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Health Benefits Navigator: Digital Edition

A tool to help veterans and their family members find and obtain service-related health benefits

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Qualifying for health benefits can be complex, but understanding the process can provide better outcomes.

This navigator can help you to:

  • Learn more about health benefits provided through the United States Department of Veterans Affairs (VA) and Department of Defense (DoD).
  • Understand how to apply for VA or other federal health care programs.
  • Identify how to get free help from certified representatives who have experience and knowledge of the VA’s process for awarding benefits.

Important Tips:

  • Be persistent. Criteria for these programs are frequently revised, so eligibility for certain benefits may change. Ask questions and seek out help.
  • Gather and organize the veteran’s information. The VA requires physical documentation to determine the benefits a service member is qualified for.
  • Stay engaged after submitting initial applications to VA and other programs. No one wants to restart the application process for missing a deadline.

You may access a printer-friendly version of this guide here.

Intro to Benefits

What are VA benefits?

The government provides a number of services to help veterans in civilian life. Although not all VA benefits are related to health, service members who experience specific hardships or disabilities as a result of their service may be eligible for specialized health benefits which can sometimes include extra assistance for their caregivers, depending on the severity of their situation.

  • Veterans who served in active uniformed service and didn’t receive a dishonorable discharge may qualify for benefits from the VA.
  • VA benefits, and the level of help they can provide, often change because the VA receives different sums of money from Congress each year.

It's important to note that, in most cases, VA health services are only provided to the Veteran and not their spouse or family.

What health benefits are available?

Depending on age, household size, income and/or disability status, veterans and dependents may qualify for all, any or none of these:

  • VA, DoD, or other government health care benefits.
  • Private or other insurance administered through the Affordable Care Act (ACA).
  • Medicare, free or low-cost Medicaid or the Children’s Health Insurance Program (CHIP).

Other forms of health care coverage (ACA or another private insurance plan, Medicare, Medicaid, or TRICARE), can be used in addition to VA healthcare benefits.

  • Having any other health insurance coverage doesn’t affect the VA health care benefits you can get.
  • Medicaid provides health care coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults in long-term care and people with disabilities. VA income-based eligibility may also be related to Medicaid criteria.

New PACT Act Benefits

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In what is being described as one of the largest VA benefit expansions in the history of the U.S., the PACT Act provides additional benefits and health services to more than 5 million Vietnam, Gulf War, post-9/11 eligible veterans. Visit va.gov/PACT to learn more.

Additional Toxic Exposure and Illness Health Coverage, Treatment and Patient Outreach

  • Every enrolled veteran will receive an initial toxic exposure screening and a follow-up screening at least every five years. Veterans not currently enrolled but who are eligible will have an opportunity to e receive the screening.
  • 20 more illnesses are now eligible for disability benefits as a result of exposure to burn pits and other toxins: meaning veterans will not have to prove that their service caused their condition(s).

This can help the paperwork required and need for a disability exam before being granted access to health care and compensation. The list includes 11 respiratory related conditions and several forms of cancer.

What does this mean for Vietnam era veterans?

  • New presumptive conditions for Agent Orange include high blood pressure and monoclonal gammopathy of undetermined significance.
  • Veterans who served at an additional five locations are now assumed to have been exposed to Agent Orange if they served during specified dates.
  • Veterans who were a part of response efforts in three locations are now assumed to have been exposed to radiation if they served during specific dates.

Impact on Gulf War and Post-9/11 Veterans

  • Newly considered presumptive conditions and cancers include brain, glioblastoma, kidney, melanoma, neck and pancreatic cancers, along with any type of cancer that is gastrointestinal, head-related, lymphatic, lymphoma, reproductive and respiratory.
  • Other conditions presumed to be service connected include: Asthma diagnosed after service; chronic bronchitis, COPD, rhinitis, sinusitis; constrictive or obliterative bronchiolitis; and emphysema.
  • Post-9/11 veterans who served in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen — and any airspace above these locations – are presumed to have been exposed to burn pit toxins.
  • Gulf War and post-9/11 era veterans who served in these locations are presumed to have been exposed to burn pits: Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, the UAE — and any airspace above these countries.

VA Health Care Enrollment Period Expanded

  • Post 9/11 and combat veterans may enroll within 10 years of their discharge date instead of five. For other veterans, a one-year open enrollment period is available to join VA healthcare without having to demonstrate a service-connected disability.
  • Veterans discharged before October 1, 2013: those who meet the requirements listed below can apply and receive care during a year-long special enrollment period beginning October 1, 2022.

