Veterans Benefits Administration: Health, Disability and TRICARE
According to the U.S. Census Bureau, there are approximately 18 million veterans in the country, and around half are age 65 or older.
While the United States has a long history of providing various programs and benefits for its military veterans, the Department of Veterans Affairs (VA) was first established as its own agency in 1930. It was made a Cabinet-level agency with a Secretary in 1989. The VA is made up of the Veterans Benefits Administration (VBA), the Veterans Health Administration (VHA) and the National Cemetery Administration (NCA).
Today, the VA and its various agencies provide and oversee a wide range of benefits for eligible military veterans. That includes health care and cemetery services as well as numerous financial and support benefits. Find out more about what these organizations offer and who qualifies for various VA benefits below.
What Is Offered by the Veterans Benefits Administration?
The Veterans Benefits Administration does not actually provide health services. Instead, this is the agency that oversees registration for veterans benefits and determines eligibility for certain programs. Not all VA benefit programs are available to every person who served any time in the military — some programs require that you were discharged other than dishonorably, and certain benefits might vary depending on how long you served, whether you served during wartime or where you served.
The Veterans Benefits Administration is also tasked with carrying out programs to provide eligible vets with some benefits that aren't medical in nature. Those benefits are related to life insurance, home loan services, vocational rehab, pension and education. These are covered in more depth in the last section of this document.
Understanding VA Health Benefits
The Veterans Health Administration provides health care services and benefits for eligible vets. VA health benefits work differently than insurance health benefits that many people receive through their employers or via marketplace plans they purchase themselves. That's because the VHA is actually a health care system.
Where Do Beneficiaries Receive Care Under VHA Benefits?
The VHA provides health services at around 2,000 facilities, including outpatient centers and hospitals, across the country. It provides services to around 9 million veterans every year, which is about half of all vets in the nation.
The medical benefits package differs slightly for each eligible veteran but does include basics such as:
- Treatment for injury
- Treatment for illness
- Preventative health care
- Treatments that help improve function or quality of life, such as physical therapy
Some veterans may also receive benefits packages that include additional services such as dental, eyeglasses or long-term care services.
Some services not covered under VHA benefits include cosmetic surgeries that aren't deemed medically necessary, gender alteration, abortion and medicines not approved by the FDA (unless under very specific circumstances).1
Does VHA Care Coordinate With Other Types of Insurance?
Yes, VA health coordinates with other types of insurance, but it's a bit more complex than the traditional "who pays first?" question. In some cases, if you have VA health benefits and a certain type of insurance, it's more a question of where you should get medical care in each instance.
Some of the details about VHA care coordination with insurance plans is detailed below. However, it's a good idea to talk to billing or admissions offices when you're planning health care services. This helps you understand what might be covered, how it will be covered and what you might owe out of pocket.
What Insurance Does the VA Bill?
Providers offering services under the VHA umbrella to qualified veterans will bill private insurance companies or Medicare supplemental plans for covered services. They do not bill Medicaid or Medicare Part A plans.2
If you want to use health coverage under Medicare Part A or Medicaid, you must seek services from a non-VA hospital or provider. Individuals who have these coverages and are qualified to seek benefits from the VA can often make a choice on where to seek benefits so that they get the care they need at the lowest potential cost to them.2
How Do Coordination of Benefits Work When the VA Bills Your Insurance?
What services you qualify for from the VHA and how much you pay for them depends in part on your priority status and what benefits package you have. Some treatments may come with a co-pay.
If you present an insurance card when seeking services at a VA hospital, the VA will bill that provider. The provider pays first, and your VA benefits kick in second. In some cases, that can mean that your health insurance helps offset some or all of the VA co-pay amount you would otherwise have had to pay.2
Again, how this process plays out can vary according to coverage and treatment details. When making decisions about where to get your care, consider consulting your VA benefits specialist or the billing expert with the provider.
Should You Carry Insurance If You Have VA Benefits?
