Health Care Plans and Programs
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TRICARE: Transitioning From TRICARE
TRICARE Transitional Assistance Management Program (TAMP)
Eligible separating military members and their family may participate in the premium-free TRICARE Transition Assistance Management Program (TAMP) for the first 180 days after discharge.
Continued Health Care Benefit Program (CHCBP)
After the Tricare TAMP transition health care benefit expires, eligible individuals may apply for extended temporary, transitional medical coverage under the Continued Health Care Benefit Program (CHCBP) offered through Humana Military. CHCBP, available for 18 to 36 months depending on the circumstances, serves as a bridge between military health benefits and civilian health plans.
These coverage plans require premium payments, deductibles, co-pays, and possibly other out-of-pocket cost shares.
TRICARE: Continuing With TRICARE Before 65
The following information is a very brief, not all-inclusive, overview of TRICARE and the US Family Health Plan. Because health care insurance coverages are detailed and impacted by individual circumstances, it is very important to research plans and communicate with health insurance and health care program customer service representatives to ensure you clearly understand their current coverages and your possible out-of-pocket cost shares. Contact and resource links are posted at the end of this section.
TRICARE offers different health plans, dental plans, and special programs to meet unique health care needs. Plan availability depends on who you are and where you live.
In general but not exclusively, TRICARE-eligible beneficiaries may include active duty military, retired military, Reserve, Guard and their families, survivors, former spouses, Medal of Honor recipients, and others registered in the Defense Enrollment Eligibility Reporting System (DEERS).
- TRICARE offers several different health plans.
- All plans meet or exceed the requirements for minimum essential coverage required by The Affordable Care Act. If you don't have minimum essential coverage, you may have to pay a fee for each month you aren't covered.
- Plan availability depends on your circumstances (veteran, spouse, duty status, etc.) and where you live.
Contacts
External Website: TRICARE & US Family Health Plan
Women Veteran's Health Care Program (Department of Veterans Affairs)
The Department of Veterans Affairs (VA) women veterans' health care and benefits contacts will help you navigate the VA health care enrollment application and disabilities compensation claim processes. The VA also publishes a handbook:
Federal Benefits for Veterans, Dependents, and Survivors (2018 Online Edition)
If you file a disabilities compensation claim, there are also other VA-accredited Veteran Service Organization (VSO) representatives, attorneys, and claims agents who can assist you.
Links to connect you with contacts and forms are listed below.
What Application Do You Submit for VA Health Care?
Women veterans--active duty, Reserve, and Guard--with active duty service may be eligible for some or all Department of Veterans Affairs (VA) physical and mental health care services. Time in service, disabilities, income, and characterization of military discharge are some of the factors considered.
It takes very little of your time to complete the VA Form 10-10EZ, Application for Health Benefits which is used to assess your eligibility. The VA determines your eligibility for health care services, and if eligible, places you in one of the health care "Priority Groups" that are determined by law.
Your eligibility for care is impacted by many factors. Some, but not all, of these considerations are listed in the last two sections below. There is no "one size fits all" VA health care eligibility criteria...beware of "barracks counseling!" While you can learn about the VA from other veterans, remember that your circumstances are most likely different and laws change, therefore, it is very important that you file an application so the VA can determine your eligibility.
Who Can Help You Apply for VA Health Care?
Women Veterans (Health) Program Manager (WVPM)
Every VA Medical Center is expected to have a Veterans Health Administration "Women Veterans Program Manager (WVPM)." The WVPM coordinates women veterans' primary, gender-specific, specialty, and mental health care.
Call Your Nearest VA Medical Center: Find the phone number on the VA locator directory web page. Click on a "state," select the "Medical Center" nearest to you, and the "Medical Center's" central phone number should be listed on the "Medical Center's" home page. Ask to be connected with your "Women Veterans Program Manager."