Veterans must have been active-duty during a theater of combat operations that include:

  • A period of war or an operation after the Persian Gulf War, or
  •  Combat service against a hostile force after November 11, 1998.

And both of these must be true:

  • A veteran must have been discharged or released between September 11, 2001, and October 1, 2013, and
  • Has not enrolled in VA health care before.

VA encourages eligible veterans to apply during the 1-year period to receive any urgent care they might need now or in the future. Enrollment is free and VA health care may be free, too.

What is Available to Military Families?

How to file a claim online

VA Specialty Programs

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Accessing Veterans Specialty Care Programs and Services

What is a specialty care program or service?

The VA recognizes that to address a number of unique situations, many veterans and their families need specialized programs and services, such as:

  • Women Veterans Health Care Program
  • Specialty Emotional and Mental Health Services
  • Specialty Dental, Oral, Hearing and Vision Services
  • Family Caregiver Assistance Program

These programs and services require specific qualifications based on circumstances that are laid out by legislation or regulations established by the VA.

Information on qualifying for and using these specialty care programs and services is provided below.

Women Veterans Health Care Program

The VA recently established a Center for Women Veterans to monitor and coordinate VA's administration of health care, benefits, services, and programs for women veterans. This includes:

  • Comprehensive primary care
  • Military exposures
  • General health and cancer screenings, such as breast, cervical, colon and other specialty services for women
  • Gynecologic and fertility treatments
  • Sensory aids and prosthetics, including gender-specific items, such as those used after a mastectomy
  • Other specialties, including radiology, neurology, cardiology, orthopedics, rheumatology, oncology and endocrinology

The Women Veterans Call Center (WVCC) is available at 1-855-829-6636 to get help or obtain specific assistance from trained women representatives regarding the VA.

Specialty Emotional and Mental Health Services

VA Health covers physical as well as emotional and mental health care. This includes a range of services, such as checkups, home health care, and mental health care services for post-traumatic stress disorder (PTSD), psychological effects of military sexual trauma (MST), depression, grief, anxiety and many other conditions.

The VA is concerned about addressing the risk of suicide among those who have served in the military and has services available for all veterans regardless of if they are enrolled in VA health care.

If you are a veteran in mental health crisis, are thinking about hurting yourself, or if you know a veteran in this situation, you can get help right away:

  • Call 988, press 1, or text 838255 — you don't have to be enrolled in VA to connect.

Veterans may also call 1-877-927-8387 to talk with a fellow combat veteran about their experiences or concerns, 24 hours a day, seven days a week, 365 days a year.

How to qualify for VA Mental Health Care:

If you have a VA primary care provider, tell them any concerns you have. Your provider can help if you have PTSD or another condition and help you develop a plan.

If you don’t have a VA primary care provider or have never been seen in a VA hospital or clinic, contact the VA in one of these ways:

Specialty Dental, Oral, Hearing and Vision Services

The VA offers comprehensive dental, oral, hearing and vision care benefits for qualifying veterans.

Hearing and vision challenges can stem from many service-connected disabilities.

Additionally, VA dental or oral care can provide a wide range of treatment from cancers to oral and facial surgery resulting from military service.

While there are exceptions, the most effective way to qualify for any of these specialty care services is to apply for VA Health Care as shown in other sections of this Navigator.

If you are not eligible for specialized services, veterans enrolled in VA Health may  purchase specialty insurance through the VA, such as dental insurance at a reduced cost. Veterans who have recently served on active duty may be entitled to a one-time free dental care visit.

For more information about eligibility for the VA’s specialty dental and medical benefits, call 1-877-222-VETS (8387) or click here.

Family Caregivers Assistance Program

This VA program provides educational services, monetary assistance and other benefits to qualifying veteran family caregivers. Eligibility is determined if the caregiver(s) and the veteran meet certain requirements.

The family caregiver must be at least 18 years old and either be:

  • A spouse, son, daughter, parent, stepfamily member or extended family member of the veteran, or
  • Someone who lives full-time with the veteran and/or is willing to do so if designated as a family caregiver.

The veteran also must meet certain qualifications:

  • Have a VA disability rating of 70% or higher that was made worse during specific periods of active duty (as described by the VA) and
  • Prove at least six months of continuous in-person personal-care services is required. 

To apply, both the veteran and the caregiver(s) need to sign and date an application and answer questions about their circumstances.

