HEALTH CARE

Information on 

Coverage Choices for 

Servicemembers, 

Former 

Servicemembers, and 

Dependents

Report to Congressional Requesters

December 2014

GAO-15-4

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-15-4, a report to 

congressional requesters

December 2014

HEALTH CARE

Information on Coverage Choices for 

Servicemembers, Former Servicemembers, and 

Dependents

Why GAO Did This Study

In fiscal year 2013, there were about 

53 million servicemembers and former 

servicemembers—those who retired 

from military service or left for reasons 

other than retirement—and their 

dependents. These individuals may be 

eligible for health care coverage 

through DOD, VA, Medicare, or 

Medicaid and may purchase coverage 

through the exchanges established by 

PPACA. These sources provide 

individuals opportunities for choosing 

the coverage that is most suited to 

their needs, but may also require 

consideration of complex factors when 

making choices.

GAO was asked to examine federal 

health care programs and exchangepurchased coverage available to 

servicemembers, former 

servicemembers, and their 

dependents. GAO examined

(1) eligibility for coverage, (2) the key 

benefits offered by this coverage and 

the individuals’ costs, (3) the extent to 

which information on exchangepurchased coverage and federal 

subsidies is provided by DOD and VA, 

and (4) the extent to which these 

individuals have coverage through 

DOD, VA, Medicare, and Medicaid. 

GAO reviewed agency documents and 

relevant laws and regulations, 

analyzed U.S. Census Bureau data,

and interviewed agency officials.

What GAO Recommends

GAO recommends that DOD provide 

information on how its coverage affects 

individuals’ qualification for federal 

subsidies for exchange-purchased 

coverage. DOD concurred with GAO’s 

recommendation. VA generally agreed 

with GAO’s conclusions. HHS had no 

comments on this report.

What GAO Found

Servicemembers’, former servicemembers’, and their dependents’ eligibility for 

health care coverage through the Department of Defense (DOD) and the 

Department of Veterans Affairs (VA) is primarily based on military status, while 

eligibility for Medicare, Medicaid, and coverage purchased through an exchange 

established by the Patient Protection and Affordable Care Act (PPACA) is based 

on age, income, or other factors. The Centers for Medicare & Medicaid Services 

(CMS)—an agency within the Department of Health and Human Services 

(HHS)—oversees health care coverage provided through Medicare, Medicaid, 

and the exchanges. Most servicemembers, and former servicemembers who 

retired from military service, and their dependents are entitled to DOD coverage, 

according to DOD officials. Those who are not entitled to DOD coverage, such as 

reservists and certain of their dependents, may be eligible to purchase it. Former 

servicemembers who left military service for reasons other than retirement are 

not eligible for DOD coverage. All former servicemembers are generally eligible 

for VA coverage. Servicemembers, former servicemembers, and their 

dependents may also be eligible for Medicare or Medicaid, if they meet eligibility 

criteria, and may purchase coverage through an exchange.

Federal programs and exchange-purchased plans generally offer comprehensive 

coverage, which includes coverage for certain benefit categories such as 

inpatient hospital and outpatient medical services. These forms of coverage may 

have cost-sharing, subject to certain limits. Cost limits vary and depend on 

factors such as military status and income. For example, servicemembers do not 

pay an annual enrollment fee for certain DOD coverage, but former 

servicemembers do. VA does not generally require cost-sharing for those with 

certain service-connected conditions or low incomes, while it may for others.

DOD and VA provide information about exchange-purchased coverage on their 

websites, including that their coverage satisfies the requirement for minimal 

essential coverage (MEC) established by PPACA. VA informs its beneficiaries 

that they do not qualify for federal subsidies that lower the cost of exchange 

plans, even if they meet income and other requirements, because VA coverage 

satisfies the requirement for MEC. VA also informs its beneficiaries that they may 

opt out of VA coverage, and thus potentially qualify for federal subsidies. DOD, 

however, does not provide information indicating that most individuals with DOD 

coverage cannot opt out of it and, therefore, cannot qualify for federal subsidies. 

Nor does DOD inform those that have the option of purchasing DOD coverage 

that they may qualify for federal subsidies, if they do not choose DOD coverage. 

This is inconsistent with federal internal controls that require communication with 

stakeholders, and by providing this information, DOD could potentially help 

servicemembers, certain former servicemembers, and their dependents make 

more informed decisions regarding their health care coverage.

About 27 million servicemembers, former servicemembers, and their dependents 

had health care coverage through DOD, VA, Medicare, or Medicaid, or a 

combination of these in 2012, according to U.S. Census Bureau data. Of these, 

about 7 million had health care coverage through two or more programs in 2012, 

most often VA and Medicare (2.4 million), Medicare and Medicaid (1.3 million), 

and DOD and Medicare (1.2 million).

View GAO-15-4. For more information, contact 

Katherine Iritani at (202) 512-7114 or 

iritanik@gao.gov.
Page i GAO-15-4 Health Care Coverage

Letter 1 

Background 7

Eligibility for DOD and VA Coverage Is Primarily Based on Military 

Status, and Eligibility for Medicare, Medicaid, and ExchangePurchased Coverage Is Based on Age, Income, or Other 

Factors 10

DOD, VA, Medicare, Medicaid, and the Exchanges Generally 

Offer Comprehensive Coverage Subject to Certain Limits 16

DOD and VA Provide Information on Eligibility for ExchangePurchased Coverage, but DOD Provides Limited Information on 

Qualifying for Federal Subsidies 25

More Than 27 Million Servicemembers, Former Servicemembers, 

and Their Dependents Had Coverage through Federal 

Programs in 2012 28

Conclusions 33

Recommendation for Executive Action 33

Agency Comments 34

Appendix I Department of Defense Comments 35

Appendix II Department of Veterans Affairs Comments 37

Appendix III GAO Contact and Staff Acknowledgments 38

Related GAO Products 39

Table

Table 1: Number of Servicemembers, Former Servicemembers, 

and Their Dependents with Multiple Forms of Coverage 

through DOD, VA, Medicare, or Medicaid in 2012 31

Contents
Page ii GAO-15-4 Health Care Coverage

Figures

Figure 1: Number of Servicemembers, Former Servicemembers, 

and Their Dependents, Fiscal Year 2013 8

Figure 2: Examples of DOD’s TRICARE Benefits Categories 17

Figure 3: Examples of VA’s Benefits Categories 17

Figure 4: Examples of Medicare Benefits Categories 19

Figure 5: Medicaid Mandatory Benefits 20

Figure 6: Categories of Essential Health Benefits Covered by 

Exchange Plans 20

Figure 7: Number of Servicemembers, Former Servicemembers, 

and Their Dependents Who Had Health Care Coverage 

through DOD, VA, Medicare, or Medicaid in 2012 29

Abbreviations

ACS American Community Survey

CMS Centers for Medicare & Medicaid Services

DOD Department of Defense

HHS Department of Health and Human Services

MEC minimum essential coverage

PPACA Patient Protection and Affordable Care Act

VA Department of Veterans Affairs

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Page 1 GAO-15-4 Health Care Coverage

441 G St. N.W.

Washington, DC 20548

December 12, 2014

The Honorable Patty Murray

Chairman

Committee on the Budget

United States Senate

The Honorable Ron Wyden

Chairman

Committee on Finance

United States Senate

In fiscal year 2013, there were an estimated 53 million servicemembers, 

former servicemembers, and their dependents.1 Servicemembers, former 

servicemembers, and their dependents may be eligible for health care 

coverage through programs administered by the Department of Defense 

(DOD) or the Department of Veterans Affairs (VA).2 Servicemembers, 

former servicemembers, and their dependents may also be eligible for 

Medicare, a federal health insurance program for individuals who are 65 

or older or have certain disabilities or conditions, such as end-stage renal 

disease, or Medicaid, a joint federal-state program that finances health 

care coverage for certain low-income individuals.3

 

1

This population of an estimated 53 million includes servicemembers—individuals who are 

currently serving on active duty or are members of the Selected Reserve—former 

servicemembers, and their respective dependents. Former servicemembers include 

individuals who retired from military service or the Selected Reserve, and individuals who 

left active duty military service for reasons other than retirement. Members of the Selected 

Reserve are those that have been designated as essential to wartime missions and 

regularly train, for pay, with active duty components. Dependents include spouses and 

children up to the age of 26. This population estimate is based on data reported by the 

Department of Defense (DOD) and the Department of Veterans Affairs (VA) in their 2014 

annual reports to Congress, which are the most recent data available. See Department of 

Defense, Evaluation of the TRICARE Program: Fiscal Year 2014 Report to Congress

(Washington, D.C.: Mar. 5, 2014) and VA’s fiscal year 2015 Congressional Budget 

Submission.

In addition, these 

2

Former servicemembers, including those who retired from military service and those who 

left for reasons other than retirement, are also known as veterans.

3

The federal government and states share in the financing of the Medicaid program. 

States receive federal matching funds for Medicaid expenditures in accordance with a 

formula established by law under which the federal share of a state’s Medicaid 

expenditures is based on the state’s per capita income. The federal contribution generally 

may range from 50 to 83 percent.
 

Page 2 GAO-15-4 Health Care Coverage

servicemembers, former servicemembers, and their dependents may also 

choose to purchase health insurance coverage through the exchanges 

established by the Patient Protection and Affordable Care Act (PPACA).4

These federal programs and the exchanges offer health care coverage in 

different ways, subject to the oversight of three federal agencies. DOD 

administers TRICARE, a health care program through which beneficiaries 

may obtain care either from military hospitals and clinics, referred to as 

military treatment facilities, or from civilian providers. VA’s health care 

program provides care directly through its medical centers and clinics 

and, in certain situations, may pay for services provided by private 

providers. CMS oversees Medicare and Medicaid, public programs that, 

for eligible individuals, pay for specified health care services provided by 

participating private providers. CMS also oversees the exchanges in each 

state.