Visit the Online VA Directory/Locator: Go to the VA locator directory web page, click on a "state," then "Medical Center" nearest to you, move over to the left-hand menu and click "Health Care Services," and then, "Women Veterans." Your "Women Veterans Program Manager" contact information is usually listed on this page.
For more information about specific health care services, see the national WomenVetsUSA Health Care Services page.
Military Sexual Trauma (MST) Coordinator
Every VA Medical Center is expected to have a Veterans Health Administration "Military Sexual Trauma (MST) Coordinator." If you are a military sexual assault/trauma survivor, consider contacting your MST Coordinator. The MST Coordinator can assist you with mental health care as well as completing the "VA Form 10-10EZ, Application for Health Benefits" and initiating the disabilities compensation claim process.
President Obama signed into law the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146) ("Choice Act"). By law, VA provides all "counseling and care and services needed to overcome psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment" which occurred while the veteran was serving on active duty, active duty for training, and inactive duty training status. Care is now available to female and male active duty, Reserves, and Guard survivors.
Care for Military Sexual Assault/Trauma (MSA/MST)-related conditions is free to eligible veterans who experienced MSA/MST.
Call Your Nearest VA Medical Center: Find the phone number on the VA locator directory web page. Click on a "state," select the "Medical Center" nearest to you, and the "Medical Center's" central phone number should be listed on the "Medical Center's" homepage. Ask to be connected with the "Military Sexual Trauma Coordinator."
Your Women Veterans Program Manager can also help coordinate an appointment with a MST Coordinator.
Women Veteran (Benefits) Coordinator (WVC)
Every VA Veterans Benefits Administration (VBA) Regional Benefit Office is expected to have a VBA "Women Veteran Coordinator (WVC)." The WVC helps you submit a VA disabilities compensation claim, including claims for Military Sexual Assault/Trauma (MSA/MST). If your claim results in service-connected disability ratings, you will also need to complete an "VA Form 10-10EZ, Application for Health Benefits" if you haven't already done so.
Meet face-to-face, if possible, with your VBA Regional Benefit Office Woman Veteran Coordinator or with a VA-accredited Veteran Service Organization (VSO) representative, attorney, or claim agent to ensure you accurately complete the claim form, including the online form. The process can also be accomplished by phone and online. See more information below about VA-accredited VSOs, attorneys, and claim agents.
Call Your Nearest VBA Regional Benefit Office: Find the phone number on the VA locator directory web page. Click on a "state," select the "Medical Center" nearest to you, and the central phone number should be listed on the "Medical Center" homepage. Ask to be connected to the "Regional Benefit Office." (There is not a direct line posted for some "Regional Benefit Offices.") Then, ask to be connected with your "Regional Benefit Office Women Veteran Coordinator."
Military Sexual Trauma (MST) Claims Coordinator
Every VA Veterans Benefits Administration (VBA) Regional Benefit Office is expected to have a VBA "Military Sexual Trauma (MST) Claims Coordinator. The MST Claims Coordinator helps you submit a VA disabilities compensation claim for Military Sexual Trauma (MST). If your claim results in service-connected disability ratings, you will also need to complete a "VA Form 10-10EZ, Application for Health Benefits" if you haven't already done so.
Call Your Nearest VBA Regional Benefit Office: Find the phone number on the VA locator directory web page. Click on a "state," select the "Medical Center" nearest to you, and the central phone number should be listed on the "Medical Center" homepage. Ask to be connected to the "Regional Benefit Office." (There is not a direct line posted for "Regional Benefit Offices.") Then, ask to be connected with your "Regional Benefit Office Military Sexual Trauma Claims Coordinator" (or your "Regional Benefit Office Women Veteran Coordinator") if you are filing a claim for Military Sexual Assault/Trauma.
E-Mail Your MST Claims Coordinator: If you are filing a claim for Military Sexual Assault/Trauma, you can communicate directly with the Regional Benefit Office MST Claims Coordinator and/or specifically request a face-to-face meeting to help you complete your claim.