If you already have VA benefits, you might wonder if it's even important to apply for insurance or Medicare or pay for it if your employer offers a sponsored plan. These are personal decisions you have to make for yourself, but the Department of Veterans Affairs notes the following reasons for keeping or getting health care coverage when you can:
- VA benefits are, unfortunately, not guaranteed for life. They rely on funding by the federal government. Should the federal government reduce funding—or should more people register for VA health benefits, people with lower priority levels might not be able to access care as needed.2
- Having insurance coverage can reduce the overall cost to you for services if you have a VA co-pay.3
Who Is Eligible for VA Health Care?
To be eligible for health care benefits through VHA, you must have met minimum duty requirements or an exception and have been discharged honorably.4
For people who enlisted after September 7, 1980 or who enlisted before that but didn't enter active duty until October 18, 1981 or after, the minimum duty requirement is 24 consecutive months or a full period of active duty. You can be eligible without meeting these requirements if you fall under one of the following exceptions:
- A disability caused or impacted by your active duty required you to be discharged
- You received an "early out" or hardship discharge
- You served actively before September 7, 1980
Reserves or National Guard members who have been called to active duty in a federal capacity and completed that service may also be eligible for benefits.4
VA Health Benefits for Family Members
Those who are qualifying family members of veterans, including spouses or surviving spouses, family caregivers and dependent children, may qualify for some health care benefits under numerous plans and programs. Those include:5
- TRICARE, which is the health insurance program for active-duty military members and their qualifying family
- CHAMPVA, which provides health insurance for dependent children or spouses of veterans who were disabled or killed in the line of duty
- The Program of Comprehensive Assistance for Family Caregivers, which provides some financial and health benefits for qualifying veteran caregivers
- The Camp Lejeune Family Member Program, which provides health care coverage for vets or family members who might have been impacted by poor drinking water at Camp Lejeune between 1953 and 1987
- The Spina Bifida Health Care Benefits Program, which provides some services to qualifying biological children of Vietnam or Korean war vets if those children have been diagnosed with spina bifida
- The Children of Women Vietnam Veterans Health Care Benefits Program, which provides benefits to biological children of female Vietnam war vets if those children have been diagnosed with certain birth defects
How Do You Enroll in VA Health Care?
You can apply for VA health care benefits online, in person or by mail or phone. To apply online, visit the VHA's online application page.
To apply, you will need the following information or documents:
- Your Social Security number
- Your DD214 or other discharge papers
- Your most recent tax return
- Financial information for yourself and your dependents
- Group or account numbers for any existing insurance coverage you have
To apply by mail, download the VA Form 10-10EZ in PDF format6. Print it and complete it. Mail it as instructed on the form with any necessary documentation.
To apply in person, download the same form and complete it. Bring it to the nearest VA medical center to you and let them know you want to apply.
To apply via phone, call (877) 222-8387. Reps are available from 8 a.m. to 8 p.m. EST every weekday to assist you.7
You typically hear back about whether you're eligible for benefits within one week.8
Understanding VA Disability Benefits
The VA offers some disability benefits to veterans who sustained a disability during or because of military service. The benefit is also available for qualifying vets who had a condition that was made worse by service. The benefit is a monthly payment. The monthly compensation is tax free.9
Who Is Eligible for VA Disability Benefits?
First, you must have served in inactive duty training or activity duty (for training or otherwise) and been discharged honorably or other than dishonorably. You must also meet at least one of the following requirements:10
- An injury or illness due to your service that led to a disability
- A condition that you had before military service was made worse by your service
- A disability related to your service appeared after your service was over
Are There Benefits for Family Members?
