Medical Care for Military Veterans and Retirees

When you were in the service, healthcare for you and members of your family was likely a given. Depending on when you served, your medical care was provided directly at facilities on a military base or possibly contracted to off-base providers.

Even though you are no longer a member of the armed forces, there are healthcare options available to you, whether you served a few years or until retirement from the military. Here’s what you need to know about the differences between these two scenarios, what healthcare is offered, and how you can take advantage of what’s available to you.

Military Veteran vs. Retired Military Veteran

If you served any length of time in the active military and were discharged “under conditions other than dishonorable,” you are a military veteran. If you made a career of it and spent 20 years or more in the armed forces, National Guard, or Reserves, or were honorably discharged due to a physical disability, you are a retired military veteran.

Depending on other factors, however, status as a veteran can mean many different things when it comes to benefits. This is especially true when it comes to medical care.

Military Veterans

If you are a former member of the active-duty military with an “other than dishonorable” discharge, regardless of the amount of time you served, you may be eligible for healthcare benefits provided by the U.S. Department of Veterans Affairs (VA).

If you qualify for VA healthcare, your coverage and the amount you pay, if anything, will depend on a number of factors including when you served, any service-connected disabilities you have, your income, and other benefits you may be receiving.

How to Apply for VA Benefits

The first part of applying for VA benefits involves answering questions to determine your eligibility via the VA Health Benefits Explorer. This online tool asks no more than 15 questions and responds with a general finding of your eligibility.

After using the VA Health Benefits Explorer to get a general idea of your eligibility, you can apply for benefits online and receive an official determination from the Veterans Administration. Even if you are initially not eligible for VA healthcare benefits, the VA encourages you to apply online using the 10-10EZ form online. This way, if the law changes you will be notified of the effect of those changes on your application. If your income decreases or deductions increase, you should update your financial information by submitting 1010EZR.

Eligibility

In addition to the active-duty requirement to receive VA benefits, if you enlisted after September 7, 1980, or entered active duty after October 16, 1981, you must have served 24 continuous months or the full period for which you were called to active duty unless one of the descriptions below is true for you:

• You were discharged for a disability that was caused—or made worse—by your active-duty service.
• You were discharged for a hardship or “early out.”
• You served prior to September 7, 1980.

Current or former members of the Reserves or National Guard only qualify for VA healthcare if they were disabled from a disease or injury incurred or aggravated in the line of duty or while training, or if they were called to active duty by a federal order and they completed the full term of that order. Annual and weekend training does not qualify as active duty status.

If you are not eligible for VA benefits due to receiving an other-than-honorable, bad conduct, or dishonorable discharge, you have two options to try to qualify:

• Apply for a discharge upgrade.
• Complete a Character of Discharge review.

Priority Groups

Assuming you are otherwise eligible for VA healthcare, during the application process you will be assigned to one of eight priority groups. Your priority group will determine which, if any benefits you are eligible to receive, how soon you will be cleared for healthcare benefits, and how much, if anything, you will pay for healthcare services.

Your assignment to a priority group will be based on the following factors:

• Your military service history
• Your disability rating
• Your income level
• Whether or not you qualify for Medicaid
• Other benefits you may be receiving (such as VA pension benefits)

If you qualify for more than one priority group, the VA will place you in the highest one.

Priority Group 1

You may be assigned to priority group 1 if any of the following is true:

• You have a service-connected disability rated as 50% (or more).
• You have a service-connected disability that makes you unable to work.
• You received the Medal of Honor (MOH).

Priority Group 2

Assignment to priority group 2 is based on a service-connected disability rated as 30% or 40% disabling.

Priority Group 3

You may be assigned to priority group 3 if any of the following applies to you:

• You are a former prisoner of war (POW).
• You received the Purple Heart medal.
• You were discharged for a disability that was caused by or got worse because of your active-duty service.
• You have a service-connected disability rated as 10% or 20% disabling.
• You were awarded special eligibility classification under Title 38, U.S.C § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”

Priority Group 4

You may be assigned to priority group 4 if either of the following applies to you:

• You are receiving VA aid and attendance or housebound benefits.
• You have received a VA determination of being catastrophically disabled.

Priority Group 5

You may be assigned to priority group 5 if any of the following is true:

• You don’t have a service-connected disability, or you have a non-compensable service-connected disability that the VA has rated as 0% disabling, and you have an annual income level below VA income limits (based on zip code).
• You are receiving VA pension benefits.
• You are eligible for Medicaid.

Priority Group 6

You may be assigned to priority group 6 if any of the following are true:

• You have a compensable service-connected disability that has been rated as 0% disabling.
• You were exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki.
• You participated in Project 112/SHAD.
• You served in the Republic of Vietnam between January 9, 1962, and May 7, 1975.
• You served in the Persian Gulf War between August 2, 1990, and November 11, 1998.
• You served on active duty at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987.

Priority Group 7

You may be assigned to priority group 7 if both of the following are true:

• Your gross household income is below the geographically adjusted income limits (GMT) for where you live.
• You agree to pay copays.

Priority Group 8

You may be assigned to priority group 8 if both of the following are true:

• Your gross household income is above VA income limits and geographically adjusted income limits for where you live.
• You agree to pay copays.

