Disabled veteran or family member? Here’s the short version: keep VA health care, and layer on TRICARE (if eligible), Medicare at 65, or Medicaid/ACA based on income and needs. Use our table and checklists to pick the mix that gives you the widest access at the lowest cost—with 2025 rules and links.
What counts as “health insurance” vs VA health care?
VA health care is not traditional insurance—it’s a federal health care system with its own facilities, networks and eligibility rules. You can use VA care alone, or combine it with insurance such as TRICARE, Medicare, Medicaid, employer plans, COBRA, or an ACA Marketplace plan. VA says you can have VA care and other coverage; they simply don’t pay for the same service at the same time. Veterans Affairs+1
Bottom line: Think of VA care as your base. Add other coverage to expand provider choice outside VA and to reduce out-of-pocket costs.
VA health care for disabled veterans (eligibility, costs, extras)
Eligibility. You may qualify if you served in the active military, naval, or air service and didn’t receive a dishonorable discharge. The PACT Act expands and extends eligibility for many veterans with toxic exposures. Veterans Affairs+1
Source: VA, last checked: September 17, 2025.
Costs & priority groups. VA assigns you to a priority group; disabled veterans generally fall into higher groups. In 2025, copay policies remain tied to your group and whether care is service-connected. Veterans with 50%+ service-connected ratings (Priority Group 1) generally owe no copays for any care, tests, or medications. Veterans with 10%+ ratings typically owe no outpatient/inpatient copays. See current VA copay tables for details. Veterans Affairs+2Veterans Affairs+2
Source: VA, last checked: September 17, 2025.
Community care (MISSION Act). If VA can’t provide the care you need, you may be eligible for community care—VA-paid care from non-VA providers—with a VA referral. Eligibility includes factors like appointment wait times, available services, or excessive drive time. Veterans Affairs+2Veterans Affairs+2
Source: VA, last checked: September 17, 2025.
Dental & vision. VA covers routine eye exams; some veterans also qualify for eyeglasses or low-vision rehab. Dental benefits are more limited and depend on your class (e.g., Class I for service-connected dental disability allows any needed dental care). If you’re not eligible for comprehensive dental, consider VADIP (discounted private dental plans for VA enrollees). Veterans Affairs+3Veterans Affairs+3Veterans Affairs+3
Source: VA, last checked: September 17, 2025.
Bottom line: Enroll in VA health care if you’re eligible; it’s usually the most affordable foundation for service-connected issues and many routine needs.
TRICARE vs. CHAMPVA: who gets which?
TRICARE is DoD’s health program for active duty, retired (including medically retired) service members, and their eligible family members. Eligibility is set by the uniformed services; plan options vary by status (Prime, Select, TRICARE For Life at 65+ with Medicare A & B). Tricare+2Tricare+2
CHAMPVA (VA program) is for spouses, dependents, and survivors of veterans who are 100% Permanent & Total (P&T) disabled due to service, or who died from service-connected conditions—but only if they aren’t eligible for TRICARE. For beneficiaries eligible for Medicare, Part A & B (or MA) are required to keep CHAMPVA. Veterans Affairs+2Veterans Affairs+2
Source: VA & TRICARE, last checked: September 17, 2025.
TRICARE For Life at VA facilities. TFL coordinates with Medicare; at VA facilities, rules differ—VA and Medicare generally can’t both pay for the same service. TRICARE explains when to use VA vs Medicare/TFL. Tricare
Source: TRICARE, last checked: September 17, 2025.
Bottom line:
- If you’re retired military/medical retiree: TRICARE is primary outside VA (and TFL after 65).
- If you’re not TRICARE-eligible, but your veteran spouse/parent is 100% P&T: CHAMPVA is usually the right family coverage.
Medicare + VA: how they work together
You can have both Medicare and VA benefits. You simply choose which benefit to use for each visit. Medicare and VA generally don’t pay for the same service. That’s why veterans are strongly encouraged to enroll in Medicare Part A and B at 65 (unless covered by active employment). Medicare
- Who pays first? If you get care at a non-VA provider, Medicare processes first (then any secondary you have). Care at a VA facility is covered by VA, not Medicare. Medicare
- Drug coverage: VA pharmacy works for VA-authorized prescriptions. Part D covers non-VA prescriptions; many vets skip Part D if they rely on VA pharmacy, but consider travel, non-VA specialists, and late-enrollment penalties. (Discuss with SHIP counselor.) Medicare
Source: Medicare.gov, last checked: September 17, 2025.
Bottom line: At 65, keep VA and add Medicare A & B to maximize access to non-VA providers.
Medicaid and ACA Marketplace options
- Medicaid/CHIP: Veterans can qualify; VA benefits aren’t counted as income in MAGI determinations. Medicaid can help with costs not covered elsewhere and long-term services. Check your state. Medicaid
- ACA Marketplace (HealthCare.gov): If you’re not enrolled in VA/TRICARE/CHAMPVA, you can shop for subsidized plans. VA/TRICARE/CHAMPVA are minimum essential coverage (MEC); if enrolled, you won’t qualify for premium tax credits. Open Enrollment typically runs Nov 1–Jan 15; Special Enrollment Periods apply for life events. HealthCare.gov+2HealthCare.gov+2
Source: HealthCare.gov, last checked: September 17, 2025.
Bottom line: If you lack VA or other coverage, the Marketplace may offer affordable plans (especially with subsidies). If you have VA, you usually don’t need Marketplace coverage.
Employer plans & COBRA after separation or job loss
If you have employer coverage, you may keep it with VA care. After job loss or reduced hours, COBRA lets you continue your employer plan temporarily (usually up to 18 months)—but you’ll likely pay the full premium plus a small admin fee. DOL+1
Source: DOL & USA.gov, last checked: September 17, 2025.
