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Are Disabled Veterans Eligible for TRICARE?
Simply being a disabled veteran doesn’t necessarily qualify you for TRICARE. TRICARE eligibility runs on military retirement status, not on your VA disability rating. Some veterans receiving VA disability are eligible, and receiving veterans disability benefits will not disqualify you. You can choose whether to apply for or retain your coverage alongside your veterans benefits, and generally the VA advises veterans to keep it.
TRICARE is administered by the Defense Health Agency rather than the VA. About 9.6 million beneficiaries are enrolled worldwide, including roughly 2 million retired service members and their families.
If you are not eligible, that is not the end of the conversation. Your spouse and children may still qualify for CHAMPVA, which is covered further down this page.
When Does a Disabled Veteran Qualify?
TRICARE provides medical coverage to active-duty service members of the military and their dependents, as well as some reservists and veterans. Unlike VA medical benefits, this is not a fixed plan. Instead, there are a variety of plans to choose from.
Veterans generally qualify in one of three ways:
- They are retired military, which typically means having served at least 20 years on active duty
- They are a Medal of Honor recipient
- They are medically retired, meaning they are on the Temporary Disability Retirement List (TDRL) or the Permanent Disability Retirement List (PDRL)
Veterans who left military service before reaching 20 years and are not on the TDRL or PDRL are generally not eligible unless they are Medal of Honor recipients.
Medical retirement happens when the military assigns a disability rating of 30% or higher and separates the service member on that basis. The determination is made through the Integrated Disability Evaluation System (IDES), which runs a single set of exams used by both the Department of Defense and the VA. A service member on the TDRL is periodically reexamined and may later be moved to the PDRL, returned to duty, or separated.
Two Ratings, Two Different Systems
This is where most of the confusion on this topic comes from.
Your military disability rating and your VA disability rating are separate numbers assigned by separate agencies for separate purposes. The military rating decides whether you are medically retired and therefore whether you get TRICARE. The VA rating decides your monthly compensation.
The two are often different, and a high VA rating does not create TRICARE eligibility. A veteran rated 100% by the VA who separated at eight years without a military disability retirement is not TRICARE-eligible. A veteran medically retired at 30% by the military is, even if the VA later rates them lower.
What If I’m Not Eligible?
For veterans who separated without a military retirement, CHAMPVA is usually the program that matters. It covers family members rather than the veteran.
The Civilian Health and Medical Program of the Department of Veterans Affairs covers the spouse and dependent children of a veteran the VA has rated as permanently and totally disabled from a service-connected condition. It also covers the surviving spouse and children of a veteran who died from a service-connected disability, or who was rated permanently and totally disabled at the time of death.
Permanent and total means the VA has rated the condition 100% disabling and does not expect it to improve. A 100% rating that is not designated permanent does not open CHAMPVA.
The rule that catches people is that the two programs are mutually exclusive. Eligibility for TRICARE disqualifies a family from CHAMPVA, and eligibility is enough on its own. A family does not have to be enrolled in TRICARE to be shut out of CHAMPVA. A veteran who is both a military retiree and rated 100% permanent and total has a TRICARE-eligible family, so CHAMPVA is not available to them.
How Does TRICARE Work?
What you can expect from this program depends on several factors. Not every beneficiary is eligible for every plan. Coverage, whether you have copays, and how much those copays are all vary depending on your status and the plan you choose. Some plans allow much greater flexibility to choose your doctors and facilities.
The main plan options include:
- Prime: A managed care option with lower out-of-pocket costs that requires using network providers and referrals for specialty care
- Select: A self-managed plan offering more provider flexibility at higher cost, with an annual deductible
- For Life: Coverage that takes over once you become eligible for Medicare. It requires enrollment in Medicare Parts A and B, and it pays second to Medicare
- Reserve Select: For qualified Selected Reserve members
- Retired Reserve: For qualified Retired Reserve members under age 60
Prime and Select are the two plans most retirees choose between, and TRICARE Open Season each fall is when you can switch.
