VA Health Care and Other Insurance

The VA has been in the hot seat for years, battling allegations of wasteful spending, substandard VA health care, and an inability to keep up with demand.  

But a concerted effort, backed by an influx of government spending, has made a measurable difference, and the numbers are showing it. 

A recent nationwide Medicare survey released in June 2023 found that veterans rated Veterans Affairs hospitals more favorably than private healthcare facilities in 10 out of 10 categories related to patient satisfaction.  

This is great news for veterans who qualify for VA Health Care and those who will in the future. 

But even with all of its perks, VA Health Care may be best when paired with health care insurance (such as Tricare, Medicare, or private insurance through your employer or your spouse). 

In this guide, we’ll talk about some of the limitations of VA Health Care and how health insurance can augment your care and ensure the best overall coverage. We’ll also answer common questions veterans have related to VA health care.

Do I Need Health Insurance if I Have VA Health Care?

If you qualify for VA Health Care, you may be wondering whether you need other coverage, such as Tricare, Medicare, or health insurance through your current private employer. 

Each of these plans comes with costs, and it may be tempting not to sign up for them (or to let them lapse). 

It’s important to note VA Health Care is not insurance. VA Health Care is a healthcare system that addresses veterans’ health needs, regardless of whether or not they have insurance. 

Here are some scenarios that could make you very glad that you have additional health care coverage apart from the VA: 

• Your VA priority group changes. If you have been assigned to the VA Health Care Priority Group 1, you will likely appreciate the comprehensive, free care that you are receiving.

But remember that your priority group is not set in stone. If your service-connected disability improves, you could get a lower VA disability rating, which could translate to a lower priority group for your VA Health Care. 

If you do not have a service-connected disability and your household income increases, you could also be moved to a lower priority group.

These downgrades could translate to fewer VA benefits, longer waits for the care you need, and higher copays, which might make an alternate plan preferable for certain services.  

• You want health care for your family. With rare exceptions, the VA doesn’t provide care for veterans’ family members. 

If you get rid of your insurance, you could leave your dependents without health care coverage.

• You move farther away from a VA facility. In general, VA Health Care covers services rendered at VA hospitals or clinics. 

If you live close to a VA facility, it will be convenient to get care there, but what happens if your circumstances change? 

Maybe you will need to move to help an ailing parent or one of your children. Or maybe you will decide to relocate to a retirement community so that you can age in place. Maybe you travel a lot and can’t always get to a VA facility. Regardless, you may find yourself out of range of VA facilities. 

Fortunately, the VA has a workaround through Community Care, which may allow you to see a provider in your local community. To qualify for Community Care, you must meet specific eligibility criteria and ensure that your unique health needs can be serviced by Community Care providers.  

If VA facilities aren’t closeby, and you’re not a candidate for Community Care, private healthcare coverage could become essential.  

• Your copays are adding up. If you are in a lower priority group for your VA care, you could be charged copayments for various services that are not related to your service-connected disabilities. 

These charges can add up! Another health plan may be more affordable.  

• You want treatment from a doctor outside the VA system. The VA may pay for care from providers outside of the VA network, but only if you get authorization in advance. 

Perhaps you want care from a doctor who has a particularly good reputation for the type of care you need. Or maybe a certain doctor is one of the few who offers a certain type of therapy that is not available at the VA. 

If the VA denies authorization, your additional health care could provide the coverage you seek.  

• You need care for non-service-connected disabilities. Depending on the VA priority group you are in, the VA may not provide care for your non-service-connected disabilities. 

Your private health care can kick in and cover these charges from non-VA providers. 

• You want additional prescription coverage. The VA’s prescription coverage is considered to be among the best, but it only covers VA providers and pharmacies. 

If you want a plan that covers prescriptions from non-VA doctors and/or allows you to pick up your medication at a pharmacy of your choice, you may want to invest in additional prescription drug coverage.  

• You want dental care. While the VA provides free dental care for some veterans, many are not eligible for this benefit. 

A private plan might offer the best dental care at the best rates for you and your family.

Who Qualifies for VA Health Care?

Active Duty Military

If you meet certain eligibility requirements, you may qualify for VA Health Care benefits. These requirements include: 

• You were an active-duty military member
• You didn’t receive a dishonorable discharge
• You meet the minimum duty requirement of having served 24 continuous months OR the full period for which you were called to active duty. This only applies if you enlisted after September 7, 1981 or entered active duty after October 16, 1981.  

Exceptions  

You may not have to meet the minimum duty requirement to be eligible for VA Health Care IF:

• You served prior to September 7, 1980 
• You were discharged from the military due to a service-connected disability
• You were discharged for a hardship or “early out” 
• You served in certain places or during certain times during the Vietnam era. These include:
  • Any U.S. or Royal Thai military base in Thailand from January 9, 1962, through June 30, 1976 
  • Laos from December 1, 1965, through September 30, 1969
  • Cambodia at Mimot or Krek, Kampong Cham Province from April 16, 1969, through April 30, 1969
  • Guam or American Samoa or in the territorial waters off Guam or American Samoa from January 9, 1962, through July 31, 1980
  • Johnston Atoll or on a ship that called at Johnston Atoll from January 1, 1972, through September 30, 1977
  • Republic of Vietnam from January 9, 1962, through May 7, 1975

Reserves or National Guard

In order to qualify for VA Health Care as a member of the Reserves or National Guard, you must have been called to active duty by a federal order and served your full obligation. 