Bottom line: COBRA can bridge gaps, but compare against TRICARE/CHAMPVA/Marketplace costs before electing.
Choosing the right mix: side-by-side comparison (2025)
| Option | Who’s eligible (high level) | Where you can use it | Typical costs | Plays well with… | Best for |
|---|---|---|---|---|---|
| VA health care | Qualifying veterans (service & discharge; PACT Act widened access) | VA facilities; community care with referral | Often lowest; no copays for many with 50%+ ratings | Can use with Medicare/Medicaid/employer plans (not for same service) | Service-connected issues; low-cost core care |
| TRICARE | Active duty/retired/medical retirees & families (DoD decides) | Broad civilian networks; some plans require PCM/referrals | Premiums/cost-shares vary; TFL wraps Medicare at 65 | Works alongside VA; special rules at VA facilities | Retired military families; consistent national network |
| CHAMPVA | Spouses/children/survivors of 100% P&T vets (not TRICARE-eligible) | Civilian networks; can use at VA under specific circumstances | Cost-share program; Medicare A&B required if eligible | Can pair with Medicare; independent of TRICARE | Families of P&T vets without TRICARE |
| Medicare (A/B, MA, D) | 65+ or disabled via SSDI | Any Medicare-participating providers | Part B premium; cost-sharing; MA/D vary | With VA (choose one per visit); TFL for retirees | Non-VA access at 65+; traveling veterans |
| Medicaid/CHIP | Income-based; varies by state | State networks | Minimal premiums; very low cost-sharing | Can have with VA; income rules apply | Low-income vets & families |
| ACA Marketplace | U.S. residents not enrolled in MEC (VA/TRICARE/CHAMPVA are MEC) | Plan networks by state | Subsidized premiums/out-of-pocket for eligible | Can hold instead of VA (if not enrolled) or alongside for dependents | Vets not enrolled in VA or covering family members |
| Employer/COBRA | Through employment; COBRA after qualifying event | Employer plan network | Employee contribution vs full premium on COBRA | Can pair with VA; who pays depends on setting | Continuity when changing jobs/separating |
Key sources: VA eligibility & community care; TRICARE eligibility; CHAMPVA rules; Medicare coordination; HealthCare.gov dates/MEC. HealthCare.gov+5Veterans Affairs+5Veterans Affairs+5
Bottom line: Most disabled veterans do best by enrolling in VA health care, then adding TRICARE (if retired) or Medicare at 65. Families may use TRICARE (if eligible) or CHAMPVA; otherwise consider Medicaid/Marketplace.
Enrollment checklists by situation
A) Under 65 with a VA disability rating
- Apply for VA health care and confirm your priority group. Veterans Affairs+1
- Ask about community care if drive times/wait times are long. Veterans Affairs
- Review dental/vision eligibility; consider VADIP if needed. Veterans Affairs+1
- If you have employer insurance, keep it; coordinate bills with VA. Veterans Affairs
B) Turning 65 this year
- Enroll in Medicare Parts A & B during your Initial Enrollment Period (even if you have VA). Medicare
- Decide on Part D (drug) vs VA pharmacy based on your non-VA prescriptions and travel. Medicare
- If you’re a military retiree, confirm transition to TRICARE For Life (requires A & B). Tricare
C) Retired (or medically retired) military
- Verify TRICARE eligibility and choose the right plan; if 65+, TFL applies with A & B. Tricare+1
- Understand using TFL at VA (different rules than non-VA providers). Tricare
- Keep VA as your base for service-connected care.
D) Spouse/dependent of a disabled veteran
- If sponsor is 100% P&T (or died from service-connected causes) and you’re not TRICARE-eligible, apply for CHAMPVA (Medicare A & B required if eligible). Veterans Affairs
- Otherwise, check TRICARE eligibility (active/retired sponsor). Tricare
- If neither applies, look at Medicaid/Marketplace options with subsidies. HealthCare.gov
Bottom line: Match your path to your status (veteran/retiree, P&T rating, age, family eligibility) and layer coverage to widen access.
FAQs
Do disabled veterans get “free health insurance”?
Not insurance, but VA health care. Many with 50%+ ratings owe no copays for care, tests, or medications; others may have modest copays by priority group. Veterans Affairs
Source: VA, last checked: September 17, 2025.
What’s the difference between CHAMPVA and TRICARE for families?
TRICARE is for active/retired service members’ families (DoD). CHAMPVA is a VA program for families of 100% P&T veterans who aren’t TRICARE-eligible. Tricare+1
Should I enroll in Medicare Part B if I have VA care?
Usually yes at 65, because Medicare and VA don’t coordinate on the same service; Medicare lets you see non-VA providers nationwide. Medicare
Can I use Medicaid with VA care?
Yes. States should not count VA benefits as income for MAGI; eligibility varies by state. Medicaid
Is VA health care “minimum essential coverage” for the ACA?
Yes. VA programs such as VA health care, CHAMPVA, and TRICARE count as MEC. HealthCare.gov
When is ACA Open Enrollment?
Typically Nov 1 – Jan 15 on HealthCare.gov (state marketplaces may vary). HealthCare.gov
How do I get non-VA care paid for?
Ask VA about community care; most cases need a VA referral/authorization first. Veterans Affairs
Does VA cover dental and vision?
Vision: routine eye exams are covered; eyeglasses for some. Dental: limited—eligibility depends on your dental class; VADIP offers discounted private dental. Veterans Affairs+2Veterans Affairs+2