Veterans & Medicare
Veterans have unique Medicare considerations. Understanding how VA Healthcare, TRICARE for Life, and CHAMPVA interact with Medicare can protect your benefits and help you avoid costly mistakes.
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VA Healthcare & Medicare
VA Healthcare and Medicare are separate programs that can work together — but there are important rules every Veteran should understand before making enrollment decisions.
Do all Veterans receive VA Healthcare benefits?
No. Veterans must be eligible based on their service. Not all Veterans can use the VA Healthcare System. Veterans must also apply for VA Healthcare benefits — they are not automatically enrolled. When in doubt, fill it out.
VA Healthcare EligibilityAre there out-of-pocket costs for Veterans that use the VA?
Many Veterans that use the VA have copays and cost-sharing. Those costs can vary for each Veteran based on their priority group. Priority Group 1 Veterans have no out-of-pocket costs at the VA.
VA Copay RatesIs there a premium for VA Healthcare?
No, there is not a premium for VA Healthcare.
Is VA Healthcare creditable coverage for Part D of Medicare?
Yes. VA Healthcare coverage is creditable coverage for Part D. This means that if a Veteran has had VA Healthcare since they turned 65 and decides to sign up for a MAPD or PDP plan, they will not face a late enrollment penalty. The VA can provide proof of creditable coverage in the form of a letter if needed.
VA Creditable Coverage LetterIs VA Healthcare creditable coverage for Part B of Medicare?
No. VA Healthcare is not creditable coverage for Part B. If a Veteran declines Part B when they first become eligible, they may be subject to the Part B late enrollment penalty should they decide to enroll at a later date.
VA Healthcare & Other InsuranceWhat do the different priority groups mean for Veterans who use the VA Healthcare System?
Priority groups determine how a Veteran qualifies for VA healthcare and what the Veteran's out-of-pocket costs are when they use the VA.
VA Priority GroupsCan the VA bill Medicare or a Medicare Advantage plan?
No. The VA cannot bill Medicare or Medicare Advantage plans for services received at the VA.
VA Healthcare & Other InsuranceWhat is the Mission Act and how does it work?
The VA Mission Act is one of several programs through which a Veteran can receive care from a community provider. A Veteran could be eligible when: the VA can't provide the services needed; the VA is unable to schedule within 30-minute average drive time for primary/mental health care or 60-minute drive time for specialty care; or appointment wait times exceed 20 days for primary/mental health care or 28 days for specialty care.
Mission ActTRICARE for Life (TFL) & Medicare
TRICARE for Life is available to military retirees who have Medicare Parts A & B. It serves as secondary coverage to Medicare and provides comprehensive protection — but enrolling in certain Medicare plans can complicate or reduce your TFL benefits.
What is the difference between TRICARE and TRICARE for Life (TFL)?
TRICARE is available to active duty military, National Guard, retirees and their families. TFL is available to retirees who are enrolled in Medicare Parts A & B and now utilize TRICARE as secondary coverage to Medicare.
TFL Eligibility & EnrollmentWho is eligible for TRICARE for Life (TFL)?
TFL is available to retired members of the military (generally those that served 20+ years), their spouses and dependents who also have Medicare Parts A & B.
TFL EligibilityDo TRICARE beneficiaries need to enroll in Part A & B of Medicare when they become eligible?
Yes. When a TRICARE beneficiary becomes eligible for Medicare they are required to take both Parts A & B to continue using TRICARE and transition to TFL. Medicare will be primary and TRICARE will be secondary. They can see any provider who accepts original Medicare with no out-of-pocket cost for services covered by both.
TFL & MedicareCan a TFL beneficiary enroll in a MAPD?
TFL beneficiaries already have creditable drug coverage without a coverage gap. Enrolling in a MAPD makes TFL drug coverage secondary and requires staying within the plan's network. We typically do not recommend TFL beneficiaries enroll in a MAPD plan.
TFL & Medicare PlansCan a TFL beneficiary enroll in an MA-only plan?
The MA-only plan will replace original Medicare as primary coverage to TRICARE, requiring the member to stay within the plan's network. We typically do not recommend TFL beneficiaries enroll in an MA-only plan.
TFL & Medicare PlansCan a TFL beneficiary enroll in a PDP plan?
