How TRICARE and VA care fit alongside your group health plan

Employees and family members who are veterans, military retirees or reservists often hold TRICARE or VA care next to your plan. Here is how the federal rules interact.

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Three Programs, One Plan.

Many of your people have more than one source of health coverage. A military retiree’s family may have TRICARE. A veteran may use the Department of Veterans Affairs for a service-connected condition. A reservist may leave for training or deployment and return months later. Each program has its own rules, and none of them replaces the duties you have as plan sponsor.

This guide sets out what the primary sources say on six questions: who pays first, how Medicare fits in, whether VA care affects an HSA, how the ACA treats these programs, what happens on military leave, and when special enrollment applies. Where a source does not answer a question, we say so rather than guess.

TRICARE For Life And Medicare.

TRICARE For Life is Medicare wraparound coverage for people who are TRICARE-eligible and have both Medicare Part A and Part B. It starts automatically when both parts take effect, and it does not extend to family members. TRICARE says that Medicare pays its portion first and TRICARE pays second.

When a person also has other health insurance, TRICARE states that it pays last, after Medicare and the other plan. TRICARE does not say whether Medicare or the other plan pays first, and sends people to the Medicare website for that. That question is governed by the Medicare secondary payer rules, which we cover separately for employer plans.

Minimum Essential Coverage And The Employer Mandate.

The regulation defining minimum essential coverage, 26 CFR 1.5000A-2(b)(1), lists TRICARE in paragraph (iv) and the veterans programs under chapters 17 and 18 of title 38 in paragraph (v). Paragraph (b)(2)(vii) excludes coverage limited to space-available care in a uniformed services facility for people not eligible for TRICARE private sector care.

The employer mandate in 26 U.S.C. 4980H(a) applies when an applicable large employer fails to offer full-time employees and their dependents the opportunity to enroll in minimum essential coverage and at least one full-time employee is certified as receiving a premium tax credit or cost-sharing reduction. The text of subsection (a) does not carve out employees who have other coverage.

Section 4980H(c)(2)(F) works elsewhere. For deciding whether you are an applicable large employer, an individual with medical coverage under TRICARE or a title 38 veterans program is not counted as an employee for that month. It affects the count, not the offer. Our reading is that you keep making your offer to every eligible full-time employee.

When TRICARE Or Other Coverage Ends.

Under 29 CFR 2590.701-6(a), an employee or dependent who had other group health plan or health insurance coverage when the plan was previously offered may request special enrollment on loss of eligibility for that coverage, on termination of employer contributions toward it, or on exhaustion of COBRA. A plan must allow at least 30 days after the event to request enrollment, and coverage must begin no later than the first day of the first calendar month after the plan receives the request. Loss caused by unpaid premiums or termination for cause does not qualify.

The regulation text we reviewed does not say whether the end of TRICARE eligibility counts as loss of other coverage, so we do not state a conclusion. Check your plan document and ask us. TRICARE separately tells members they have 90 days after gaining or losing other insurance to change their TRICARE plan, so employees may be working to two different clocks.

Where To Read Next.