Women Veterans Call Center
Call the VA's Women Veterans Call Center: Call 1-855-VA-WOMEN (1-855-829-6636) during the Call Center's hours of operation. The Call Center associates will do their best to work all your VA health care and other benefit questions, and connect you with the closest VA health care providers, services, and programs.
State and County Veterans' Services Officers (VSOs)
Each state, and sometimes county, offices provide information and assistance with benefits available through state, federal, and local municipalities. The state and/or county veterans' service officers (VSOs) can also assist you with developing a VA compensation and benefits claim. You must submit a VA Form 21-22 and VA Form 21-22A requesting VA-accredited representation, which the VSOs will provide. Consult with your VA-accredited representative before you send in a claim, including the online form. The expectation is that they know how to better "speak VA."
State Veterans' Affairs Offices
State and County Veterans' Services Offices' Contact Information
VA-Accredited Chartered Veteran Service Organization (VSO) Representatives/Attorneys/Claims Agents
If you decide to have a veteran service representative from a chartered organization like Veterans of Foreign Wars, The American Legion, American Veterans, Paralyzed Veterans of America and others or an accredited attorney or a claims agent assist you with developing a VA compensation and benefits claim, you must submit a VA Form 21-22 and VA Form 21-22A requesting VA-accredited representation. The representatives will provide these forms. Consult with your VA-accredited representative before you send in a claim, including the online form. The expectation is that they know how to better "speak VA."
Directory of Veteran Service Organizations (VSOs)
What to Do If You Lose Contact With Your VA-Accredited Veteran Service Organization (VSO) Representative/Attorney/Claims Agent
Once a claim is officially filed with the VA, you can contact your closest Veterans Benefits Administration Regional Benefit Office direct should you lose contact with your representative.
Call Your Nearest VBA Regional Benefit Office: Find the phone number on the VA locator directory web page. Click on a "state," select the "Medical Center" nearest to you, and the central phone number should be listed on the "Medical Center" homepage. Ask to be connected to the "Regional Benefit Office." (There is not a direct line posted for "Regional Benefit Offices.") Then, ask to be connected with your "Regional Benefit Office Women Veteran Coordinator" (or your "Regional Benefit Office Military Sexual Trauma Claims Coordinator" if you are filing a Military Sexual Assault/Trauma claim).
Health Care Enrollment/Renewal Applications & Disability Claims Forms
Application for Health Care Benefits 10-10EZ--Fillable Form
Application for Health Care Benefits 10-10EZ--Print and Fill Out by Hand
Health Benefits Renewal--Fillable Form
Apply for VA Dental Insurance Program (VADIP)
Disability Compensation Claim Contacts & Forms
What Impacts Your Eligibility for VA Health Care?
Listed below are some, but not all, of the factors that may impact eligibility. Some, all, or none of the considerations in this section and the next may be relevant to you. Eligibility criteria changes as laws are passed. When you apply for VA care, the legal eligibility requirements at that time are what will be considered.
Eligibility for VA services and benefits is based on your one-of-a-kind set of circumstances.
Minimum time on active duty requirements. VA encourages all veterans to apply as there are exceptions to these requirements. They are too numerous to list and may change with new laws.
Separation under any condition other than dishonorable.
Your eligibility can change from year to year because your life circumstances change. You can reapply.
Once enrolled in the VA health care program, you can cancel your VA health care enrollment and reapply any time, but the reenrollment decision is based on the VA eligibility rules at the time. It could mean you may not be able to reenroll.
VA service- and nonservice-connected disability ratings define what VA care you receive.
Income may, but not necessarily, be considered.
Changes with your health care insurance and entitlement (e.g. Medicare) be it private or public insurance. VA health care, by law, is not an insurance plan and is prohibited from billing some insurance plans. To avoid out-of-pocket cost shares for care, consult with the VA Fee Services office to ensure you understand what care is or is not covered and that you secure pre-authorization as required.