The Centers for Medicare & Medicaid Services (CMS)—an agency within 

the Department of Health and Human Services (HHS)—oversees health 

care coverage provided through Medicare, Medicaid, and the exchanges. 

Coverage available through DOD, VA, Medicare, and Medicaid, and 

coverage purchased through an exchange provides a range of health 

care benefits at different costs to eligible servicemembers, former 

servicemembers, and their dependents. Eligibility for more than one 

program may provide servicemembers, former servicemembers, and their 

dependents with opportunities for choosing the health coverage that is 

most suited to their needs, but also may require these individuals to 

consider complex factors when making these choices.

5

 

4

The exchanges—also referred to as marketplaces—are where eligible individuals can 

compare and select among private health plans. PPACA required the establishment of 

exchanges in each state. In states that did not elect to operate their own exchange, 

the federal government was required to operate an exchange. Pub. L. No. 111-148, 

§§ 1311(b), 1321(c), 124 Stat. 119, 173, 186 (2010), as amended by the Health Care and 

Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010). In this 

report, references to PPACA include any amendments made by the Health Care and 

Education Reconciliation Act of 2010.

These exchanges facilitate the purchase of private health 

insurance by individuals. In addition, PPACA provides federal subsidies to 

qualifying individuals that reduce the cost of coverage purchased through 

an exchange, provides states the option to expand Medicaid to adults 

In this report, the term “state” includes the District of Columbia.

5

CMS manages the federally facilitated exchanges, while states that established their own 

exchanges operate and manage exchange activities, subject to the oversight of CMS.
 

Page 3 GAO-15-4 Health Care Coverage

who may not have been previously eligible, and requires individuals to 

maintain minimum essential coverage (MEC) for themselves and their 

dependents or be subject to a tax penalty, subject to certain exceptions.6

Individuals covered by certain government-sponsored programs 

(including DOD’s TRICARE program, VA’s health care program, 

Medicare, and Medicaid), an employer-sponsored health insurance plan, 

or a health insurance plan purchased on or off the exchanges that 

provides certain health benefits (referred to as essential health benefits),7

You asked us to review federal health care programs and exchangepurchased health care coverage available to servicemembers, former 

servicemembers, and their dependents. This report addresses four 

objectives:

are generally considered to have MEC and will not be subject to a penalty 

when filing their federal taxes.

1. What factors determine servicemembers’, former servicemembers’, 

and their dependents’ eligibility for health care coverage through 

DOD, VA, Medicare, Medicaid, and the exchanges?

2. What key benefits do DOD, VA, Medicare, Medicaid, and exchangepurchased coverage offer and at what potential cost to 

servicemembers, former servicemembers, and their dependents?

3. To what extent is information on exchange-purchased coverage and 

federal subsidies available to servicemembers, former 

servicemembers, and their dependents through DOD and VA 

websites?

 

6

For the purposes of this report, we are defining federal subsidies as the premium tax 

credits and cost-sharing reductions that apply to certain plans purchased through an 

exchange. Under PPACA, specific types of coverage (e.g., government-sponsored) 

qualify, by definition, as MEC. Individuals who have MEC, other than coverage purchased 

through the exchange, generally do not qualify for federal subsidies for exchangepurchased coverage.

7

PPACA defines essential health benefits as 10 broad categories of health care services, 

which include ambulatory patient services, emergency services, hospitalization, maternity 

and newborn care, mental health and substance abuse disorder services, prescription 

drugs, rehabilitative and habilitative services and devices, laboratory services, preventive 

services and chronic disease management, and pediatric services (including dental and 

vision).
 

Page 4 GAO-15-4 Health Care Coverage

4. To what extent do servicemembers, former servicemembers, and their 

dependents have health care coverage through DOD, VA, Medicare, 

and Medicaid?

To examine the factors used to determine servicemembers’, former 

servicemembers’, and their dependents’ eligibility for health care 

coverage through DOD, VA, Medicare, Medicaid, and to purchase 

coverage through an exchange, we reviewed relevant federal laws, or 

program descriptions provided on agency websites or in program 

materials, such as handbooks and fact sheets. We also interviewed DOD, 

VA, and CMS officials knowledgeable about the eligibility requirements for 

these respective programs and the eligibility requirements for purchasing 

coverage through an exchange.

To examine the key benefits offered by DOD, VA, Medicare, Medicaid, 

and exchange-purchased coverage, we identified and summarized 

benefit categories for each form of coverage as described by program 

descriptions provided on agency websites or in program materials, such 

as handbooks and fact sheets. We also reviewed relevant federal laws, 

regulations, or our prior work. Due to the potential differences in the 

individual services offered and definitions for terms used to describe 

individual services provided by DOD, VA, Medicare, Medicaid, and 

exchange-purchased coverage, we did not compare the individual 

services covered by each type of coverage within each benefit category, 

or differences in the amount, duration, or scope of covered services. Nor 

did we examine the differences in coverage within individual health plans 

that some programs or the exchanges may offer, such as different 

managed care plan options. To examine the potential cost to 

servicemembers, former servicemembers, and their dependents, we 

identified and summarized individuals’ costs for coverage through DOD, 

VA, Medicare, Medicaid, and exchange-purchased coverage as 

described by program descriptions provided on agency websites or in 

program materials, such as handbooks and fact sheets. For exchangepurchased coverage, we also identified and summarized available federal 

subsidies and their effect on individuals’ costs. We also interviewed 

agency officials knowledgeable about the costs to individuals for each 

program and reviewed relevant federal laws, regulations, or our prior 

work.8

 

8

See the Related GAO Products section at the end of this report.
 

Page 5 GAO-15-4 Health Care Coverage

To examine the extent to which information on exchange-purchased 

coverage and related federal subsidies is available to servicemembers, 

former servicemembers, and their dependents through DOD and VA, we 

reviewed agency materials that address this coverage, including 

information provided on agency websites and in downloadable program 

materials, such as fact sheets. We also reviewed federal internal control 

standards related to effective and timely communications, including 

sharing information externally and with stakeholders, and interviewed 

knowledgeable DOD and VA officials.9

To examine the extent to which servicemembers, former 

servicemembers, and their dependents have health care coverage 

through DOD, VA, Medicare, and Medicaid, we examined the results of 

VA’s analysis of the American Community Survey (ACS) of the U.S. 

Census Bureau. The ACS provides estimates of the average 

characteristics of the population over a specified period, including 

information on individuals’ military service and health insurance coverage. 

VA’s results from the 2012 ACS were the most recent, nationally available 

data at the time of our analysis and included the number of 

servicemembers, former servicemembers, and their dependents that 

reported having health care coverage through DOD, VA, Medicare, 

Medicaid, another source, or that were uninsured.10 Because the ACS 

data are based on a sample of the population, the numbers in this report 

are not the same as those that would be obtained if everyone in the 

population were actually counted.11

 

9

See GAO, Standards for Internal Control in the Federal Government, 

To provide a sense of the magnitude 

for how many servicemembers, former servicemembers, and their 

dependents have health care coverage through DOD, VA, Medicare, and 

Medicaid, we reviewed VA’s results from its analysis of ACS data, which 

provide an estimate of the number of respondents who self-identified as 

an individual who was either currently serving or who had previously 

GAO/AIMD-00-21.3.1 (Washington, D.C.: November 1999). Internal control is 

synonymous with management control and comprises the plans, methods, and 

procedures used to meet missions, goals, and objectives.

10These estimates from the ACS cover the January 1, 2012, to December 31, 2012, 

calendar year and represent the average value over the full period. 

11Additionally, nonsampling errors may affect the data. For example, errors may occur 

because ACS data analyses are based on self-reported information. However, the U.S. 

Census Bureau takes steps to minimize these errors by applying logical edits to correct for 

obvious misunderstanding of questions.
 

Page 6 GAO-15-4 Health Care Coverage

served on active duty and who reported having health care coverage 

through one or more federal programs—DOD’s TRICARE program, VA, 

Medicare, Medicaid, or a combination of these. We also supplemented 

these results with fiscal year 2012 and 2013 DOD and VA administrative 

data, such as eligibility and enrollment data. We used these data as a 

basis of comparison to the most currently available ACS data and to 

assess the extent to which servicemembers, former servicemembers, and 

their dependents had health care coverage through DOD and VA.12

We assessed the reliability of the three data sources we obtained—the 

ACS data provided by VA, DOD administrative data, and VA 

administrative data—in several ways, including reviewing each data 

source for reasonableness and cross-referencing the ACS data with the 

agencies’ administrative data from fiscal year 2012. To assess the 

reasonableness of the ACS data, we reviewed related documents, such 

as the ACS guidebooks, which describe how the ACS data are collected 

and processed and how researchers should use the data. To assess the 

reasonableness of DOD’s and VA’s administrative data, we reviewed 

prior DOD and VA reports to Congress that use these agency data to 

report on eligibility and enrollment. We also interviewed DOD and VA 

officials knowledgeable about these data. Based on these checks, we 

determined that the data we used were sufficiently reliable for the 

purposes of this report.

We conducted this performance audit from December 2013 to December

2014 in accordance with generally accepted government auditing 

standards. Those standards require that we plan and perform the audit to 

obtain sufficient, appropriate evidence to provide a reasonable basis for 

our findings and conclusions based on our audit objectives. We believe 

that the evidence obtained provides a reasonable basis for our findings 

and conclusions based on our audit objectives.

 

12These administrative data are more recent than the ACS data available, but do not 

generally include servicemembers’, former servicemembers’, and dependents’ health care 

coverage through Medicare and Medicaid. Nor do these data allow for an assessment of 

the prevalence of multiple sources of coverage. See Department of Defense, Evaluation of 

the TRICARE Program: Fiscal Year 2014 Report to Congress (Washington, D.C.: Mar. 5, 

2014) and VA’s fiscal year 2015 Congressional Budget Submission.
 