Yes, but TFL beneficiaries already have creditable drug coverage without a coverage gap. Enrolling in a PDP makes TFL drug coverage secondary. We typically do not recommend TFL beneficiaries enroll in a PDP plan.
TFL Pharmacy & MedicareDoes TFL pay for copays on an MA/MAPD plan?
TFL may pay for copays on an MA/MAPD plan. However, members must use in-network providers and follow the proper steps to ensure TFL pays or reimburses the copays associated with the plan.
TFL & Medicare PlansCan a TFL beneficiary enroll in a Medicare Supplement/Medigap (Med Supp) plan?
Yes, but there would be little to no benefit. A TFL member with original Medicare already has no out-of-pocket costs for services covered by Medicare and TRICARE. A Medicare Supplement/Medigap plan would be duplicate coverage and an unnecessary monthly premium expense.
TFL & Medicare PlansCan a TFL beneficiary enroll in a MA/MAPD plan just for extra benefits (dental, OTC, giveback, etc.)?
No. Enrolling in an MA/MAPD plan means the member will no longer have original Medicare and must use the plan's network for all care. However, they can enroll in stand-alone dental or vision plans to fill coverage gaps.
Do TFL beneficiaries receive dental coverage?
TFL beneficiaries can purchase Federal Employees Dental and Vision Insurance Program (FEDVIP) dental coverage through the BENEFEDS website. The annual enrollment period runs from the Monday of the second full work week in November through the Monday of the second full work week in December.
TFL Dental CoverageCan a Veteran have both TFL and VA Healthcare benefits?
Yes, it is common for military retirees with TFL to also be enrolled in VA Healthcare. The VA can bill TRICARE for non-service-connected care received at the VA. TRICARE can pay up to 20% of the TRICARE allowable charge; the Veteran pays the remaining amount.
TFL & VA HealthcareDo Medicare enrollment periods apply to TFL beneficiaries?
Yes. All enrollment periods (IEP, ICEP, AEP, SEP, etc.) apply to TFL beneficiaries.
How are claims filed with TRICARE when a beneficiary has an MA/MAPD plan?
Claims are filed one of two ways: (1) The member tells the provider they have TRICARE as secondary and requests the provider bill the TRICARE Medicare Eligible Program (TMEP) / Wisconsin Physician Services (WPS) for the copay. (2) If the provider cannot bill WPS, the member fills out a reimbursement form and sends it to WPS.
TFL ClaimsTFL Claims Scenarios
These scenarios are examples only. Actual interactions with TFL or provider representatives may differ.
Scenario: TFL member enrolls in MA plan, visits a network provider, and provider agrees to bill Wisconsin Physician Services (WPS)
Member pays nothing. (Ideal, but not guaranteed — providers may not fully understand how to bill the claim.)
Scenario: TFL member enrolls in MA plan, visits a network provider, but provider does NOT agree to bill WPS
Member is subject to the plan's copay/coinsurance. Member may seek reimbursement by filling out a reimbursement form and mailing it to WPS with the provider bill.
Scenario: TFL member enrolls in MA plan and visits an out-of-network (OON) provider
Member is responsible for the copay. Reimbursement is not guaranteed. If TFL does reimburse, it will only be up to Medicare allowable amounts — not necessarily the full OON cost.
CHAMPVA & Medicare
CHAMPVA provides healthcare benefits to eligible dependents and survivors of certain Veterans. When combined with Medicare, it acts similarly to a Medigap plan with drug coverage — making additional plans largely unnecessary and potentially harmful to your benefits.
Who is eligible for CHAMPVA?
A spouse or dependent of a Veteran who is: rated permanently and totally disabled due to a service-connected disability; was rated permanently and totally disabled due to a service-connected condition at the time of death; died of a service-connected disability; or died on active duty, and the dependents are not eligible for DoD TRICARE benefits. Spouses or dependents eligible for TRICARE are not eligible for CHAMPVA.
CHAMPVA EligibilityDo CHAMPVA beneficiaries need to enroll in Parts A & B of Medicare when they become eligible?
Yes. When a CHAMPVA beneficiary becomes eligible for Medicare they are required to enroll in Parts A & B to continue using CHAMPVA. Medicare will be primary and CHAMPVA will be secondary. They can see any provider who accepts original Medicare.
CHAMPVA & Medicare Fact SheetCan a CHAMPVA and Medicare recipient sign up for an MA, MAPD, or PDP plan?