Age can be a factor. If you participate in Medicare at 65 years of age and older, VA is generally prohibited from billing Medicare, but can bill Medicare supplemental health insurance for covered non-service connected care. To avoid out-of-pocket cost shares for care, consult with the VA Fee Services office to ensure you understand what care is or is not covered and that you secure pre-authorization as required.
Don't self-eliminate...it takes little time to apply. File an "VA Form 10-10EZ, Application for Health Benefits" and let the VA determine your eligibility. Learn what VA care you may incur out-of-pocket cost shares for.
Who is Considered for VA Health Care?
Veterans with varying lengths of active duty service time and varying active duty-related experiences, some but not all of which are listed below.
Former members of the Reserves or National Guard who were called to active duty by a federal order and completed the full period for which they were called or ordered to active duty.
Combat and non-combat veterans. One does not take away from the other. The VA's budget is based on how many veterans are using (not just enrolled) in their services and benefits programs.
Certain veterans may be afforded "enhanced eligibility status." See extensive list for specifics.
Veterans with service-connected, nonservice-connected, and no disabilities, and in some cases their families and caregivers, seek available assistance.
Veterans of all ages.
Veterans with overseas, stateside, and overseas and stateside active duty tours of duty use the VA.
Veterans with VA-recognized presumptive illnesses, diseases and/or conditions like ALS (Lou Gehrig's disease) or defined Agent Orange- and/or Camp Lejeune contaminated water-related conditions. See the VA "Environmental Health Registry" for a current list of recognized environmental hazard exposures.
Veterans below VA's National Income or Geographical-Adjusted Thresholds and/or receiving a VA pension.
Veterans who are employed and unemployed.
Veterans with both public and private insurances. Before using VA care, validate what care VA covers based on your particular circumstances, what care your insurance will cover, and what care you will have to pay out of pocket (cost share).
Veterans with one or more of the criteria listed above, and possibly other criteria not listed here. Legislation can change the criteria every year just as your personal circumstances change.
Why Might Women Veterans Be Underutilizing VA Health Care Services and Other Benefits? You Can Help Identify Them!
History sheds light on why some women veterans are not reaching in and accessing the care and benefits they earned from their military service. Going forward, there is an indisputable mandate for proactive and informed advocacy to ensure women veterans will have access to the full spectrum of health care services and benefits.
1980: The VA officially opened it doors to women veterans in 1980 and began providing medical and psychosocial services for women in 1988 when women represented 4.4 % of all veterans. Many women veterans who served prior to 1980 (32 years after women were legally integrated into the military in 1948) when the VA officially opened its doors to women veterans, are not aware they may be eligible for VA health care services and many other VA benefits. Because they were not considered veterans when they departed the military, and they were not necessarily officially notified of their legally-sanctioned access to VA, it is important to ask them: "Did you serve in the military?" Oftentimes they do not self-identify as a (military) veteran.
2008: Sixteen years later, the VA established a formalized gender-specific care training initiative to "interested" providers to enable them to become proficient in women's health care.
2014: Two-thirds of the VA Medical Centers have on site OB/GYN physicians, not all of whom are full time. Gender-specific care can, however, be fee-serviced out to community practitioners.
2016: About 10% (over 2 million) of military veterans are women. Women are the fastest growing population of veterans using the VA. In April 2016, 100% of military combat positions opened to qualified women. More will experience catastrophic, lifetime-altering physical and mental injuries.
2040: The percentage of women veterans projected to double by 2040.
Job-based Health Care Plans
A job-based health care plan could be health care coverage from a military veteran's employer or a family member's employer. Employers offering health care insurance may pay part or all of the insurance premiums. As with all insurance plans, it's important to know all possible out-of-pocket cost shares.
Even with job-based health care plans, you can explore other "Marketplace" health care plans.
Marketplace Insurance for Individuals & Small Businesses
Who Purchases Marketplace Insurance?
If you don't have health insurance through a job, Medicare, Medicaid, the Children's Health Insurance Program (CHIP), or another source that provides qualifying coverage, then the "Health Insurance Marketplace" is the site to access to explore insurance plan options.