Page 7 GAO-15-4 Health Care Coverage

Individuals within the population of servicemembers and former 

servicemembers are generally designated by their military status. 

Dependents are generally designated by the military status of their 

sponsor—the uniformed servicemember or retiree with which the spouse 

or dependent child is associated. Servicemembers, which include 

individuals who are currently serving on active duty in the U.S. military 

and members of the military’s Selected Reserve, and their dependents, 

accounted for a small proportion of the total population—about 4.3 million 

of the 53 million total—in fiscal year 2013. Former servicemembers, 

which include individuals who either retired from active duty or the 

Selected Reserve, or left active duty military service for reasons other 

than retirement, and their dependents, accounted for the remainder of this 

population. Generally speaking, individuals who served on active duty for 

a certain period of time, usually a minimum of 20 years, may choose to 

retire from military service. Additionally, individuals with service 

connected injuries or illnesses may be retired from the military for medical 

reasons. Former servicemembers who retired from military service 

accounted for about 5.3 million of this population. All servicemembers 

who retire from active duty military status or the Selected Reserve are 

considered to be veterans, according to DOD officials. Individuals who 

served on active duty for less than 20 years, were not medically retired, 

and did not choose to re-enlist are generally not eligible to retire from the 

military. Former servicemembers who left military service for reasons 

other than retirement—who are also considered to be veterans—

generally join the civilian workforce after leaving the military. Former 

servicemembers who left the military for reasons other than retirement 

and their dependents accounted for the majority—about 43.7 million of 

the 53 million total—of this population (see fig. 1).

Background
 

Page 8 GAO-15-4 Health Care Coverage

Figure 1: Number of Servicemembers, Former Servicemembers, and Their 

Dependents, Fiscal Year 2013

Note: Former servicemembers who retired from military service are veterans who served on active 

duty for a certain period of time, generally a minimum of 20 years, then chose to retire from military 

service. This group also includes individuals who retired from the Selected Reserve and those who 

receive retired disability pay from the DOD. Former servicemembers who left military service for 

reasons other than retirement are veterans who generally served fewer than 20 years prior to leaving 

military service. 

DOD primarily provides health coverage through TRICARE, a health care 

program that combines the resources available at military treatment 

facilities with private health care providers and, for certain types of care, 

VA medical centers. TRICARE health plans offer standard health benefits 

packages nationwide for eligible individuals. Generally speaking, 

TRICARE consists of three main health plan options: TRICARE Prime, a 

managed care option; TRICARE Standard, a fee-for-service option; and 

TRICARE Extra, a preferred provider option. DOD also offers TRICARE 

for Life, a Medicare supplemental coverage option for TRICARE 

beneficiaries that are covered by Medicare; TRICARE Reserve Select 

and TRICARE Retired Reserve, coverage options available to certain 

current or retired reservists and their dependents; and TRICARE Young 

DOD
 

Page 9 GAO-15-4 Health Care Coverage

Adult, a program that provides services for dependent children up to 

age 26.13

VA, through the Veteran’s Health Administration, operates an integrated 

health care delivery system. VA’s health care system provides services at 

its medical centers, outpatient clinics, and residential facilities located 

nationwide. When necessary, VA also pays for services provided by 

private providers.14 VA provides a standard health care benefits package 

nationally to veterans enrolled in VA health care.15 In addition, VA also 

provides health care for certain individuals through programs such as the 

Civilian Health and Medical Program of the Department of Veterans 

Affairs and the Spina Bifida Program.

Medicare consists of four parts—Parts A, B, C (also known as Medicare 

Advantage), and D. Medicare Part A covers hospital, certain other 

inpatient stays, and hospice care services. Medicare Part B covers 

hospital outpatient, physician, and other medical services. Instead of 

choosing to receive Part A and B services through Original Medicare, 

Medicare beneficiaries generally also have the option of obtaining 

coverage for Medicare services from private health plans that participate 

in Medicare Advantage—also known as Part C. Individuals who select 

coverage through Medicare Advantage receive their Medicare Part A and 

Part B coverage from a Medicare Advantage plan. These plans cover all 

Medicare medical services, except hospice, and may cover additional 

services, but may charge different out-of-pocket costs than Original 

Medicare and these plans may have different requirements for how 

individuals get services, such as requiring a referral to see a specialist. All 

Medicare beneficiaries may purchase coverage for outpatient prescription 

 

13Additionally, DOD’s TRICARE programs provide coverage for eligible individuals in 

remote and overseas locations, such as TRICARE Prime Remote and Prime Overseas.

14If an individual is being treated at a VA medical facility or is under the jurisdiction of a VA 

provider and the provider determines that the individual needs care that is not available in 

the VA medical facility, VA is responsible for authorizing and paying for that care.

15In certain situations, individuals who are not enrolled may receive some VA care. For 

example, VA pays a per diem rate for nursing home care at states’ veterans’ nursing 

homes for some veterans who may not be enrolled.

VA

Medicare
 

Page 10 GAO-15-4 Health Care Coverage

drugs through Part D, either as a stand-alone benefit or as part of a 

Medicare Advantage plan.

Medicaid is a joint federal-state health program where each state designs 

and operates its own program, in accordance with federal parameters. As 

a result, there is variation between states. For example, while states must 

cover certain populations, such as low-income children, they also have 

the option to cover additional ones, such as low-income adults without 

children. Additionally, states’ Medicaid programs must cover a set of 

mandatory services, including services provided by physicians and 

inpatient and outpatient hospital services. States may elect to cover 

additional, optional benefits and services, such as clinic services or 

hospice, resulting in variation across the states.

PPACA required states to establish health insurance exchanges, or 

marketplaces, where eligible individuals can compare and select among 

health plans offered by participating private issuers of health care 

coverage. In states electing not to establish and operate such an 

exchange, PPACA requires the federal government to establish and 

operate an exchange in the state. Individuals purchasing insurance 

through the exchanges may also qualify for income-based federal 

subsidies to reduce the cost of that coverage.

Servicemembers’, former servicemembers’, and their dependents’ 

eligibility for coverage through DOD and VA is primarily based on military 

status. However, these individuals’ eligibility for Medicare, Medicaid, and 

to purchase coverage through an exchange is based on age, income, or 

other factors.

Medicaid

Exchange-Purchased 

Coverage

Eligibility for DOD and 

VA Coverage Is 

Primarily Based on 

Military Status, and 

Eligibility for 

Medicare, Medicaid, 

and ExchangePurchased Coverage 

Is Based on Age, 

Income, or Other 

Factors
 

Page 11 GAO-15-4 Health Care Coverage

Eligibility for DOD health care coverage, TRICARE, is primarily based on 

military status—whether or not individuals are on active duty, assigned to 

a designated reserve component, or retired from the military. Similarly, 

dependents’ eligibility is largely determined by the military status of their 

sponsor.16 According to DOD officials, the vast majority of those who are 

eligible for TRICARE are statutorily entitled to this coverage. Certain 

individuals who are statutorily entitled to coverage must enroll in 

TRICARE Prime, while others may choose the TRICARE plan through 

which they wish to receive coverage. Specifically, servicemembers must 

enroll in TRICARE Prime.17 Former servicemembers who retired from 

military service and their dependents who are under the age of 65, 

eligible spouses of servicemembers and former servicemembers, and 

eligible children of servicemembers and former servicemembers who are 

under the age of 2118 may choose either enrolling in TRICARE Prime or

receiving coverage through TRICARE Standard or Extra. Individuals who 

choose coverage through TRICARE Standard or Extra do not go through 

an enrollment process.19 All former servicemembers who retired from 

military service and their dependents who are aged 65 and older are 

entitled to coverage through TRICARE for Life.20

Certain dependents of servicemembers and former servicemembers who 

retired from military service, reservists, and retired reservists are not 

 

16For dependent children, age and health care status also may affect their eligibility for 

TRICARE.

17Active duty servicemembers assigned to duty stations located in areas not served by the 

military health care system are required to enroll in TRICARE Prime Remote, which is a 

specialized version of TRICARE Prime, which provides services in these locations. 

Dependents who reside with servicemembers who are enrolled in TRICARE Prime 

Remote are eligible to enroll in and receive care through TRICARE Prime Remote for 

Active Duty Family Members.

18In certain circumstances, a dependent child may remain eligible for TRICARE past age 

21. To remain TRICARE-eligible past age 21, the dependent child must be enrolled as a 

full-time student in an accredited institution of higher learning and be dependent on the 

sponsor for over 50 percent of his or her financial support. This dependent child may be 

TRICARE-eligible under student status until he or she graduates from the institution of 

higher learning or age 23, whichever comes first.

19TRICARE Standard and Extra are DOD’s fee-for-service and preferred provider options, 

respectively.

20In order to be eligible for TRICARE for Life, individuals who are entitled to Medicare 

Part A must also enroll in Medicare Part B.

Eligibility for DOD and VA 

Coverage Is Based 

Primarily on Military Status
 

Page 12 GAO-15-4 Health Care Coverage

statutorily entitled to TRICARE coverage, but may choose to purchase 

TRICARE coverage through specified plans, according to DOD officials. 