If you’re assigned to priority group 8, your eligibility for VA healthcare benefits will depend on which sub-priority group you are placed in. There are 6 sub-priority groups based on whether you have a service-connected condition when you enroll for VA healthcare benefits and your income.

VA Healthcare Benefits

The healthcare benefits you will receive as a veteran will vary and depend on your medical condition and priority group. In general, you will receive the following:

• Treatment of illnesses and injuries
• Prevention of future health problems
• Improvement in your ability to function
• Enhancement of your quality of life

All veterans receive coverage for most care and services. Not everyone will qualify for added benefits such as dental care. Your specific care will depend on these three factors:

• Your priority group
• The advice of your VA primary care provider
• Standard medical treatment for any condition you may have

You should also know that being signed up for VA healthcare meets your Affordable Care Act (ACA) health coverage requirement of having “minimum essential health coverage.”

Cost of VA Healthcare

If you have a service-connected illness or injury, you may qualify for free VA healthcare. You may also qualify for free care if you have a catastrophic disability or disability rating of at least 50%, or if the VA determines you can’t afford to pay for care.

Certain other services are also offered for free, including readjustment counseling, related mental health services, care for issues related to military sexual trauma (MST), or other health problems linked to military service.

If none of the above apply and you qualify for healthcare, you may be required to pay a fixed amount known as a copay for certain types of services, tests, or medications.

Whether or not you’ll need to pay copays depends on your disability rating, income level, military service record, and which of the VA’s eight priority groups you are assigned to.

Retired Military Veterans

Retired members of the military receive medical care under the same system as active-duty military: TRICARE. As the current worldwide U.S. military healthcare program, TRICARE provides exclusive medical, pharmacy, and dental coverage to uniformed service members, retirees, and their families. TRICARE’s healthcare plans provide two basic types of care:

• Direct care at a military treatment facility (MTF)
• Purchased care at a civilian provider contracted by the Department of Defense (DoD).

According to the Defense Health Agency (DHA), approximately 60% of healthcare services are purchased, with 40% provided by MTFs. The amount of purchased care is expected to rise in the future.

Retired Active Duty Military

Retired active duty service members and their families are eligible for the following TRICARE health plans:

• TRICARE Prime
• TRICARE Select
• US Family Health Plan (in specific U.S. locations)
• TRICARE For Life (if you have Medicare Parts A & B coverage)
• TRICARE Select Overseas

Adult children who “age out” at 21 (or 23 if attending college) may qualify to purchase TRICARE Young Adult.

In addition, you and your family members may be eligible for the Federal Employees Dental and Vision Insurance Program (FEDVIP).

Medically Retired Active Duty Military

If you are placed on the temporary disabled retirement list (TDRL) due to both:

• A physical condition, injury, or disease that renders you unfit for military service, and a
• A disability rating of at least 30%, separate from the one given by the VA,

you will be evaluated at least once every 18 months for up to five years. If your situation has improved, you may be returned to active duty. If it has stayed the same or gotten worse, you could be:

• Retained on the TDRL; or
• Separated from service; or
• Placed on the permanent disability retirement list (PDRL)

As long as you are on the TDRL or PDRL, you and your family members remain eligible for TRICARE benefits for retired active duty service members (see above).

If your Service disability rating is less than 30% and you’re separated from active duty, you may qualify for transitional healthcare benefits including:

• Transitional Assistance Management Program (TAMP)
• Continued Health Care Benefit Program (CHCBP)

Retired National Guard or Reserve Members

Your healthcare benefits as a retired member of the National Guard or Reserves depend on your age.

Under Age 60

If you are under the age of 60, you and members of your family may qualify to purchase TRICARE Retired Reserve.

• If you purchase TRICARE Retired Reserve and you have adult children who “age out” at 21 (or 23 if attending college), they may qualify to purchase TRICARE Young Adult.
• You may be eligible for dental coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP).
• If you don’t purchase TRICARE Retired Reserve, you will not be eligible for any other TRICARE plan until you turn 60.

Age 60 and Older

Once you reach 60, you and your family are eligible for the same benefits available to active duty retired service members, which vary based on where you live.

If you live in the United States, you can enroll in:

• TRICARE Prime
• US Family Health Plan
• TRICARE Select
• TRICARE For Life (with Medicare Part A & Part B)

If you live outside of the United States, your choices include: 

• TRICARE Select Overseas
• TRICARE For Life (if you have Medicare Part A & Part B)

No matter where you live:

• Your adult children who “age out” at 21 (or 23 if attending college) may qualify to purchase TRICARE Young Adult.
• You may be eligible for dental coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP).

Retired Military Healthcare Benefits

The TRICARE Covered Services webpage includes information on all covered services and procedures including medical care, dental, mental health, pharmacy, vision, and more. Use the page to search by keyword or category.

Cost of Retired Military Healthcare

Your healthcare costs as a retired military veteran depend on your status and your TRICARE health plan. To determine your cost, use the TRICARE Compare Costs Tool.

Using the tool and drop-down menus, select your plan, status, and when you enlisted or were appointed, in that order. Then click on the View Costs link. This will generate a chart showing costs, including enrollment fees, deductibles, copays, and more.