A CHAMPVA recipient currently has no network requirements and very little, if any, out-of-pocket cost. Enrolling in a plan creates a network restriction and eliminates reimbursement for out-of-network costs. Enrolling in any Part D plan also causes loss of access to Meds by Mail — the mail-order prescription benefit for CHAMPVA beneficiaries. A Medicare Supplement/Medigap plan is also not needed; CHAMPVA with Medicare acts like a Medicare Supplement/Medigap plan with drug coverage built in.
CHAMPVA & Other InsuranceCan a CHAMPVA beneficiary enroll in an MAPD?
CHAMPVA beneficiaries already have creditable drug coverage without a coverage gap. Enrolling in an MAPD makes CHAMPVA drug coverage secondary and eliminates access to Meds by Mail. The MAPD plan replaces original Medicare as primary coverage, requiring the member to stay within the plan's network.
CHAMPVA & Other InsuranceCan a CHAMPVA beneficiary enroll in an MA-only plan?
The MA-only plan replaces original Medicare as primary coverage to CHAMPVA, requiring the member to stay within the plan's network. They can enroll, but it is not recommended.
CHAMPVA GuideCan a CHAMPVA beneficiary enroll in a PDP plan?
CHAMPVA beneficiaries already have creditable drug coverage without a coverage gap. Enrolling in a PDP makes CHAMPVA drug coverage secondary and eliminates access to Meds by Mail.
CHAMPVA & Other InsuranceDoes CHAMPVA pay for copays on an MA/MAPD plan?
CHAMPVA may pay for copays on an MA/MAPD plan. However, members must use in-network providers and follow the proper steps to ensure CHAMPVA pays or reimburses the copays.
CHAMPVA Copay InformationCan a CHAMPVA beneficiary enroll in a Medicare Supplement/Medigap (Med Supp) plan?
There would be little to no benefit. A CHAMPVA member with original Medicare already has no out-of-pocket costs for services covered by Medicare and CHAMPVA. A Medicare Supplement/Medigap plan would be duplicate coverage and an unnecessary monthly premium.
CHAMPVA & Medicare Fact SheetCan a CHAMPVA beneficiary enroll in an MA/MAPD plan just for extra benefits (dental, OTC, giveback, etc.)?
No. The CHAMPVA beneficiary would need to use the MA/MAPD plan's network for all care because they will no longer have original Medicare.
Do CHAMPVA beneficiaries receive dental coverage?
CHAMPVA beneficiaries can purchase dental coverage through the VA Dental Insurance Program (VADIP). They can also purchase stand-alone dental or vision coverage if there is a plan that fits their needs.
VA Dental Insurance ProgramDo Medicare enrollment periods apply to CHAMPVA beneficiaries?
Yes. All enrollment periods (IEP, ICEP, AEP, SEP, etc.) apply to CHAMPVA beneficiaries.
How are claims filed with CHAMPVA when a beneficiary has an MA/MAPD plan?
Claims are filed one of two ways: (1) The member tells the provider they have CHAMPVA as secondary and requests the provider bill CHAMPVA for the copay. (2) If the provider cannot bill CHAMPVA, the member fills out a reimbursement form and sends it to CHAMPVA for reimbursement.
CHAMPVA Claims Scenarios
These scenarios are examples only. Actual interactions with CHAMPVA or provider representatives may differ.
Scenario: CHAMPVA member enrolls in MA plan, visits a network provider, and provider agrees to bill CHAMPVA
Member pays nothing. (Ideal, but not guaranteed — there are no guarantees with this arrangement.)
Scenario: CHAMPVA member enrolls in MA plan, visits a network provider, but provider does NOT agree to bill CHAMPVA
Member is subject to the plan's copay/coinsurance. Member may seek reimbursement by filling out a reimbursement form and mailing it to CHAMPVA with the provider bill.
Scenario: CHAMPVA member enrolls in MA plan and visits an OON provider
Member is responsible for the copay. Reimbursement is not guaranteed. If CHAMPVA does reimburse, it may not cover the full OON cost.
Questions About Your Veterans Benefits & Medicare?
Navigating VA Healthcare, TRICARE for Life, and CHAMPVA alongside Medicare can be complex. We're here to help you make the right decisions — at no cost to you.
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