Specifically, unmarried dependent children, who lose their entitlement to 

TRICARE because of their age and are not eligible for coverage through 

an employer, may choose to purchase TRICARE coverage through the 

TRICARE Young Adult plan until age 26. Members of the Selected 

Reserve who are not serving on active duty or do not have other 

coverage may choose to purchase TRICARE Reserve Select for 

themselves or their dependents.21 Retired Reserve members who are 

younger than age 60 may choose to purchase TRICARE Retired Reserve 

for themselves and their dependents.22 Generally speaking, former 

servicemembers who choose to leave military service for reasons other 

than retirement are not eligible for TRICARE after their military 

separation.23

Eligibility for VA health care coverage is primarily based on military status, 

income, and service-connected disabilities. Generally, former 

servicemembers—both retired and those who left military service for 

reasons other than retirement—are eligible for VA coverage. VA assigns 

individuals who have enrolled in VA health care to one of eight priority 

groups, which are established by law. These groups, which are designed 

to manage access to services in relation to available resources, define 

 

21Members of the Selected Reserve may not enroll in TRICARE Reserve Select if they 

are covered under the Transitional Assistance Management Program, which provides 

180 days of premium-free transitional health care benefits after regular TRICARE benefits 

end, or if they are eligible for or enrolled in the Federal Employees Health Benefits 

program. Additionally, members of the Individual Ready Reserve including Navy Reserve 

Voluntary Training Units do not qualify to purchase TRICARE Reserve Select.

22To purchase TRICARE Retired Reserve coverage, Retired Reserve members must be 

qualified for retirement as defined under federal law, be under the age of 60, and not be 

eligible for or enrolled in the Federal Employees Health Benefits program.

23Servicemembers who separate from military service for reasons other than 

retirement may be eligible for transitional coverage options, including the Transitional 

Assistance Management Program or the Continued Health Care Benefit Program, 

which is a premium-based plan that offers temporary transitional health coverage for 

18 to 36 months after TRICARE eligibility ends.
 

Page 13 GAO-15-4 Health Care Coverage

the conditions under which a particular individual is eligible for benefits.24

Priority is generally determined by the individual’s degree of serviceconnected or other disability, financial need, or other special status. 

Priority Group 1, which has the highest priority for enrollment, includes 

former servicemembers with 50 percent or more service-connected 

disability or those who VA has determined to be unemployable due to 

service-connected conditions.25 Priority Group 8, which has the lowest 

priority for enrollment, includes individuals with no disability and an 

income exceeding certain VA income thresholds. Former 

servicemembers with a low income—individuals with an annual income or 

net worth that is less than certain VA income thresholds or who are 

eligible for Medicaid—are placed in a higher priority group than 

individuals with higher incomes.26 Additionally, certain servicemembers 

are also eligible for VA coverage, such as those seeking care in 

emergency situations or upon referral. Although dependents are generally 

not eligible for VA coverage, there are certain dependents, caregivers, 

and survivors of certain former servicemembers who may qualify for VA 

coverage through the Civilian Health and Medical Program of the 

Department of Veterans Affairs. For example, the primary family caregiver 

may be eligible for this coverage if the caregiver is without other health 

care coverage.

 

24If sufficient resources are not available to provide care that is timely and acceptable in 

quality, VA may restrict enrollment consistent with its priority categories. In January 2003, 

VA imposed a general freeze on new enrollments in Priority Group 8, the group which has 

the lowest priority for enrollment. In June 2009, VA began easing enrollment restrictions 

for individuals who may have been previously denied enrollment because their income 

exceeded a certain VA income threshold.

25VA calculates disability ratings for individuals with service-connected disabilities (i.e., 

injuries or diseases incurred or aggravated while on active military duty) according to the 

severity of the disability. VA’s ratings are awarded in 10 percent increments, from 0 to 

100 percent.

26VA has both national and regional income thresholds. For 2014, VA’s national income 

threshold is $31,443 or less for an individual, and $42,055 or less for a family of four. VA’s 

regional income thresholds vary depending on individuals’ residences and may, in some 

cases, be higher than the national income threshold.
 

Page 14 GAO-15-4 Health Care Coverage

Eligibility for Medicare is generally based on age or disability. Generally 

speaking, former servicemembers and their dependents are eligible for 

coverage through Medicare if they are aged 65 or older. If these 

individuals are under age 65, they may be eligible for Medicare if they are 

disabled; have end-stage renal disease; amyotrophic lateral sclerosis, 

also known as Lou Gehrig’s disease; or a condition resulting from an 

environmental health hazard.27 Part A coverage is generally automatic for 

eligible individuals,28

Medicaid eligibility for all individuals, including servicemembers, former 

servicemembers, and their dependents, is based on a set of factors that 

includes income, age, disability, citizenship status, and state residency. 

Minimum income and other eligibility criteria are established by federal 

law; although states may opt to cover additional individuals beyond these 

but Part B coverage is voluntary, and eligible 

individuals who elect this coverage must generally pay a monthly 

premium. Certain individuals must maintain Medicare coverage in order to 

remain eligible for DOD or VA coverage. Specifically, former 

servicemembers who retired from the military and their dependents who 

are eligible for TRICARE for Life and entitled to Medicare Part A must be 

enrolled in Medicare Part B coverage to maintain their TRICARE benefits. 

Additionally, dependents and survivors who are covered through the 

Civilian Health and Medical Program of the Department of Veterans 

Affairs who are entitled to Medicare Part A must be enrolled in Medicare 

Part B coverage to maintain their VA benefits.

 

27In order for an individual to become eligible for Medicare due to a disability, the 

individual generally must have been determined disabled by the Social Security 

Administration and have received Social Security benefits for at least 24 months. 

Medicare eligibility was also expanded under PPACA to include individuals who have 

been exposed to certain environmental hazards and, as a result, developed certain 

conditions, such as asbestosis. Currently, the benefits and services for individuals 

exposed to these environmental hazards are provided under the Medicare Pilot Program 

for Asbestos Related Disease and are limited to certain areas of Montana, Washington, 

and Idaho. Individuals diagnosed with end-stage renal disease, amyotrophic lateral 

sclerosis, or environmental health hazards are not subject to this 24-month waiting period.

According to DOD officials, in certain circumstances, servicemembers may be eligible for 

Medicare because they are deemed disabled as a result of illness or injury and then return 

to duty. According to DOD officials, in some instances, these individuals may maintain 

their Medicare coverage while serving on active duty.

28If individuals or their spouses did not work long enough in a job where Medicare taxes 

were paid, Medicare Part A coverage is not automatic. Under these circumstances, 

individuals may be able to get Part A by signing up during designated enrollment periods 

and paying a monthly premium.

Eligibility for Medicare, 

Medicaid, and ExchangePurchased Coverage Is 

Based on Age, Income, or 

Other Factors
 

Page 15 GAO-15-4 Health Care Coverage

federal minimums under their Medicaid state plans or under Medicaid 

demonstrations.29 Additionally, as a result of PPACA, states have the 

option to expand eligibility for Medicaid to certain adults whose income 

does not exceed 133 percent of the federal poverty level.30 As of 

September 2014, 28 states had expanded their Medicaid programs to 

cover these individuals. As a result, adults who reside in a state that has 

chosen to expand Medicaid and who do not fall into one of the other 

Medicaid-eligible population groups (e.g., are low-income parents and 

pregnant, aged, or disabled individuals) may now be eligible for Medicaid, 

whereas those residing in other states may not be. To further add to this 

complexity, Medicaid eligibility can affect a former servicemember’s 

access to health care through VA. Specifically, former servicemembers 

who are eligible for Medicaid in the state in which they reside may be 

placed in a higher VA priority group. As a result, a former servicemember 

residing in a state with broader Medicaid eligibility criteria may receive VA 

health care at a lower cost than a former servicemember with an identical 

income that resides in a state with more restrictive Medicaid eligibility 

criteria.31

Individuals, including servicemembers, former servicemembers, and their 

dependents, may purchase coverage through an exchange if they meet 

certain criteria established by PPACA. Specifically, to purchase coverage 

through an exchange, individuals must reside in the state where the 

Dependents of servicemembers and former servicemembers 

are primarily eligible for Medicaid coverage under the same conditions as 

servicemembers and former servicemembers, providing they are lowincome and meet other eligibility criteria.

 

29Under section 1115 of the Social Security Act, the Secretary of the Department of Health 

and Human Services may allow states to cover additional populations or services that 

would not otherwise be covered if they are likely to promote Medicaid objectives, which 

includes allowing states to test and evaluate new approaches for delivering Medicaid 

services.

30Specifically, states may expand coverage to nonpregnant adults under the age of 65 

who are not eligible for Medicare. Pub. L. No. 111-148, § 2001(a)(1),124 Stat. 119, 271 

(2010).

PPACA also provides for a 5 percent income disregard when calculating income 

for determining Medicaid eligibility, which effectively increases this income level to 

138 percent of the federal poverty level.

31Former servicemembers who are eligible for Medicaid are placed in VA’s Priority 

Group 5, which has lower cost-sharing requirements than lower priority groups, such as 

Priority Groups 7 and 8.
 

Page 16 GAO-15-4 Health Care Coverage

exchange is located, must be U.S. citizens or otherwise lawfully present 

in the United States, and must not be incarcerated. To obtain exchangepurchased coverage, individuals sign up for plans through the exchanges 

and pay their first monthly premiums.

DOD, VA, Medicare, Medicaid, and exchange-purchased coverage 

generally offer comprehensive health care coverage to their respective 

beneficiaries, which include servicemembers, former servicemembers, 

and their dependents. However, the key benefits within these programs 

may vary. DOD, VA, Medicare, Medicaid, or exchange plans may have 

cost-sharing requirements for their respective beneficiaries, including 

servicemembers, former servicemembers, and their dependents, but 

each is subject to certain limits.