Spouses, parents or children of veterans who died due to an injury or illness sustained during service or because of a service-related injury may be eligible for benefits payments. These payments are known as VA Dependency and Indemnity Compensation (VA DIC).11
To qualify as a spouse, you must have met at least one of the follow criteria:11
- Married the vet prior to 1957
- Married the vet no more than 15 years after they were discharged from the service that related to their disability
- Been married at least a year
- Had a child with the vet and not been remarried, plus meet some requirements for not being at fault in a separation if there was any
To qualify as a surviving child, you must be under age 18 or under age 23 if you're still in school. You must also not be married and not be included on any compensation provided to the surviving spouse.11
To qualify as a surviving parent, you must demonstrate that you're the foster, adoptive or biological parent of the vet and that your income is below the threshold for benefits.11
Surviving spouses and children can reach out to their military casualty assistance officer for assistance applying for DIC. They can also complete a VA Form 21P-534EZ12. Surviving parents can complete a VA Form 21P-53513
How to Apply for VA Disability Benefits
To make a disability claim, you'll need supporting documents demonstrating the disability. Evidence might include medical records and supporting statements from friends, family, those you have served with or others who can speak to your condition.14
You can file a claim online on the VA's website or in person at a VA regional office. You can also print VA Form 21-526EZ 15, complete the application and mail it and supporting documents to Department of Veterans Affairs, Claims Intake Center, PO Box 4444, Janesville, WI 53547-4444.14
What Is TRICARE and Who Qualifies for It?
TRICARE is not a veterans administration benefit. It's a program offered by the U.S. Department of Defense Military Health System that provides health care coverage for active and required military service members and their qualifying family.16
TRICARE offers a number of plans, and most of them do meet the requirements of the Affordable Care Act. They can include comprehensive medical coverage, dental and prescription coverage as well as some special programs.16
Who Is Eligible for TRICARE?
TRICARE eligibility ranges fairly wide, but it can be complex to understand. There are two major types of people who can be eligible for TRICARE coverage. The first are sponsors, which are the military members themselves. They can qualify for TRICARE themselves, but they can also sponsor eligible family members, which include children, spouses and dependent parents or in-laws.17
To be eligible as a sponsor, you must be an active, retired or reserve member of the U.S. military or the National Guard or a Medal of Honor recipient.
To be eligible as a family member, you must be a child or survivor, a current or former spouse or a dependent parent of a sponsor. You must also be registered in the Defense Enrollment Eligibility Reporting System (DEERS).17
DEERS automatically includes all eligible sponsors18. Sponsors can make changes to their eligible family members listed in DEERS at a local ID card office19.
Whether you're a sponsor or a family member, the types of TRICARE plans and coverage you qualify for varies. For example, active duty service members can choose to enroll in TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas or TRICARE Prime Remove Overseas. Their family members can enroll in one of several plans, including options such as TRICARE Young Adult, US Family Health Plan or TRICARE Select.20
Take the time to consider the plans available to you, whatever your status is, and get help understanding plan language if you're not sure which is right for you.
How Do You Enroll in TRICARE?
If you qualify for TRICARE coverage, you can enroll in and purchase a plan online, via phone or via mail or fax. The TRICARE website offers a list of all available plans with details for applying for each.21
Typically, you apply online at the milConnect website. You can call regional contractors to apply via phone, and you can also download an enrollment form online and mail or fax it to the regional contractor.21
Like many health care plans under the ACA, TRICARE has an open enrollment period. It runs from November 9 through December 14. During this time, you can enroll in a plan if you're not already covered by one or change plans.22
The only time you can enroll in a TRICARE plan outside of the open enrollment period is if you have a qualifying event, which can include a death in the family, a change of jobs, a change in sponsor status (such as separation from active duty) or losing or gaining other health insurance.
Other qualifying events include a change in station, such as being moved overseas or government-directed changes that impact coverage.23
Does TRICARE Coordinate With Medicare?
TRICARE provides a secondary insurance plan that coordinates with Medicare. If someone who is eligible for TRICARE becomes eligible for Medicare Parts A and B, they can change their TRICARE plan to TRICARE for Life.
This plan is designed specifically to supplement Medicare coverage, which means it may pick up some or all of the deductible and coinsurance costs left after Medicare pays for eligible health care services.
You must change your TRICARE plan within 90 days of becoming eligible for Medicare if you want to use your plans in this way. However, if you are enrolled in TRICARE Prime, you can choose to keep it as your primary insurance.24
Other VA Benefits and Related Sources
In addition to health care benefits, the VA offers a number of benefits for eligible veterans. Plus, many other organizations offer resources for retired military personnel across the nation.
