How Medicare works with VA benefits and TRICARE

photo of a man in the military hugging a women

As a veteran, when you become eligible for Medicare, you may already have other insurance through Veterans Affairs (VA) or TRICARE. Because of this, you may be wondering if you need Medicare, too. The short answer? It’s all about what works for you. Medicare can add another layer of coverage, cost savings, and convenience if you already have VA benefits or TRICARE. Here’s how.

VA benefits and Medicare enrollment

You can be enrolled in benefits through Veterans Affairs (VA) and Medicare at the same time. Having both gives you more options for care, as well as the flexibility and freedom to choose providers within the VA or with a non-VA provider in your Medicare network. Plus, Medicare Advantage plans can come with extra benefits that most veterans don’t receive through the VA, such as over-the-counter allowances and transportation benefits.

How Medicare and VA benefits work together

Although you can have benefits through Veterans Affairs (VA) and Medicare, you’ll need to choose which benefits you want to use when receiving care:

  • To use your VA benefits, you must visit a VA doctor or VA medical facility. The VA may also cover care at a non-VA facility if it’s preauthorized.
  • To use your Medicare benefits, you must receive care at a Medicare-authorized facility. In some cases, Medicare may also be able to pay for services the VA has not authorized.

What Medicare does and doesn’t cover will depend on your plan, where you’re receiving care, and which benefits you plan to use — if you can use both.

TRICARE and Medicare enrollment

As a veteran, your coverage under TRICARE ends once you become eligible for Medicare. That means you’ll need to enroll in Medicare Parts A and B during your Initial Enrollment Period to avoid any lapse in TRICARE coverage. When you enroll in Medicare Parts A and B, TRICARE will automatically switch to TRICARE For Life (TFL). TFL acts as supplemental coverage for your Medicare plan. That means Medicare is your primary payer and covers what it owes on your bill first, while TFL reduces or eliminates out-of-pocket costs for deductibles, coinsurance, and copayments.

How Medicare and TRICARE work together

When you have Medicare and TRICARE For Life, you can visit any authorized provider. Here’s how the two work together to pay your health care costs:

  1. The provider will file the claim(s) with Medicare.
  2. Medicare will then pay the portion it’s responsible for and send the claim to the TRICARE For Life claims processor.

TRICARE For Life will pay its portion directly to the provider for the services TRICARE covers.

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Highmark Choice Company, Highmark Senior Health Company, and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company, and HM Health Insurance Company depends on contract renewal.

Health benefits or health benefit administration may be provided by or through Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Senior Health  Company, Highmark Senior Solutions Company, or Highmark Health Insurance Company, all of which are independent licensees of the Blue Cross Blue Shield Association.  All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.