DOD, VA, Medicare, Medicaid, and health plans offered through the 

exchanges generally offer comprehensive care to their respective 

beneficiaries, which include servicemembers, former servicemembers,

and their dependents—coverage that includes certain benefit categories 

such as inpatient hospital services, outpatient medical services, and 

certain prescription drugs, though some of these benefits may vary. For 

example, DOD’s TRICARE program offers a variety of plans that 

generally cover all of these categories of services (see fig. 2).32 DOD’s 

TRICARE program may also provide health care to servicemembers and 

former servicemembers who retired from military service, and their 

dependents who are living and working in designated overseas locations 

where other major federal programs may not provide care.33

 

32Certain rules and limitations may apply to some types of care and some services may 

not be covered by TRICARE. Examples include reproductive technology services and 

custodial nursing home care.

33VA may also cover health care services for certain service-connected disabilities for VA 

beneficiaries who are residing or traveling in Canada and other foreign countries 

(excluding the Philippines), if that service is medically necessary and authorized by VA’s 

Foreign Medical Program office. Former servicemembers living in the Philippines are 

entitled to the same VA benefits as those living in the United States.

DOD, VA, Medicare, 

Medicaid, and the 

Exchanges Generally 

Offer Comprehensive 

Coverage Subject to 

Certain Limits

DOD, VA, Medicare, 

Medicaid, and ExchangePurchased Coverage 

Generally Offer 

Comprehensive Health 

Care Coverage; Key 

Benefits within Programs 

May Vary
 

Page 17 GAO-15-4 Health Care Coverage

Figure 2: Examples of DOD’s TRICARE Benefits Categories

VA offers a standard, nationwide benefits package to former 

servicemembers—both retired and those who left military service for 

reasons other than retirement—and certain dependents of these former 

servicemembers. VA’s benefits package includes a full range of hospital 

and outpatient services, prescription drugs, and long-term care services 

provided in individuals’ own homes and in other locations in the 

community (see fig. 3).34 VA also provides some services that other major 

federal programs may not provide, such as long-term nursing home 

care.35

Figure 3: Examples of VA’s Benefits Categories

a

Certain rules and limitations may apply to VA long-term nursing home care. For example, VA is 

required to provide long-term nursing home care only to certain individuals, such as those that need 

such care for a service-connected disability. VA may provide this care to other eligible individuals on 

a discretionary basis as capacity and resources permit. 

 

34Certain limitations may apply to some types of care, such as dental services, durable 

medical equipment, and prosthetics.

35With respect to long-term care services, VA provides adult health day care, respite care, 

and other noninstitutional long-term care services as part of the medical benefits package 

it provides to all enrolled individuals.
 

Page 18 GAO-15-4 Health Care Coverage

Medicare offers nationwide benefits to individuals—including former 

servicemembers and their dependents—through Part A (standard hospital 

insurance), Part B (standard medical insurance), and Part D (prescription 

drug coverage). See figure 4 for examples of the categories of benefits 

offered through Medicare Parts A, B, and D. Medicare Part A benefits 

include inpatient hospital services, post hospital skilled nursing facility 

care, hospice care, and certain home health services. Medicare Part B 

coverage includes medically necessary outpatient hospital services, 

physicians’ services, and durable medical equipment—such as walkers 

and wheelchairs.36

 

36Certain limitations apply to Part A and Part B benefits. For example, under Part A, for 

each benefit period, inpatient hospital services are covered up to 90 days and skilled 

nursing facility care is covered up to 100 days following a hospital discharge. A benefit 

period ends when a beneficiary has not been an inpatient of a hospital or a skilled nursing 

facility for at least 60 consecutive days.

Part B covers a limited number of outpatient 

prescription drugs, such as injections administered in a physician’s office. 

However, outpatient prescription drugs provided to individuals are 

generally covered through Medicare Part D. Medicare Part C—Medicare 

Advantage—is Medicare’s private health plan option that offers coverage 

for all Part A and Part B services, but may charge different amounts and 

may cover additional services, such as vision, hearing, dental, or health 

and wellness programs. Additionally, Medicare Advantage plans may also 

include prescription drug coverage (Medicare Part D). The number of 

Medicare Advantage plans varies regionally, but nearly all Medicare 

beneficiaries—including former servicemembers and their dependents 

who received Medicare benefits—have a Medicare Advantage plan 

available to them.
 

Page 19 GAO-15-4 Health Care Coverage

Figure 4: Examples of Medicare Benefits Categories

Note: Medicare Part C—Medicare Advantage—covers all the benefits that are included in Parts A and 

B, except for hospice care. However, Medicare Part A covers hospice care for individuals covered by 

a Medicare Advantage plan. Most Medicare Advantage plans also include prescription drug coverage 

(Part D), and plans may cover additional benefits not covered by Medicare Parts A or B.

State Medicaid programs offer a package of benefits to individuals—

including dependents of servicemembers and former servicemembers 

and their dependents. State Medicaid programs may design their own 

benefits packages, provided they fall within federal parameters. As a 

result, Medicaid benefits may vary by state. State Medicaid programs 

generally must cover certain categories of mandatory benefits, as defined 

under federal law (see fig. 5). Additionally, states may also cover a range 

of optional benefits, such as prescription drugs, physical therapy, hospice, 

and preventive and dental services for adults.37

 

37Additionally, states may receive CMS approval of demonstrations or waivers under 

which the state may cover additional benefits or tailor benefit packages to specified 

groups of Medicaid beneficiaries. For example, states may cover a broad range of home

and community-based services for targeted populations under an approved waiver.

State Medicaid programs 

may also cover benefits that are not covered through other major federal 

programs, such as long-term services and supports for individuals who 

have limited ability to care for themselves because of physical, cognitive, 

or mental disabilities or conditions that are delivered in institutional (e.g., 

nursing facilities) and community-based (e.g., private homes) settings.
 

Page 20 GAO-15-4 Health Care Coverage

Figure 5: Medicaid Mandatory Benefits

Note: Rehabilitative services and devices are provided to help a person regain, maintain, or prevent 

deterioration of a skill that has been acquired but then lost or impaired due to illness, injury, or 

disabling condition. Habilitative services and devices, as defined by several advocacy groups, are 

provided to help a person attain, maintain, or prevent deterioration of a skill or function never learned 

or acquired due to a disabling condition.

Exchange plans offer benefits to individuals—including servicemembers, 

former servicemembers, and their dependents—who purchase this 

coverage. Beginning in 2014, health plans offered through the exchanges 

are required to cover 10 categories of benefits, referred to as essential 

health benefits (see fig. 6). For example, these health plans cover certain 

preventive health services, which include a variety of screenings, such as 

blood pressure and cholesterol screening, and certain vaccinations.38

Figure 6: Categories of Essential Health Benefits Covered by Exchange Plans

Exchange plans may cover additional health care benefits beyond the 

essential health benefits, such as health club memberships, hearing aids 

for children, adult dental services, and infertility treatments.

 

38Centers for Medicare & Medicaid Services, Preventive Care Benefits, accessed 

September 24, 2014, https://www.healthcare.gov/what-are-my-preventive-carebenefits/#part=1. 
 

Page 21 GAO-15-4 Health Care Coverage

DOD, VA, Medicare, Medicaid, or exchange plans may have premiums or 

cost-sharing for their respective beneficiaries, including servicemembers, 

former servicemembers, and their dependents, but the costs for each are 

subject to certain limits. Cost-sharing includes copayments, coinsurance, 

or deductibles.39

VA’s health care program generally does not require former 

servicemembers to pay premiums and generally does not require costsharing for certain groups of former servicemembers, such as those with 

certain service-connected disabilities or who are low income. Other 

former servicemembers, such as those seeking care for non-serviceconnected disabilities or who have higher incomes, may be required to 

participate in cost-sharing that is subject to certain limits. The average, 

annual out-of-pocket costs for those required to participate in cost-sharing 

was $322 for fiscal year 2013.

DOD’s TRICARE plans may require servicemembers, 

former servicemembers, and their dependents to pay a premium—

referred to as an enrollment fee—or to participate in certain cost-sharing. 

The amount of the premium or copayment is based on individuals’ military 

status, which TRICARE plan they use, and where they choose to receive 

their care. For example, servicemembers and their dependents covered 

by TRICARE’s Prime plan do not pay an enrollment fee, although former 

servicemembers who retired from military service and their dependents 

are required to pay an annual enrollment fee of $273.84 for an individual 

and $547.68 for a family for fiscal year 2014. Conversely, there are no 

enrollment fees for TRICARE Standard or Extra. Additionally, former 

servicemembers who retired from military service, dependents of 

servicemembers, and dependents of retired servicemembers may have to 

pay copayments or meet deductibles.

VA’s health care programs for eligible dependents of former 

servicemembers generally require individuals to meet an annual 

deductible and pay coinsurance for health care services that were not 

provided at a VA facility. For example, in 2014, dependents of former 

servicemembers enrolled in the Civilian Health and Medical Program of 

 

39A copayment is a fixed dollar amount that a consumer must pay at the time a covered 

service is provided, such as a $25 payment for a physician visit. Coinsurance is a fixed 

percentage of the total cost of covered services that a consumer must pay. A deductible is 

a specified amount that must be paid by the consumer before the health plan will begin 

paying for covered services. Health plans may also have an annual limit on the maximum 

out-of-pocket costs a consumer could incur.

DOD, VA, Medicare, 

Medicaid, and ExchangePurchased Coverage May 

Have Premiums or CostSharing Subject to Certain 

Limits
 

Page 22 GAO-15-4 Health Care Coverage

the Department of Veterans Affairs pay an annual deductible of $50 for 

outpatient care. After this deductible is paid, VA’s health care program 

pays for 75 percent of covered health care expenses, and the individual is 

responsible for the remaining 25 percent of expenses until the 

catastrophic cap—$3,000 per family per calendar year—is reached.40

Medicare may require beneficiaries—including former servicemembers 

and their dependents—to pay premiums and other cost-sharing, 

depending on their income and other factors. For example, Medicare Part 

A coverage does not generally require payment of premiums, but 

beneficiaries who did not pay Medicare taxes while working may be 

required to pay a monthly premium (of up to $426 in 2014).41

 

40The catastrophic cap is the annual limit of how much a beneficiary can be charged in a 

calendar year for covered services and supplies.

