Medicare with Veterans, TRICARE, Indian Health, or Medicaid Coverage

Adapted from How Medicare Works with Other Insurance, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Coverage from a federal program

If you have Medicare and Veterans’, benefits who pays first?

If you have (or can get) both Medicare and Veterans’ benefits, you can get coverage under either program. However, Medicare doesn’t pay for any care that you get at a U.S. Department of Veterans Affairs (VA) facility. Medicare and the VA can’t pay for the same items or services. Each time you get health care or visit a provider, you’ll have to choose which coverage to use.

Medicare pays for Medicare-covered items and services. The VA pays for VA-authorized items or services in a VA or (authorized) non-VA facility.

What about drug coverage?

You may be able to get drug coverage through the VA program. You may also join a Medicare drug plan, but if you do:

• You can’t use both types of coverage for the same drug at the same time.
• You won’t be able to use the VA “Meds by Mail” program.

What else do you need to know?

If the VA authorizes services in a non-VA hospital but didn’t authorize all the services you get during your hospital stay, then Medicare may pay for the Medicare-covered services the VA didn’t authorize.

If a doctor takes you as a patient, and bills the VA for VA-authorized services, the doctor must accept the VA’s payment as payment in full. The doctor can’t bill you or Medicare for these services.

There may be circumstances where you’ll need to file a claim with the VA yourself. The VA will pay the approved amount either to you or to your doctor.

For more information, visit VA.gov, call your local VA office, or call the national VA information number at 1-800-827-1000. TTY users can call 1-800-829-4833.

You have Medicare and TRICARE. Who pays first?

If you’re on active duty and have Medicare, TRICARE pays first for Medicare-covered services or items, and Medicare pays second.

If you aren’t on active duty, Medicare pays first for Medicare-covered services, and TRICARE may pay second.

If you get items or services from a military hospital or clinic, or any other federal health care provider, TRICARE pays the bills. Medicare usually doesn’t pay for services you get from a federal health care provider or other federal agency.

TRICARE For Life (TFL) provides expanded medical coverage to Medicare-eligible uniformed services retirees 65 or older, to their eligible family members and survivors, and to certain former spouses. You must have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) to get TFL benefits. Visit tricare.mil/tfl, or call 1-866-773-0404 to learn more. TTY users can call 1-866-773-0405.

What about drug coverage?

Most people with TRICARE who are entitled to Medicare Part A must also have Medicare Part B to keep their TRICARE drug benefits. If you have TRICARE, you don’t need to join a Medicare drug plan. However, if you do, your Medicare drug plan pays first, and TRICARE pays second.

If you join a Medicare drug plan, TRICARE and your plan may coordinate their benefits if your plan’s network pharmacy is also a TRICARE network pharmacy.

For more information, visit tricare.mil, or call the TRICARE Pharmacy Program 1-877-363-1303. TTY users can call 1-877-540-6261.

You have Medicare and get care from Indian Health Services (IHS) or an IHS provider. Who pays first?

Generally, Medicare pays first for your health care bills, before the IHS delivery system. The IHS delivery system is comprised of health facilities operated by IHS, a Tribe or Tribal organization, or an urban Indian organization. However, these conditions apply:

• If you have non-tribal group health plan coverage through an employer, the non-tribal group health plan pays first, and Medicare pays second if:
• The employer has 20 or more employees, or
• The employer has fewer than 20 employees, but is part of a multi-employer group where at least one employer has 20 or more employees
• If you have non-tribal group health plan coverage through an employer who has fewer than 20 employees, Medicare pays first, and the non-tribal group health plan pays second.
• If you have a health insurance through a Tribal health plan, Medicare pays first and the Tribal health plan pays second.

What about drug coverage?

Many Indian health facilities participate in the Medicare Part D drug program. If you get drugs through an Indian health facility, you’ll continue to get them at no cost to you, and your coverage won’t be interrupted. Your local Indian health benefits coordinator can help you choose a plan that meets your needs and tell you how Medicare works with the Indian health care system.

You have Medicare and coverage under the Federal Black Lung Program. Who pays first?

For any health care including drugs related to black lung disease, the Federal Black Lung Program pays first as long as the program covers the service. Medicare won’t pay for doctor or hospital services or drugs covered under the Federal Black Lung Program.

Your provider should send all bills for the diagnosis or treatment of black lung disease to:

Federal Black Lung Program P.O. Box 8302 London, Kentucky 40742-8302

For all other health care that isn’t related to black lung disease, Medicare pays first, and your health care provider should send your bills directly to Medicare. If the Federal Black Lung Program won’t pay your bill, ask your health care provider to send Medicare the bill. Also ask them to include a copy of the letter from the Federal Black Lung Program that says why it won’t pay your bill.

Call 1-800-638-7072 if you have questions about the Federal Black Lung Program. Call the Benefits Coordination & Recovery Center toll-free at 1-855-798-2627 if you have questions about who pays first. TTY users can call 1-855-797-2627.

You have Medicare and Medicaid. Who pays first?

Most health care costs are covered if you qualify for both Medicare and Medicaid. Medicaid never pays first for services Medicare covers. It only pays after Medicare has paid. In rare cases where there’s other coverage besides Medicare, Medicaid pays after the other coverage has paid.

What about drug coverage?

Medicare covers your drug costs. You’ll need to join a separate Medicare drug plan or a Medicare health plan with drug coverage for Medicare to pay for your drugs. Medicaid can pay for a limited number of drugs that that are excluded from Medicare drug coverage.

If you have full Medicaid coverage or qualify for your state’s Medicare Savings Program, you automatically qualify for Extra Help with your Medicare drug coverage costs. If you don’t join a drug plan on your own, Medicare will sign you up for one. Visit Medicare.gov/basics/costs/help/drug-costs for more information about how Extra Help works.

• If you have full coverage from Medicaid and live in a nursing home, you pay nothing for covered drugs.
• If you have full coverage from Medicaid and live at home or in an assisted living or adult living facility, you’ll pay a small copayment for each drug.

Visit Medicaid.gov/about-us/where-can-people-get-help-medicaid-chip, or call 1-800-MEDICARE (1-800-633-4227) to get the phone number for your state’s Medicaid office. TTY users can call 1-877-486-2048.

Source and further reading

How Medicare Works with Other Insurance — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.