Applications can be submitted online, by mail or in person at a VA Medical Center (Caregiver Support Coordinator).

Additional information on qualifications and program details are available by clicking here, or by calling the VA at 1-855-260-3274.

Steps to Obtaining VA Health Benefits

Three Steps to Getting VA Health Benefits

  1. Identify if a service member is eligible for VA health services (see next section).
  2. Ensure you have the necessary documents.
  3. If you need help, reach out to certified VSO's, state or country veteran representatives.

How to Determine Which VA Benefits Are Available

Veterans qualify for health benefits in these ways:

  1. Service-connection: Having a disability from an injury or illness incurred during or because of military service.
  2. Special circumstance: Recipients of a Purple Heart or Medal of Honor, prisoners of war or served in certain geographic locations.
  3. Low income: Those with an income below a certain dollar amount determined by the VA.

Disability-Related Benefits

How to Qualify for Disability-Related Benefits

Disabilities come in two forms:

  1. Physical conditions like a chronic illness or injury.
  2. Mental health conditions like PTSD, that developed before, during or after service.

If you have a disability, you may also qualify for disability compensation: monthly tax-free payments based off your condition.

To qualify, both of the following must be true:

  1. Served at least 180 days of active duty, active duty for training, or inactive duty training.
  2. Have an illness or injury that affects your body or mind.

AND at least ONE of the following must be true:

  1. In-service disability: A sickness or injury that occurred while serving and linked to current condition.
  2. Preservice disability: An illness or injury before joining the military that was made worse from serving.
  3. Post-service disability: A disability related to active duty that didn’t appear until after service ended.

If you are already receiving disability pay, it should be easier to also obtain health benefits

Special Circumstance Benefits

How to Qualify for Benefits in a Special Circumstance

An additional way to secure benefits can be through a special circumstance such as:

  • Prisoner of War (POW)
  • Received Purple Heart
  • Received Medal of Honor
  • Served in Vietnam between 1962 and 1975
  • Served in Southwest Asia/Gulf War between 1990 and 1998
  • Served at least 30 days at Camp Lejeune between 1953 and 1987

Family members may qualify for health care benefits if they lived at Camp Lejeune as well.

Income Based Benefits

How to Qualify for Benefits Based on Income

You must meet BOTH of the following requirements:

  • Receive or qualify for Medicaid benefits (refer to Medicaid health benefits section, and program description in Glossary).
  • Earn less than specified income requirements. Explore current income requirements here:*

Proof of income is required. That means submitting your past year's federal income tax return, and potentially other documents.

What is “enhanced” eligibility?

If you receive “enhanced” eligibility you will be placed in a higher priority group and are more likely to get benefits. Those who qualify must meet one of these requirements:

  • You are a combat Veteran discharged or released on or after September 11, 2001
  • You receive a VA pension.
  • You’re a former prisoner of war (POW).
  • You have received a Purple Heart.
  • You have received a Medal of Honor.
  • You get (or qualify for) Medicaid benefits.
  • You served in Southwest Asia during the Gulf War between August 2, 1990, and November 11, 1998.
  • You served at least 30 days at Camp Lejeune between August 1, 1953, and December 31, 1987.
  • You served during specific times and locations during the Vietnam War.
  • You receive financial compensation (payments) from VA for a service-connected disability.
  • You were discharged for a disability resulting from something that happened to you in the line of duty.
  • You were discharged for a disability that got worse in the line of duty.

Emergency Mental Health Care

Free care for veterans in acute suicidal crisis

Veterans who are in acute suicidal crisis may go to any VA or non-VA health care facility at no cost. Treatment options include 30 days of inpatient treatment or outpatient care for up to 90 days.

The program also includes:

  • Referrals for care following the period of emergency care
  • Determination of other services and benefits from VA

Veterans are eligible, regardless of if they are enrolled in VA health care, if:

  • They were discharged or released from active duty after more than 24 months of active service and were not dishonorably discharged
  • Or are former members of the armed forces, including the Reserves, serving more than 100 days under a combat exclusion or in support of a contingency operation directly or by operating an unmanned aerial vehicle from another location, and were not dishonorably discharged
  • Or a former member of the armed forces who was a victim of a physical sexual assault or sexual harassment

Meanwhile, veterans in crisis or those who are concerned about one can connect with a trained responder at the Veterans Crisis Line via phone (dial 988 and then press 1), text message (838255) or online chat. Responders may connect you with local community services or the nearest VA medical center.