Additionally, 

Part A beneficiaries—including former servicemembers and their 

dependents—may be responsible for a deductible, coinsurance, or a 

copayment for services. Medicare Parts B and D coverage generally 

requires individuals to pay a monthly premium. The monthly premium for 

Medicare Part B in 2014 ranges from $104.90 to $335.70, depending on 

the beneficiary’s income. Additionally, Medicare Part B generally requires 

individuals to pay 20 percent of the cost of the medical service received. 

Medicare Parts A and B have a per service limit on cost-sharing, but no 

annual limit on these out-of-pocket costs. The costs, including premiums 

and copayments, for Medicare Part C vary by health plan though there 

are certain, established cost limits. For example, Medicare Advantage 

plans are not able to charge more in cost-sharing than Original Medicare 

for certain services, such as chemotherapy, renal dialysis, and skilled 

nursing facility care. Specifically, Medicare Advantage plans cannot 

require beneficiaries to share in the cost of the services beyond what is 

allowed for Medicare Part B for services, which generally requires 

beneficiaries to pay 20 percent of the Medicare-approved amount. 

Additionally, Medicare Advantage plans have a yearly limit, which varies

by plan, on an individual’s out-of-pocket costs for medical services. There 

are no such annual out-of-pocket cost limits in the Original Medicare 

program.

41A beneficiary generally pays no premium for this coverage unless the beneficiary or 

spouse has worked fewer than 40 quarters in his or her lifetime, but the beneficiary is 

responsible for required deductibles, coinsurance, and copayment amounts.
 

Page 23 GAO-15-4 Health Care Coverage

Certain servicemembers and former servicemembers and their 

dependents who have Medicare Parts A and B are also automatically 

covered by TRICARE for Life. Because TRICARE for Life serves as 

supplemental coverage that may minimize out-of-pocket expenses, such 

as copayments and deductibles, these individuals may have lower out-ofpocket expenses than an individual who does not have this additional 

coverage.

State Medicaid programs may not impose premiums or cost-sharing on 

certain populations or services. Specifically, states are prohibited from 

imposing premiums on Medicaid beneficiaries—including dependents of 

servicemembers and former servicemembers—with incomes below 150 

percent of the federal poverty level. Additionally, states may not impose 

cost sharing on services provided to certain populations, such as children 

under the age of 18 or pregnant women. Further, states may not charge 

cost-sharing for certain services, including emergency and family 

planning services.

42 States can choose to impose premiums or costsharing for other Medicaid beneficiaries, but these costs are subject to 

certain limits. For example, total premiums and cost-sharing amounts 

cannot exceed 5 percent of a family’s income.43

Exchange-purchased coverage provided by participating health insurance 

issuers may require beneficiaries—including servicemembers, former 

servicemembers, and their dependents—to pay premiums and costsharing, such as deductibles and copayments. Individual premium and 

cost-sharing amounts depend on the type of plan purchased, and 

exchange plans are categorized according to the costs expected to be 

paid by the plan—designated as bronze, silver, gold, or platinum. For 

example, a bronze plan will typically have lower premiums and higher 

cost-sharing when services are delivered, while a gold or platinum plan 

will have higher premiums and lower cost-sharing.44

 

42States have the option to extend this exemption to children under the age of 21.

Additionally, PPACA 

established an annual limit on cost-sharing for exchange plan 

43States have the option to apply this limit on a quarterly or monthly basis.

44Each level has an assigned actuarial value, which is defined as the estimated amount 

an average enrollee will have to pay out of pocket (excluding premiums). For example, a 

silver plan has an average value of 70 percent, which means that an enrollee will be 

responsible for 30 percent of the cost of services.
 

Page 24 GAO-15-4 Health Care Coverage

beneficiaries, which in 2014, was $6,350 for self-only coverage and 

$12,700 for other coverage.45

PPACA established two forms of federal subsidies for exchangepurchased coverage—premium tax credits and cost-sharing reductions—

which reduce costs of the coverage to individuals who qualify. To qualify

for federal subsidies, individuals must be eligible to enroll in an exchange 

plan, meet income criteria, and not have MEC, including coverage 

through government-sponsored programs, such as DOD or VA, Medicare, 

or Medicaid. Individuals who purchase health care coverage through the 

exchanges may qualify for premium tax credits if they have an income 

between 100 and 400 percent of the federal poverty level.46 Cost-sharing 

reductions, available to individuals with incomes from 100 to 250 percent 

of the federal poverty limit, are only available to individuals who purchase 

a silver plan through an exchange. In addition, the amounts of costsharing assistance vary by income. For example, in the case of one state 

plan, individuals with incomes at 150 percent of the federal poverty level 

and with a silver plan would have their primary care visit copayment 

reduced from $45 to $3 and their specialty care visit copayment reduced 

from $65 to $5.47

Federal subsidies for exchange-purchased coverage may be available to 

certain former servicemembers and certain dependents of 

servicemembers and former servicemembers who are not covered by 

DOD or VA health care, if they meet applicable income and other 

requirements.48

 

45This limit does not include premiums, but does include deductibles.

Most servicemembers and former servicemembers and 

their dependents have MEC and therefore are ineligible for premium tax 

46PPACA provides for a federal tax credit to lower the premium cost for eligible individuals 

to between 2 and 9.5 percent of income for individuals whose incomes are from 100 to

400 percent of the federal poverty level. This assistance is based on the premiums for the 

second-lowest-cost silver plan. Accordingly, if an individual chooses to enroll in a gold or 

platinum plan, their premium costs may exceed these levels.

47See GAO, Retirement Security: Challenges for Those Claiming Social Security Benefits 

Early and New Health Coverage Options, GAO-14-311 (Washington, D.C.: Apr. 23, 2014).

48For example, these individuals cannot be incarcerated or have another form of MEC.
 

Page 25 GAO-15-4 Health Care Coverage

credits and cost-sharing reductions, regardless of their income.49

Therefore, in order to qualify for federal subsidies, these individuals would 

first need to cancel their government-sponsored coverage. This is an 

option for certain individuals, but not for others. Specifically, former 

servicemembers and their dependents who have the option to enroll in 

VA coverage and certain TRICARE beneficiaries who are not statutorily 

entitled to TRICARE coverage—such as certain reservists and 

dependents eligible for TRICARE Young Adult—may choose not to enroll 

or may cancel their existing VA or TRICARE coverage. However, the 

majority of servicemembers and former servicemembers who retired from 

military service and their dependents are statutorily entitled to TRICARE 

coverage and, therefore, do not have the option to disenroll from 

TRICARE in order to potentially qualify for federal subsidies.

Both DOD and VA provide information to servicemembers, former 

servicemembers, and their dependents on how DOD and VA coverage is 

affected by PPACA requirements, as well as information on eligibility for 

exchange-purchased coverage. DOD and VA disseminate this 

information using a variety of mechanisms, including dedicated websites 

(e.g., www.tricare.mil/aca and www.va.gov/health/aca) and program 

materials available on their websites (e.g., fact sheets). The information 

provided generally focuses on PPACA’s impact on their programs. For 

example, as of September 2014, both DOD and VA provided the following 

information through their websites:

• DOD and VA health care are considered MEC, with certain 

exceptions.50

 

49Certain types of DOD coverage may not qualify as MEC. For example, under a 

proposed regulation, DOD care that is limited to those services provided in the line of duty 

or as space is available at a military treatment facility would not qualify as MEC. 79 Fed. 

Reg. 4305, 4307-8 (Jan. 27, 2014).

As a result, servicemembers, former servicemembers, 

and their dependents who have coverage through DOD or VA do not 

need to take additional steps or obtain other coverage to satisfy 

PPACA’s requirement that individuals have MEC in order to avoid 

paying a tax penalty.

50For example, special TRICARE programs, such as TRICARE Plus, which only provide 

certain limited services at a military treatment facility, are not considered to be MEC.

DOD and VA Provide 

Information on 

Eligibility for 

Exchange-Purchased 

Coverage, but DOD 

Provides Limited 

Information on 

Qualifying for Federal 

Subsidies
 

Page 26 GAO-15-4 Health Care Coverage

• PPACA does not change servicemembers’, former servicemembers’, 

and their dependents’ existing TRICARE and VA benefits or 

individuals’ out-of-pocket costs for benefits offered through TRICARE 

or VA’s health care program.

Additionally, both DOD’s and VA’s websites provide information to 

servicemembers, former servicemembers, and their dependents on how 

eligible individuals may get health care coverage through their respective 

programs, if they are not currently covered. For example, DOD’s website 

provides a link to update its eligibility database and VA provides links to 

its application process. Further, agencies’ websites or program materials 

suggest individuals who either do not have, or are ineligible for, coverage 

through their programs consider purchasing coverage from an exchange.

VA’s website also provides information to former servicemembers and 

their dependents on qualifying for federal subsidies on exchangepurchased coverage. Specifically, VA provides information on its website 

that informs its users that VA coverage meets the standard for MEC 

under PPACA and, as a result, individuals covered by VA do not qualify 

for federal subsidies on exchange-purchased coverage. VA’s website 

also provides information on how former servicemembers and their 

dependents who are enrolled in VA coverage may cancel this coverage, if 

they so choose. This type of information may be useful for former 

servicemembers and their dependents to compare the costs and other 

factors associated with VA coverage with the costs of exchange plans. 

For example, in some circumstances, former servicemembers and their 

dependents who do not live near a VA medical center may wish to 

consider whether federal subsidies may make exchange-purchased 

coverage affordable and whether that coverage may enable them to 

receive care closer to home.