Most people must have qualifying health coverage or pay a fee with their federal taxes unless they qualify for an exemption.
If you have job-based insurance: You can buy a plan through the Marketplace, but you'll pay full price unless your employer's insurance doesn't meet certain standards. Most job-based plans do meet the standards.
Changing from Marketplace insurance to Medicare: If you have a Marketplace plan, you can keep it until your Medicare coverage starts, and when you cancel, there is no penalty.
If you have Medicare: You cannot switch to Marketplace insurance, supplement your coverage with a Marketplace plan, or buy a Marketplace dental plan.
However, you can purchase a Medicare Supplement Insurance (Medigap) policy, sold by private companies. These Medigap policies vary depending on your particular circumstances and what health care costs they cover that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Learn about Medicare,the Marketplace, and Medigap insurance policies.
Important! The laws impacting Marketplace insurance and Medicare change. Visit the applicable sites to ensure you get the most current information about these plans and programs.
Enrollment in Marketplace Insurance Plans
Dates and Deadlines for Enrollment
Contacts
Call the Marketplace Help Center
External Website: USA Health Care
Public, Private, and Employer Plans for the Unemployed/Uninsured
To learn about health plans and medical insurance coverage and benefits programs for the unemployed and/or uninsured, visit these links:
COBRA (Consolidated Omnibus Budget Reconciliation Act)
When you lose job-based insurance, you may be offered COBRA continuation coverage by your former employer. The Department of Labor's "Employee's Guide to Health Benefits Under COBRA" explains employee options and rights under the COBRA program. Visit the Marketplace to explore whether or not you are eligible and interested in health plans other than COBRA.
Marketplace Health Insurance Plans
If you don't have coverage through a job, Medicare, Medicaid, the Children's Health Insurance Program (CHIP), or another source, the Marketplace helps you find and enroll in a plan that fits your budget and meets your needs.
You can apply online, by phone, or with a paper application.
Other Health Care Insurance Outside the Marketplace
Some individuals need or want to find private health plans available outside of the federal Health Insurance Marketplace that best meet their budget and personal requirements. Available insurance plans can be searched on the "Plan Finder."
Medicaid and the Children's Health Insurance Program (CHIP)
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost coverage to low-income people, families and children, pregnant women, the elderly, and people with disabilities, and other situations. Children may qualify for CHIP even if their parents don't qualify for Medicaid.
In addition to covering services like doctor's visits, prescription drugs, and preventive care, Medicaid helps seniors and people with disabilities receive long term services and supports in their communities as well as in nursing homes.
Application for Medicaid and CHIP
Each state has a unique name for their Medicaid program.
Consider VA Health Care As Well
A veteran may be eligible for comprehensive care through the Department of Veterans Affairs Women Health Services program. Eligibility for VA health care and any out-of-pocket cost sharing if any is primarily, but not exclusively, determined by an income means test and/or service-connected disabilities ratings.
If a veteran is eligible for VA care, and the required care is available and accessible, using VA health care services may be an federally-sponsored health care alternative to using state-sponsored health care services. A veterans' spouse and/or children may still need Medicaid assistance.
It's best to apply and let the VA assess your individual circumstances. Don't self-eliminate or allow "barracks counseling" to deter you from validating whether or not you are eligible for VA care. It costs you very little time to complete the application below.
VA "Application for Health Benefits"
Visit the national WomenVetsUSA VA Women Veterans' Health Care Program in this same section and Health Care Services to better understand how to apply for VA health care, who can help you with the application process, and what services VA offers.
External Website: Medicaid
Marketplace to Medicare: Turning 65 or Already 65?
If you're nearing 65 years of age, it's time to learn about Medicare and apply for benefits when allowed.
If you're already 65 and having a problem because you didn't switch from your insurance plan to Medicare, connect with the knowledgeable resources provided below.
