare pays

• Approved charges

TRICARE pays

• Not applicable

You pay

• Medicare deductible
• Applicable copays or coinsurance

Your share depends on Medicare cost-sharing requirements.

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TRICARE Only

Medicare pays

• Not applicable

TRICARE pays

• Allowed TRICARE amount

You pay

• TRICARE deductible
• Applicable copays or cost share

Out-of-pocket costs are based on your TRICARE plan benefits.

In some cases, VA-entitled retirees are also covered by the Federal Employee Health Benefits (FEHB) program.⁵ If so, it’s important to review coordination of benefit⁶ issues with both insurers before proceeding with care.

According to the U.S. Office of Personnel Management (OPM), FEHB benefits are payable for:

• Inpatient hospital costs at a Uniformed Services facility
• Services and supplies provided by a Department of Veterans Affairs facility for treatment of a non-service connected disability⁷

Keep in mind that these extensive benefit-coordination programs are designed to make sure you get the coverage you deserve. Work closely with your health care providers before you get care to make sure this is the case.