However, unlike VA’s website, DOD’s website does not provide 

information on circumstances under which servicemembers or former 

servicememembers who retired from military service, or their dependents 

might qualify for federal subsidies, which could be useful in understanding 

their health care choices. Specifically, DOD’s website does not inform 

servicemembers and former servicemembers that retired from military 

service that they and their dependents are statutorily entitled to TRICARE 

coverage and, as a result, they may not opt out of this coverage in order 

to potentially qualify for federal subsidies. Nor does DOD’s website inform 

those individuals who may opt in to TRICARE coverage—including 

reservists, retired reservists, and dependent children under the age of 26 

eligible for the young adult program—that they may choose not to enroll 
 

Page 27 GAO-15-4 Health Care Coverage

or cancel their TRICARE coverage in order to potentially qualify for 

federal subsidies.51 Not providing such information is inconsistent with 

federal internal control standards.52

DOD officials stated that their focus has been on ensuring that 

servicemembers, former servicemembers who retired from military 

service, and their dependents understand that TRICARE coverage meets 

the standard for MEC and is not adversely affected by the enactment of 

PPACA. DOD officials also stated that to avoid confusion, they direct 

servicemembers and their dependents who are no longer eligible for 

TRICARE, such as those who have separated from military service or 

young adults over the age of 26, to obtain information on other coverage 

options from the healthcare.gov website. However, healthcare.gov does 

not inform servicemembers, former servicemembers that retired from 

military service, and their dependents who may qualify for federal 

subsidies that these subsidies are not available to individuals who have 

coverage through TRICARE. As a result, these individuals may not have 

complete information to make choices on the form of coverage that best 

meets their individual financial and health care needs. DOD officials 

acknowledged that changes could be made to DOD’s program materials 

in order to clarify that when servicemembers, former servicemembers 

who retired from military service, and their dependents are eligible for 

TRICARE, they do not qualify for federal subsidies on exchangepurchased coverage.

 

51The TRICARE Young Adult plan provides coverage to eligible adult children aged 21 to 

26 who are not otherwise eligible for employer-sponsored health care coverage or another 

TRICARE plan.

52Federal internal control standards require agencies to use effective and timely 

communications—including communications with external stakeholders—in order to meet 

their mission and goals. See GAO/AIMD-00-21.3.1.
 

Page 28 GAO-15-4 Health Care Coverage

More than 27 million servicemembers, former servicemembers, and their 

dependents reported that they had health care coverage through DOD, 

VA, Medicare, Medicaid, or a combination of these in 2012, according to 

data we reviewed from the ACS. Of these, about 20 million reported they 

had coverage through a single program and 7 million reported they had 

coverage through a combination of two or more of these programs. 

Additionally, about 22 million servicemembers, former servicemembers, 

and their dependents reported that they did not have coverage through 

any of these federal programs in 2012. Of these, about 18 million 

reported they had coverage through another source, such as employersponsored coverage, and 4 million reported they were uninsured.53

We found that the number of servicemembers, former servicemembers, 

and their dependents covered by DOD, VA, Medicare, and Medicaid 

varies by program (see fig. 7). The number of individuals with coverage 

through each of these programs includes those who have coverage 

through a single program and those covered through that program and 

one or more other federal programs. For example, an individual with 

coverage through DOD and Medicare is counted in the DOD count and 

the Medicare count. As a result, the total number of those with coverage 

across all four programs is greater than the 27 million total unique 

servicemembers, former servicemembers, and their dependents who 

reported that they had health care coverage through these programs.

 

53We used ACS data to estimate the number of servicemembers, former servicemembers, 

and dependents that had health care coverage under these programs because it is the 

only source that provides, for this population, information regarding coverage through all 

of these programs. ACS data, which are self-reported survey data, underestimates certain 

populations, including the servicemember, former servicemember, and dependent 

population. According to VA officials, the data reported on the ACS may reflect numbers 

lower than what is contained in DOD’s and VA’s administrative data because the ACS 

data does not include responses from individuals residing in the Virgin Islands, Pacific 

Islands, or other overseas locations (such as the Philippines). Additional factors, such as 

ACS survey respondents confusing their training for active duty with actually being 

activated for service, may account for other differences.

More Than 27 Million 

Servicemembers, 

Former 

Servicemembers, and 

Their Dependents 

Had Coverage 

through Federal 

Programs in 2012
 

Page 29 GAO-15-4 Health Care Coverage

Figure 7: Number of Servicemembers, Former Servicemembers, and Their 

Dependents Who Had Health Care Coverage through DOD, VA, Medicare, or 

Medicaid in 2012

Note: Servicemembers, former servicemembers, and their dependents may have health care 

coverage through more than one federal program. Individuals covered by two or more programs are 

included in the count of each program through which they have coverage. As a result, the total 

number of those with coverage across all four programs is greater than the 27 million total unique 

servicemembers, former servicemembers, and their dependents who reported that they had health 

care coverage through these programs.

ACS survey respondents reported coverage through DOD’s TRICARE 

and VA health care programs. About 7.7 million servicemembers, former 

servicemembers who retired from military service, and their dependents 

reported that they had health care coverage through DOD’s TRICARE 

program in 2012, according to data we reviewed from the ACS.54

 

54DOD has administrative records that provide the number of individuals covered by its 

program, but do not include information on health care coverage for individuals not 

covered by its program, such as former servicemembers who left the military for reasons 

other than retirement and their dependents. DOD’s administrative records for individuals 

covered by its program showed that an average of 8.1 million servicemembers, former 

servicemembers who retired from military service, and their dependents used their 

TRICARE coverage to access health care services in fiscal year 2012. In fiscal year 2013, 

an average of 8.0 million servicemembers, former servicemembers who retired from 

military service, and their dependents (of the 9.6 million eligible beneficiaries) used their 

TRICARE coverage.

About 
 

Page 30 GAO-15-4 Health Care Coverage

6.4 million former servicemembers and their dependents reported that 

they had health care coverage through VA according to the 2012 ACS 

data.55

ACS survey respondents also reported coverage through Medicare and 

Medicaid. About 16 million servicemembers, former servicemembers, and 

their dependents reported that they had coverage through Medicare in 

2012, according to the ACS data we reviewed. Former servicemembers 

may be 65 years of age or older, as may be their spouses, and therefore 

would qualify for Medicare. In fiscal year 2012, there were approximately 

2.0 million individuals aged 65 and older who were covered through 

DOD’s health care program and 3.6 million who were covered through 

VA’s health care program. Additionally, servicemembers, former 

servicemembers, and their dependents may qualify for Medicare due to 

disability or illness. About 5.3 million servicemembers, former 

servicemembers, or their dependents reported that they had health care 

coverage through Medicaid according to the 2012 ACS data we reviewed. 

These 5.3 million individuals may include former servicemembers with 

low incomes, or dependents of servicemembers or former 

servicemembers with special-needs children.

About 7 million servicemembers, former servicemembers, and their 

dependents had health care coverage through two or more programs in 

2012. Of these, most—nearly 6 million—had coverage through two 

programs; far fewer were covered by three or four programs (see table 1).

 

55While many individuals who leave military service for reasons other than retirement are 

eligible for health care coverage through VA, many choose not to enroll for reasons that 

include distance between the former servicemembers’ homes and VA facilities or 

perceptions about VA care.

VA has administrative records that provide the number of individuals covered by its 

program, but the records do not include information on health care coverage for 

individuals not covered by its program, such as servicemembers, their dependents, former 

servicemembers not enrolled in VA health care, and dependents of former 

servicemembers not eligible for VA health care. VA’s administrative records for individuals 

covered by its program showed that about 6.3 million individuals used their VA coverage 

to access health care services in fiscal year 2012. In fiscal year 2013, approximately 6.5 

million individuals (of the 9.3 million eligible beneficiaries) used their VA coverage. Of 

these 9.3 million enrolled beneficiaries, 8.9 million were servicemembers or former 

servicemembers and, according to VA officials, 378,000 were dependents, caregivers, or 

survivors enrolled in the Civilian Health and Medical Program of the Department of 

Veterans Affairs or the Spina Bifida Program.
 

Page 31 GAO-15-4 Health Care Coverage

Table 1: Number of Servicemembers, Former Servicemembers, and Their 

Dependents with Multiple Forms of Coverage through DOD, VA, Medicare, or 

Medicaid in 2012

Types of coverage

Number of servicemembers, former 

servicemembers, and their dependents

(reported in millions)

Two forms of coverage 5.9

VA and Medicare 2.4

Medicaid and Medicare 1.3

TRICARE and Medicare 1.2

TRICARE and VA 0.6

VA and Medicaid 0. 2

TRICARE and Medicaid 0.1

Three forms of coverage 1.2

TRICARE, VA, and Medicare 0.7

VA, Medicaid, and Medicare 0.4

TRICARE, Medicaid, and Medicare 0.1

TRICARE, VA, and Medicaid 0.04

Four forms of coverage

TRICARE, VA, Medicaid, and Medicare 0.1

Total 7.2

Source: GAO analysis of 2012 American Community Survey (ACS) data provided to us by the Department of Veterans Affairs (VA).

   |   GAO-15-4 

Note: Certain dependents of servicemembers and former servicemembers who retired from military 

service, reservists, and retired reservists may choose not to be covered by TRICARE even if they are 

eligible to purchase this coverage, according to Department of Defense (DOD) officials. Similarly, 

former servicemembers and their dependents may choose not to be covered by VA health care even 

if they are eligible.