What TRICARE Costs
Costs depend on which beneficiary group you fall into. Group A applies when the sponsor’s initial enlistment or appointment was before January 1, 2018. Group B applies on or after that date. Group B pays more.
For 2026, TRICARE Prime annual enrollment fees for retirees are $381.96 for an individual and $765 for a family in Group A, and $462.96 and $927 in Group B. TRICARE Select fees are roughly $187 and $375 for Group A, and $594.96 and $1,191 for Group B. Prime carries no annual deductible; Select does. Active duty family members pay no enrollment fee.
The catastrophic cap is the most out-of-pocket you can pay in a calendar year for covered care. Once you hit it, TRICARE pays covered costs in full for the rest of the year. For 2026 it is $4,381 for Group A retirees on Select and $4,635 for Group B.
Two Cost Rules That Favor Medically Retired Veterans
Both of these apply specifically to veterans who were medically retired, and both are easy to miss.
The catastrophic cap is lower. For 2026, the cap for Group A retirees on TRICARE Select who are medically retired service members, or their dependents, is $3,000 rather than $4,381. Survivors of sponsors who died on active duty get the same treatment.
The enrollment fee is frozen. Medically retired members and their family members, along with survivors of sponsors who died on active duty, are exempt from the annual Prime enrollment fee increases, provided at least one family member has stayed enrolled continuously since the original enrollment. The fee holds at whatever rate applied when you first enrolled. Letting coverage lapse gives that up permanently.
TRICARE with Veterans Disability Benefits
TRICARE is especially useful for veterans rated below 50%, because the care they can get from the VA is more limited and they may owe copays for treatment of conditions that are not service-connected. There are still good reasons to keep TRICARE at 50% or higher. Provider flexibility is one. The bigger one is family coverage, since VA health care does not cover your spouse and children, and TRICARE does.
You can be enrolled in both TRICARE and VA health care at the same time, and many veterans are. What you cannot do is bill both for the same episode of care. In practice, veterans use the VA for service-connected treatment and TRICARE for everything else and for their family.
Frequently Asked Questions About TRICARE for Disabled Veterans
Can I have both TRICARE and VA health care benefits? Yes, you can be enrolled in both programs simultaneously. Many veterans maintain both coverages to maximize their healthcare options and ensure family members have access to care.
Does my VA disability rating affect my TRICARE eligibility? Your VA disability rating and military disability rating are separate. TRICARE eligibility is based on your military retirement status, not your VA disability rating. However, veterans with a military disability rating of 30% or higher may qualify for medical retirement and TRICARE.
Are my family members covered under TRICARE? Yes, if you’re TRICARE-eligible, your eligible family members (spouse and unmarried children under 21, or under 23 if in college) typically qualify for coverage as well.
Can I lose my TRICARE eligibility? TRICARE eligibility generally continues for life if you meet the retirement criteria (20+ years of service or medical retirement). However, you must maintain enrollment by paying required premiums and following program rules.
I have a 100% VA rating. Does that get me TRICARE? Not on its own. If you separated before 20 years and were not medically retired, a 100% VA rating does not make you TRICARE-eligible. If the rating is 100% permanent and total, your spouse and children may qualify for CHAMPVA instead.
What is the difference between TRICARE and CHAMPVA? TRICARE is a Department of Defense program for service members, retirees, and their families. CHAMPVA is a VA program for the spouse and dependent children of veterans rated permanently and totally disabled from a service-connected condition. You cannot be eligible for both. TRICARE eligibility rules a family out of CHAMPVA.
At Veterans Help Group, we help veterans and surviving family members navigate the often-complicated processes of securing veterans disability benefits. To learn more about how we can help, contact us here or call (855) 855-8992 right now.
We have successfully helped thousands of veterans secure their entitled benefits, with a team of experienced advocates who understand both VA disability claims and military healthcare benefits like TRICARE.
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