Documentation and Paperwork

Required Documentation

Before applying for any VA or DoD benefit, veterans or individuals applying on their behalf should obtain these documents:

  • The retiree’s DD-214 and any other important records of service.
  • Social Security numbers for the retiree and any of their beneficiaries.
  • The account numbers of the retiree’s current health insurance (Medicare, ACA, private coverage, etc.) or related health policies.
  • If you are representing a veteran, you must also provide either a signed Power of Attorney or other evidence of your legal relationship with the service member.

When applying to TRICARE, contact the Defense Enrollment Eligibility Registration Service (DEERS) to determine qualification requirements: 1-800-538-9552*.

How to Obtain the Necessary Paperwork

Veterans will need a copy of their official record of military service (DD-214) document. It can be obtained in the following ways:

Starting the Application Process

Starting the Application Process

You can apply for VA health benefits through ANY of the following means:

What are Veterans Service Organizations (VSOs)?

A great way to determine eligibility, and to receive VA benefits, is to ask for assistance from a VSO.

VSOs are private, nonprofit groups that are chartered by Congress or the VA. Their primary mission is to advocate on behalf of veterans, their dependents and survivors.

Most VSOs have accredited representatives who have gone through a formal training process to assist individuals with their claims before the VA.

These representatives can assist veterans or their loved ones review and gather documentation and submit a claim to the VA without any cost. VSOs recognized by the VA can be searched for here.

Click here to find a nearby VSO.

VA and Other Insurance Plans

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VA Health Services Works With Other Health Insurance Plans

If not already enrolled, make sure to enroll in Medicare during the eligibility window — three months prior to turning 65 years of age, through the three months after turning 65 (a total of seven months). Here’s how:

  • Social Security online
  • Call Social Security at 1-800-772-1213*, Monday through Friday, from 7 a.m. to 7 p.m., or
  • In person at any local Social Security office.

If a veteran already has other forms of health coverage (like a private insurance plan, Medicare, Medicaid or TRICARE), they can use VA health benefits along with these plans — so applying to the VA is still a good idea.

Learn more about how VA works with other health insurance by calling the VA toll-free hotline at 1-877-222-8387*, Monday through Friday, 8 a.m. to 8 p.m. ET and ask for assistance.

Additionally, 1-800-MyVA411* is a national, toll-free number that serves as a “front door” to VA. You can still reach VA at any other direct or contact center numbers, but 1-800-MyVA411 offers the simplicity of a single number to call when you don’t know whom to call.

Also, use the recommendations for applying for VA Health Benefits.

Tricare

TRICARE Health Benefits

What is TRICARE?

TRICARE is the health care program for active duty uniformed service members, retirees and their families. It offers comprehensive health care coverage through several plan options, as well as pharmacy benefits, dental options and other special programs for eligible individuals.

Who is eligible? Generally, people who are in one of these categories are eligible for TRICARE:

  • Active duty, retired uniformed service, and Guard/Reserve members.
  • Spouses and their children (generally, those who are dependents and registered in DEERS).

What is TRICARE for Life?

TRICARE For Life is a program for TRICARE beneficiaries who become Medicare eligible (usually at age 65). It serves as a supplement to Medicare, covering certain out-of-pocket Medicare expenses. Enrollment is automatic for anyone who qualifies for and receives Medicare parts A and B.

You don’t pay enrollment fees for TRICARE for Life, but you must pay Medicare Part B monthly premiums. Your Medicare Part B premium is based on your income. 

How to Obtain TRICARE Services

  1. Get the retiree’s DD-214 or other important records. These may be located at the Defense Finance Accounting Service (DFAS): 1-800-321-1080*.
  2. Ensure you are registered with the Defense Enrollment Eligibility Registration System (DEERS) to qualify for TRICARE health care benefits: 1-800-538-9552.
  3. Contact The Defense Health Agency TRICARE Health Plan Office at 1-844-204-9351*.

If you, or the military retiree (sponsor) is Medicare eligible, they must have Medicare Part A and Part B to enroll in TRICARE for Life. Call 1-866-773-0404* with questions.

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Medicare

Medicare Health Benefits

What is Medicare?

Medicare is a federal program that began in 1966. It provides guaranteed health insurance for people who are age 65 and over, or for younger people who qualify on the basis of disability.

Who is eligible?