According to the ACS data we reviewed, approximately 2.4 million former 

servicemembers and their dependents were covered by VA and 

Medicare. Generally, those covered through both VA and Original 

Medicare may choose which form of coverage they would like to use for a 

particular episode of care. For example, former servicemembers may

elect to use their VA coverage to obtain regular preventive care visits at a 

nearby VA community-based outpatient clinic and their Medicare 

coverage to obtain certain specialty services, such as surgery, from a 

non-VA community-based provider. In general, if an individual chooses to 

receive care from a VA provider, VA pays in full if the care is for a serviceconnected disability and, for a non-service-connected disability, may 

assess any copayments that an individual may owe through VA rules. 

Conversely, if the individual chooses a Medicare participating provider, 
 

Page 32 GAO-15-4 Health Care Coverage

Medicare would cover the cost of the services and assess any costsharing charges owed through the Original Medicare program rules.

According to the ACS data we reviewed, approximately 1.3 million former 

servicemembers and their dependents are covered by both Medicare and 

Medicaid. This type of coverage may occur when former servicemembers 

and their dependents, who are not covered through DOD or VA, meet the 

requirements for coverage through both Medicare and Medicaid. For 

these individuals, Medicare generally covers most of the cost of services, 

and Medicaid may cover some or all of the cost-sharing. Additionally, 

Medicaid may cover certain services that Medicare does not.56 For 

example, a former servicemember who is 65 years of age or older who 

requires long-term nursing home care may receive coverage of this 

service through his or her state Medicaid program, as that service is not 

covered through Medicare.57

According to the ACS data we reviewed, approximately 1.2 million 

servicemembers, former servicemembers, and their dependents are 

covered by both TRICARE and Medicare, and which program provides 

the benefits depends on where the individuals receive the services. While 

these individuals are eligible to receive care directly from a military 

treatment facility, DOD rules allow these individuals to receive care only if 

space is available. When an individual uses this option, DOD generally 

covers the full cost of that episode of care. However, if these individuals 

choose to receive care from a Medicare participating provider, Medicare 

generally is the primary payer, with TRICARE paying the out-of-pocket 

expenses for services it covers that are owed by the individuals, such as 

any copayments or deductibles.

 

56Individuals covered by both Medicare and Medicaid may be categorized as full-benefit or 

partial-benefit. Those with full benefits generally receive coverage of their Medicare 

premiums and cost-sharing as well as the entire range of Medicaid benefits. Those with 

partial benefits do not receive Medicaid-covered services, but Medicaid covers their 

Medicare premiums and/or cost-sharing, or both. Partial-benefit beneficiaries have limited 

income and assets, but their income and assets are not low enough to qualify them for full 

Medicaid benefits in their states.

57State Medicaid programs are required to cover nursing facility service, subject to certain 

limitations. Examples of these limitations include medical necessity and utilization control 

procedures.
 

Page 33 GAO-15-4 Health Care Coverage

Servicemembers, former servicemembers, and their dependents may 

face complex choices in considering which forms of coverage best meet 

their health care needs and financial situations given that DOD, VA, 

Medicare, Medicaid, and the exchanges offer a range of benefits and 

cost-sharing requirements depending on individuals’ eligibility for these 

programs. In 2014, the initiation of exchange-purchased coverage, and 

the expansion of Medicaid in states choosing to participate, added to the 

choices and complexity these individuals face in making choices for 

health care coverage. Moreover, changes in servicemembers’, former 

servicemembers’, and their dependents’ military status, age, disabilities, 

and other factors over time can result in the need to reconsider complex 

choices in coverage through different federal programs.

For servicemembers and former servicemembers to make well-informed 

decisions for themselves and their dependents, it is important that federal 

agencies provide complete information about individuals’ health care 

coverage choices, including the range of benefits offered, and the 

potential cost-sharing associated with each program. In particular, 

servicemembers, former servicemembers, and their dependents need 

complete information on the complex health care coverage choices 

offered by DOD, VA, and the recently implemented exchanges in order to 

select the coverage that best meets their needs. This includes information 

on how they may qualify for federal subsidies that may reduce the cost of 

exchange-purchased coverage. While DOD and VA both provide 

information on their eligibility for coverage through the exchanges, only 

VA provides information on how individuals may qualify for federal 

subsidies. Consequently, certain servicemembers, former 

servicemembers, and their dependents may not have adequate 

information to compare costs efficiently and choose the coverage that 

best meets their health care needs and their available financial resources.

To help ensure that servicemembers, former servicemembers, and their 

dependents have complete information for considering their choices for 

their health care coverage, we recommend that the Secretary of Defense 

disseminate information on how DOD health care coverage may affect 

servicemembers’, former servicemembers’, and their dependents’ ability 

to qualify for federal subsidies that reduce the costs of exchangepurchased coverage.

Conclusions

Recommendation for 

Executive Action
 

Page 34 GAO-15-4 Health Care Coverage

We provided a draft of this report to DOD, VA and HHS for comment. In 

its written comments—reproduced in appendix I—DOD concurred with 

our recommendation. DOD stated that it will continue to assess and 

implement strategies that strengthen the dissemination of information on 

how TRICARE eligibility affects its beneficiaries’ ability to qualify for 

subsidies on exchange-purchased coverage. In its written comments—

reproduced in appendix II—VA generally agreed with our conclusions. VA 

also provided technical comments that were incorporated, as appropriate. 

HHS had no comments.

We are sending copies of this report to the Secretary of the Department 

of Defense, the Secretary of the Department of Health and Human 

Services, the Secretary of the Department of Veterans Affairs, the 

Administrator of CMS, and the appropriate congressional committees. In 

addition, the report will be available at no charge on the GAO website at 

http://www.gao.gov. 

If you or your staffs have any questions about this report, please contact 

me at (202) 512-7114 or at iritanik@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on 

the last page of this report. GAO staff who made key contributions to this 

report are listed in appendix III. 

Katherine Iritani

Director, Health Care

Agency Comments
Appendix I: Department of Defense Comments

Page 35 GAO-15-4 Health Care Coverage

Appendix I: Department of Defense 

Comments
Appendix I: Department of Defense Comments

Page 36 GAO-15-4 Health Care Coverage
Appendix II: Department of Veterans Affairs 

Comments

Page 37 GAO-15-4 Health Care Coverage

Appendix II: Department of Veterans Affairs 

Comments
Appendix III: GAO Contact and Staff 

Acknowledgments

Page 38 GAO-15-4 Health Care Coverage

Katherine Iritani, (202) 512-7114 or iritanik@gao.gov

In addition to the named above, key contributors to this report were 

James C. Musselwhite, Jr., Assistant Director; Kathryn Black; 

Sarah Harvey; Laurie Pachter; Vikki Porter; and Hemi Tewarson.

Appendix III: GAO Contact and Staff 

Acknowledgments

GAO Contact

Staff 

Acknowledgments
Related GAO Products

Page 39 GAO-15-4 Health Care Coverage

VA Nursing Homes: Reporting More Complete Data on Workload and 

Expenditures Could Enhance Oversight. GAO-14-89. Washington, D.C.: 

December 20, 2013.

Patient Protection and Affordable Care Act: Status of CMS Efforts to 

Establish Federally Facilitated Health Insurance Exchanges. 

GAO-13-601. Washington, D.C.: June 19, 2013.

Patient Protection and Affordable Care Act: Status of Federal and State 

Efforts to Establish Health Insurance Exchanges for Small Businesses. 

GAO-13-614. Washington, D.C.: June 19, 2013.

Medicaid: States Made Multiple Program Changes, and Beneficiaries 

Generally Reported Access Comparable to Private Insurance. 

GAO-13-55. Washington, D.C.: November 15, 2012.

Medicare Advantage: Enrollment Increased from 2010 to 2011 while 

Premiums Decreased and Benefit Packages Were Stable. GAO-12-93. 

Washington, D.C.: October 31, 2011.

VA Mental Health: Number of Veterans Receiving Care, Barriers Faced, 

and Efforts to Increase Access. GAO-12-12. Washington, D.C.: 

October 14, 2011.

DOD Health Care: Cost Impact of Health Care Reform and the Extension 

of Dependent Coverage. GAO-11-837R. Washington, D.C.: 

September 26, 2011.

Health Care Price Transparency: Meaningful Price Information Is Difficult 

for Consumers to Obtain Prior to Receiving Care. GAO-11-791. 

Washington, D.C.: September 23, 2011.

Medicaid and CHIP: Given the Association between Parent and Child 

Insurance Status, New Expansions May Benefit Families. GAO-11-264. 

Washington, D.C.: February 4, 2011.

VA Health Care: VA Has Taken Steps to Make Services Available to 

Women Veterans, but Needs to Revise Key Policies and Improve 

Oversight Processes. GAO-10-287. Washington, D.C.: March 31, 2010.

Medicare Part D: Spending, Beneficiary Out-of-Pocket Costs, and Efforts 

to Obtain Price Concessions for Certain High-Cost Drugs. GAO-10-529T. 

Washington, D.C.: March 17, 2010.

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Page 40 GAO-15-4 Health Care Coverage

VA Faces Challenges in Providing Substance Use Disorder Services and 

Is Taking Steps to Improve These Services for Veteran. GAO-10-242R. 

Washington, D.C.: March 10, 2010.

Medicare Part D: Spending, Beneficiary Cost Sharing, and CostContainment Efforts for High-Cost Drugs Eligible for a Specialty Tier. 

GAO-10-294R. Washington, D.C.: January 29, 2010.

Medicaid: States Reported That Citizenship Documentation Requirement 

Resulted in Enrollment Declines for Eligible Citizens and Posed 

Administrative Burdens. GAO-07-889. Washington, D.C.: June 28, 2007.

Medicare Part D: Challenges in Enrolling New Dual-Eligible Beneficiaries. 

GAO-07-272. Washington, D.C.: May 4, 2007.

TRICARE: Enrollment of the Department of Defense’s TRICARE 

Beneficiaries in Medicare Part B. GAO-06-489R. Washington, D.C.: 

June 20, 2006.

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