Dual Eligibility: TRICARE and VA

Friday, March 19, 2021

In some cases, you may encounter beneficiaries eligible for benefits under both TRICARE and the U.S. Department of Veterans Affairs (VA). In this instance, they have the option to use either TRICARE or VA benefits. 

What does this mean for you?
It’s important to know that programs offered through the VA are not TRICARE programs, but rather unique health care programs administered by VA. In certain situations, TRICARE providers may be asked to accept requests from VA to provide care to veterans. If a provider agrees to see a VA patient, the referral and instructions for seeking reimbursement from the VA Medical Center (VAMC) will be provided prior to the time of the appointment. However, if the VA patient is also a TRICARE beneficiary and chooses to use his/her TRICARE benefits, TRICARE procedures should be followed.

If you provide care to a beneficiary who is covered by both TRICARE and VA, it is imperative that claims be submitted to one or the other, but not both. 

Keep in mind: 

• If eligible, patients can receive care under either TRICARE or VA.
• Once treatment has begun, the patient must continue to get care under the same program until the end of that particular episode of care.
• There is no coordination of benefits between TRICARE and VA.
• The rules and costs for the program chosen will apply.

Find more information on dual eligibility in the TRICARE Provider Handbook.