I have Medicare and TRICARE. Can I get care at a Veterans Affairs facility?
Yes, but you may pay more. If you go to a Veterans Affairs (VA) facility, that is a TRICARE-participating facility, to get care for a nonservice-connected condition:
- Medicare won't pay, even if it's a Medicare-covered service.
- TRICARE can only pay up to 20% of the TRICARE-allowable chargeThe maximum amount TRICARE pays for each procedure or service. This is tied by law to Medicare's allowable charges..
- You may be responsible for paying what’s left-over of the TRICARE-allowable charge to the VA.
For example, Mr. Jones needs to get care for a nonservice-connected condition. He goes to a VA facility to get the care. Medicare and TRICARE cover the care. The charge for the service is $1,000. (Assume Mr. Jones already paid his Medicare Part B and TRICARE deductibles for the year.)
| Mr. Jones gets care from a Medicare Participating Doctor | Mr. Jones gets care from a VA doctor | ||
|---|---|---|---|
| Billed Amount |
$1,000 |
Billed Amount |
$1,000 |
| Medicare-approved amount (The maximum amount Medicare pays for a procedure or service) |
$400 |
TRICARE-allowable charge (The maximum amount TRICARE pays for a procedure or service) |
$400 |
| Medicare pays 80% |
$320 |
Medicare pays nothing |
$0 |
| TRICARE pays remaining 20% of Medicare-approved amount |
$80 |
TRICARE pays 20% of the TRICARE-allowable charge |
$80 |
| Mr. Jones pays $400 - $320.00 - $80.00 = $0 |
$0 |
Mr. Jones may pay $400 - $80 = $320 |
$320 |
Last Updated 12/10/2024