Housing Benefits and Resources
The VA provides a wide range of housing benefits for vets, including VA-backed home loans. These loans are provided via private lenders, and vets must still go through the process of getting approved for a mortgage.
But if you're eligible for a VA-backed loan, you may benefit from lower interest rates for approval when you might not have gotten it alone. That's because the VA backing reduces some of the risks for the lender, making them more willing to approve mortgages for qualifying vets or surviving family members.25 Many times, VA-backed mortgage loans require no down payment26.
VA-backed loans come in a variety of types, including:25
- Purchase loans for the purpose of buying a new home
- Interest Rate Reduction Refinance Loans, which let you potentially lower your interest rate by refinancing a VA-backed loan you already have
- Cash-out refi loans, which let you cash out equity in your home by refinancing it
- Native American Direct Loan Program, which provides benefits to Native American vets
- Adapted housing grants, which help vets build or adapt a home to fit the needs created by a disability
The VA also provides financial counseling for veterans. That includes counseling for vets who are struggling to make mortgage payments and would like some guidance in how to avoid foreclosure.27
Some other housing resources for veterans include:
- The National Coalition for Homeless Veterans, which assists veterans in need of emergency housing28
- The Support Services for Veterans Families, which provides local organizations with grants for the purpose of supporting housing for vets29
- The Armed Forces Retirement Home, which supports retirement homes for veterans30
Mental Health Benefits and Resources
Individuals who qualify for health care by the VHA can access counseling for mental health and substance abuse issues at VA hospitals and outpatient centers or provider offices. VA community-based outpatient clinics31 and Vet Centers32 often have on-staff counselors or can help vets arrange counseling via individual or group sessions.
Some other mental health and substance abuse resources for veterans include:
- The Veterans Crisis Line, which you can call at (800) 273-8255 anytime for support33
- Military OneSource, which provides free, confidential counseling to vets34
- The Veterans Alcohol and Drug Dependence Rehabilitation Program, which provides assistance to veterans dealing with addiction35
Education Benefits and Resources
Eligible veterans can take advantage of the GI Bill, which provides financial assistance in paying for school or job training after someone has served on active duty in the military. Other programs, including the Yellow Ribbon Program, Tuition Assistance Top-Up and $600 Buy-Up program help eligible veterans pay for educational expenses that aren't covered by GI Bill funding.36
Eligibility for VA education benefits is different for each program. The VA provides a list of requirements for various programs and links to applications on its website.37
Career and Employment Benefits and Resources
The VA offers a number of resources to vets who are transitioning out of the military and into the public sector for employment.
These are called Chapter 31 programs, or Vocational Rehabilitation and Education. They cover a wide range of supports, including helping veterans find a new job or start a business. Educational counseling and help learning new skills for the purpose of getting employed are also included. Eligibility for some programs is limited to those with disabilities.38
Other resources for career and employment for vets include programs such as:
- Helmets to Hardhats, which helps former military members find work in construction39
- Troops to Teachers, which helps vets find employment in educational careers40
- The Veterans Employment and Training Service (VETS), which is a program from the U.S. Department of Labor41
Burial and Memorial Benefits and Resources
The VA and United States Military offers several options for memorializing eligible veterans. The exact benefits that someone qualifies for depends on their discharge status and service, but some common burial-related benefits include:
- The cost of a headstone or marker covered through the VA
- A burial allowance to help cover the costs associated with burial; allowances for vets who died after October 1, 2018 are $300 for burial and $780 for plot. The allowance is more for those who died related to a service injury or illness.42
- Burial flags and Presidential Memorial Certificates to honor the veteran43
- Potential options for burial in a national cemetery and/or honor guard presence at a burial or memorial service
From health care to death care, the Department of Veterans Affairs provides a wide range of benefits and assistance programs for former military service men and women. Educating yourself about these programs can help ensure that you take advantage of them to reduce the costs of daily life and help protect your health and overall wellness.