Every person's situation is different. It's very important to talk with someone you can trust who will have the most current and accurate information to help you avoid losing affordable health coverage and future penalties.
Contacts
Find your State's Health Insurance Assistance Program (SHIP)
National State Health Insurance Assistance Program Help Center
Eldercare/Area Agencies on Aging Locator
Other Resources
External Website: National State Health Insurance Assistance Program Help Center
TRICARE: Continuing With TRICARE When Medicare Eligible
The following information is a very brief, not all-inclusive, overview of TRICARE for Life and the US Family Health Plan for Medicare-eligible beneficiaries. Because health care insurance coverages are detailed and impacted by individual circumstances, it is very important to research plans and communicate with health insurance and health care program customer service representatives to ensure you clearly understand their current coverages and your cost shares. Contact and resource links are posted at the end of this section.
Who is Eligible?
TRICARE for Life (TFL) is insurance coverage for TRICARE-eligible beneficiaries enrolled in Medicare A (Hospital Insurance) and Medicare B (Medical Insurance).
- Beneficiaries may include retired active duty, Reserve, Guard and their families, survivors, former spouses, Medal of Honor recipients, and others registered in the Defense Enrollment Eligibility Reporting System (DEERS). US Family Health Plan (USFHP)/TRICARE Prime beneficiaries who enrolled in or disenrolled from the program on October 1, 2012 or later are only eligible for TFL. See below for USFHP beneficiaries who enrolled September 30, 2012 or earlier.
US Family Health Plan (USFHP) is TRICARE Prime insurance coverage for TRICARE-eligible beneficiaries who enrolled and remained enrolled in USFHP September 30, 2012 or earlier and are entitled to Medicare A (Hospital Insurance) at age 65. (USFHP is TRICARE Prime offered in six specified service areas.)
- Beneficiaries may include retired active duty, Reserve, Guard and their families, survivors, former spouses, Medal of Honor recipients, and others registered in the Defense Enrollment Eligibility Reporting System (DEERS). These beneficiaries participate in the USFHP instead of the TRICARE for Life insurance plan.
When Does TFL or the US Family Health Plan Begin?
TRICARE for Life (TFL) coverage begins on the first day someone is enrolled in both Medicare Part A and B coverage. This may be at age 65 or older, under 65 with certain disabilities, or any age with ALS (Lou Gehrig's disease) or end stage renal disease (ESRD).
US Family Health Plan (USFHP) coverage continues when someone is enrolled in Medicare Part A (Hospital Insurance) at age 65 as long as the beneficiary was enrolled in USFHP September 30, 2012 or earlier and remained enrolled.
Key Points to Better Understand TRICARE for Life (TFL)
- TFL is a Military Health System program under the Defense Health Agency.
- TFL is Medicare wraparound insurance coverage for TRICARE beneficiaries enrolled in both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- TFL meets the requirements for minimum essential coverage under the Affordable Care Act.
- There is no enrollment/premium fee for TFL, but you must be enrolled in Medicare Part B and pay the monthly premium which is income based and may change by law annually in addition to paying prescription drug copayments.
- Medicare A and Medicare B are billed before TFL for "Medicare-participating" and "Medicare-nonparticipating" providers. For "opt-out" providers, Medicare is not billed and TFL may pay only about 20% of the allowable charge.
- TFL out-of-pocket costs vary depending on a) the type of service received and what Medicare and/or TRICARE will pay, b) whether or not you have Other Health Insurance (OHI) coverage, and c) who provided care--a Medicare-participating, Medicare-nonparticipating, or an opt-out provider.
Key Points to Better Understand Medicare
- Medicare is a federal entitlement health insurance program for people: a) age 65 or older, b) under age 65 with certain disabilities (ALS/Lou Gehrig's disease is included), or c) any age with end-stage renal disease (ESRD).
- Medicare A (Hospital Insurance) and Medicare B (Medical Insurance) are billed before TRICARE for Life, the Medicare wraparound insurance.