Most people 65 or older are eligible for Medicare hospital insurance (Part A) based on their own — or their spouse’s — employment. You are eligible at 65 if you:

  • Receive Social Security or Railroad Retirement Benefits.
  • Are not getting Social Security or Railroad Retirement Benefits, but you have worked long enough to be eligible for them.
  • Would be entitled to Social Security benefits based on your spouse’s (or divorced spouse’s) work record, and that spouse is at least 62. Your spouse does not have to apply for benefits in order for you to be eligible based on your spouse’s employment.
  • Worked long enough in a federal, state or local government job to be insured for Medicare.

Applying to Medicare

How to enroll in Medicare?

You should apply for Medicare online at age 65 (three months prior to turning 65 or up to three months after), even if you don't want to start receiving Social Security retirement benefits at that time.

If you do not wish to apply online, you can make an appointment by calling the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778*) from 7 a.m. to 7 p.m. weekdays.

If you are already receiving Social Security benefits, you will automatically be enrolled in Medicare parts A and B. However, because you must pay a premium for Part B coverage, you have the option of turning it down. You will be contacted by mail a few months before you become eligible and given all the information you need. Be aware that you will pay a significant penalty for later enrollment (for life) if you don't enroll when you're eligible.

What are the four parts of Medicare?

  • Part A helps pay for the cost of inpatient stays in hospitals and short-term skilled nursing facilities, home health services, and hospice care.
  • Part B helps pay for doctors’ services (including those in the hospital), outpatient care (in or out of a hospital), diagnostic tests, preventive care, and some medical equipment and supplies.
  • Part C, or Medicare Advantage, is an alternative coverage option to original Medicare that allows you to choose to receive all of your Medicare healthcare benefits through one plan. These plans must cover all Part A and Part B services, and most include Part D drug coverage. Some plans also provide extra benefits that original Medicare doesn’t offer.
  • Part D helps cover the cost of outpatient FDA-approved prescription drugs.

Medicaid

Medicaid Health Benefits

What is Medicaid?

Medicaid is a state-and federal-funded program that generally provides health coverage for people with lower incomes. The eligibility rules for Medicaid are different for each state. Click here to learn more about your state Medicaid program*.

Why does Medicaid vary by state?

Where you live matters in terms of your eligibility for Medicaid coverage and what benefits you can receive. While states are required to provide Medicaid coverage to most low-income older adults and individuals living with a disability, they can choose to extend coverage to other populations, including people who spend so much of their income paying for their own care — often on Long-Term Services and Supports (LTSS) — that they ultimately qualify for Medicaid.

How do I apply for Medicaid?

Your state will determine if you qualify for Medicaid. Contact your state for renewal or application information.

NOTE: You will not lose Medicaid eligibility if you receive Medicare (or vice versa). As long as your income falls under the limits for Medicaid eligibility in your state, you will receive both types of coverage. More than 8 million people have both Medicare and Medicaid.

If Medicare becomes your primary insurance, it will cover your medical bills first, while Medicaid becomes secondary. When paying for services that Medicare doesn’t cover, Medicaid will usually pay most out- of-pocket expenses.

Glossary

REPRESENTATIVE

A person who is legally authorized to act for another or who may function on another’s behalf.

DISABILITY RATING OR STATUS

The VA assigns a disability rating based on the severity of an individual’s physical or mental health condition. Disability ratings help determine eligibility for and level of benefits, such as VA health care.

MEDICAID

A federal health insurance program, jointly operated by states, that provides health care benefits to low-income families or individuals. Medicaid may also cover nursing home and other long-term care services for persons who have exhausted personal assets providing care.

MEDICARE

A federal health insurance program designed to cover most of the medical and hospital expenses of eligible people 65 and older.

TRICARE

The health care program managed by the Department of Defense for uniformed service members, retirees and their families.

DD-214

Certificate of release or discharge from active duty. It documents an individual’s service in the military.

POWER OF ATTORNEY (POA)

A POA is a legal document allowing someone (an agent) to act for another. In the case of a Health care POA, it is used when the principal cannot speak for themselves.

DEERS

Defense Enrollment Eligibility Registration Service. You must register in DEERS to get TRICARE benefits, call 1-800-538-9552.

VETERANS SERVICE ORGANIZATION (VSO)

VSOs advocate on behalf of Veterans and provide a range of resources. Many are recognized by Congress (federally chartered), and their trained representatives can legally assist Veterans secure benefits (usually at no cost).

Disclaimer: There are several phone numbers, web links and email addresses with an asterisk (*) to make direct contact with public agencies or organizations that can provide additional information. These are not AARP resources. Any information you provide to the host agency or organization will be governed by its privacy policy.

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