If you were only given active-duty status for training purposes, you do not qualify for VA Health Care.  

If I’m Eligible, Will I Automatically Get VA Health Care?

Sometimes.

If you already have a VA rating, then you automatically have access to VA Health Care. If you don’t have a VA rating, you may have to apply for VA Health Care.

If you’re eligible for VA Health Care, you’ll be assigned to a priority group ranging from 1 (highest priority) to 8 (lowest priority). This prioritization is based on your:

• Military service history
• VA disability rating
• Income level
• Eligibility for Medicaid
• Eligibility for other benefits (like VA pension benefits)

The highest priority group (#1) is for veterans who meet one or more of these qualifications:

• Have a service-connected VA disability rating of 50% or more
• Have a service-connected disability that the VA concluded makes you unable to work (also called unemployable)
• Received a Medal of Honor

The lowest priority group is reserved for people without a service-connected disability whose gross household income is above VA limits.

Veterans in lower priority groups may experience a delay in receiving certain health care benefits, and they may have to pay copays.

What if I Don’t have a Service-Connected Disability?

It is a common misconception that if you do not have a service-connected disability, you cannot receive VA Health Care, but this is not always true. 

Even if you don’t have a disability rating, if you meet the eligibility requirements described above, you will likely qualify for VA Health Care, but you may be placed in a lower priority group.  

Does VA Health Care Count as Insurance?

Yes.

While VA Health Care is not technically the same thing as health insurance, it still meets the standard for minimum essential healthcare coverage under the Affordable Care Act.

Do I Need to Sign Up for Medicare?

Those with VA benefits may wonder if they should sign up for Medicare as they approach the eligibility age of 65. After all, do you really need two government-backed health plans? 

The VA not only allows this—they encourage those with VA Health Care to sign up for Medicare Parts A and B during their initial enrollment period at age 65 unless they are insured through their current employer. This opens up options for care at non-VA facilities. 

Medicare Part D is optional, but it can expand your prescription drug coverage significantly. It allows you to get prescriptions from non-VA doctors and fill your prescriptions without having to go to the VA pharmacies (saving you travel time and potentially long wait times). Your Part D plan may also cover drugs that are not part of the VA formulary.  

While the VA and Medicare are both government-funded, they operate in their own orbits. Medicare does not cover VA copays, nor does the VA cover Medicare copays, deductibles, etc.  

If you don’t sign up for Medicare and realize that you need it later, you could have to wait until the next general enrollment period. 

If you drop Medicare but decide you need it later, you may also have to pay a fee for reinstatement.

Can I Have Tricare and VA Health Care?

Yes. 

VA Health Care is a health care system—not an insurance plan. Tricare is an insurance plan. 

The basic Tricare plans are free for active duty members and their dependents. Tricare is also available for retirees and their families, but it comes with annual fees and copayments.  

Probably the biggest benefit of Tricare is that it provides coverage for your family members, whereas the VA won’t (at least in most cases). 

Tricare will cover care for non-service-connected disabilities, and it can also offer a lot of convenience if you don’t want to travel to a VA facility or deal with potentially long VA wait times.

How will my VA Health Care Work with my Insurance Plan?

If you have health insurance (whether a private plan, Medicare, Medicaid, etc.), you are required to report it to the VA. This includes coverage under your own plan or your spouse’s plan.

Having additional health insurance will not deprive you of any of your VA health benefits. 

Those remain constant regardless of any outside insurance. On the contrary, reporting your insurance will allow the VA to cooperate with your insurance plan and potentially save you money.

If the VA treats you for a non-service-connected disability, they will have to bill your private health insurance provider* for care, supplies, medicine, etc. 

If there is an unpaid balance that is not covered by your insurance provider, you will not have to pay that balance, but you may have to pay a copay (depending on your insurance).

On the other hand, when your insurance company pays the VA, the VA may be able to use some of those funds to defray your copay. In addition, your private insurer may apply your VA Health Care charges toward your yearly deductible, which will represent more savings.

*This does not apply to Medicare/Medicaid. The VA generally does not bill these federal insurance plans. However, if you have a supplemental Medicare plan, they may bill that plan.  

Conclusion

Many veterans benefit from having both VA Health Care and outside insurance plans, particularly if they: 

• Have dependents
• Don’t live close to a VA hospital or VAMC
• Are in lower VA priority groups

Related Veteran Resources (Dental, Eyecare, etc)

NEED MORE ASSISTANCE?

If you are in a low VA priority group but believe you are eligible for a higher VA rating, then reach out and schedule your FREE VA Claims Insider Discovery Call.

This call can help educate you on how to increase your VA disability rating, get you more tax-free monthly VA disability compensation, and qualify for more comprehensive VA healthcare.