- Medicare A (Hospital Insurance) and Medicare B (Medical Insurance) are not billed by the US Family Health Plan. The US Family Health Plan covers care and Medicare "remains silent."
Key Points to Better Understand US Family Health Plan (TRICARE Prime)
- US Family Health Plan is a TRICARE Prime contract option within the Military Health System program under the Defense Health Agency. It is offered in six service areas.
- US Family Health Plan enrollees who remain in this plan after becoming entitled to Medicare A (Hospital Insurance), pay no enrollment/premium fees. Copayments for prescription drugs may be required.
- US Family Health Plan enrollees do not lose their Medicare entitlement.
- This plan meets the requirements for minimum essential coverage under the Affordable Care Act.
- Unlike TFL, the US Family Health Plan does not bill Medicare A (Hospital Insurance) and Medicare B (Medical Insurance). Instead, Medicare A and Medicare B "remain silent." Enrollees continue to receive care from approved network providers.
- Enrollment in Medicare B (Medical Insurance) is not required, but is strongly recommended to ensure medical insurance coverage if placed in a long-term care facility which the US Family Health Plan does not cover. Additionally, there is a substantial monetary penalty for not enrolling in Medicare B when first eligible and enrollment may be delayed until the annual open enrollment period.
- USFHP members are not allowed to use their Medicare benefit for services covered by the USFHP as noted in the member handbook. Services not covered by USFHP may be Medicare covered. Misuse of Medicare benefits could be a cause for USFHP disenrollment. Members are not allowed to enroll in Medicare-sponsored managed care plans (HMOs) while enrolled in the USFHP Plan.
Key Points to Better Understand VA Care if Eligible for Medicare and TFL or USFHP
- VA is NOT considered a health insurance plan. It is considered a medical/health care services program for eligible veterans.
- The Department of Veterans Affairs (VA) is NOT a Medicare provider and by law, CANNOT bill Medicare, but can bill Medicare supplemental health insurance for covered services. If you are eligible for both TFL and VA benefits and elect to use your TFL benefit to see a VA provider for non-service connected care, you will incur significant out-of-pocket costs. By law, TFL may only pay up to 20% of the TFL-allowable amount, which means the TFL beneficiary may be billed a substantial amount. Reference the TRICARE "TRICARE and Medicare Turning 65" brochure for further details.
- If a TFL/Medicare beneficiary wants to use the VA for care, be sure to check with the Wisconsin Physicians Service (WPS) which administers TFL and/or check with the servicing VA's billing and insurance contact to confirm coverage details--what will and will not be covered--before medical care, supplies, and/or prescriptions are rendered.
- If a USFHP/Medicare beneficiary wants to use the VA for care, be sure to check with US Family Health Plan "Member Services" to confirm a) a particular VA is in their provider network, b) if all or only specified providers in a particular VA are in their network, and c) what service and/or non-service connected care is covered before you receive medical care, supplies, and/or prescriptions.
Other Resources
Contacts
Family Member and Survivor Health Care Programs (Department of Veterans Affairs)
Civilian Health and Medical Program of VA (CHAMPVA)
Certain family-members and survivors (spouse, widow or widower, child) can receive medical expense reimbursements for the following: inpatient and outpatient care, mental health, skilled nursing care, durable medical equipment and prescription medication.
Contact Information
CHAMPVA telephone assistance: 1.800.733.8387
Write: VA Health Administration Center, CHAMPVA, P.O. Box 469028, Denver CO 80246
Stay Current and Learn More About CHAMPVA
CHAMPVA Eligibility Criteria and Other Program Information
VA Dental Insurance Program (VADIP)
CHAMPVA beneficiaries have the opportunity to purchase dental insurance at reduced rates under VA Dental Insurance Program.
Contact Information
MetLife telephone assistance: 1.888.310.1681
Delta Dental telephone assistance: 1.855.370.3303
Stay Current and Learn More About VADIP
Eligibility and other program information: