Veterans and military families represent a significant market segment with unique health insurance needs. Successful agents know how military benefits coordinate with civilian coverage and can explain the value of beefing up those benefits with OHI (other health insurance). Here are some strategies for establishing yourself as an authority in this niche while effectively serving those who served the country.
TRICARE for veterans and retirees
Military retirees and certain veterans have access to TRICARE, but many agents misunderstand how these benefits work outside of active duty service. TRICARE offers two main options for veterans:
TRICARE Select functions similar to a PPO, giving veterans flexibility in choosing providers. Veterans pay premiums, deductibles, and cost-shares, but don't need referrals for specialty care. This appeals to veterans who value provider choice and are willing to pay more for flexibility.
TRICARE Prime resembles an HMO, generally requiring care from military treatment facilities or network providers with referrals for specialists. The trade-off is lower out-of-pocket costs. This option appeals to veterans living near military facilities who prefer predictable expenses.
A critical point agents often miss: When veterans have TRICARE along with civilian coverage, their other health insurance (OHI) typically pays first, with TRICARE serving as secondary coverage. This coordination can substantially reduce a veteran's expenses and represents a key selling point for civilian plans.
Veterans Affairs (VA) healthcare
VA healthcare differs fundamentally from TRICARE and traditional insurance. Eligibility depends on service connection, income, and discharge status.
Make sure your clients with VA healthcare knows that VA coverage is a healthcare provider system, not traditional insurance. They probably already know they don’t pay a premium for VA healthcare, but they might not know copays sometimes apply.
For veterans with both VA and private insurance, the VA generally serves as primary payer for service-connected conditions, while private insurance pays first for non-service-connected care. If your clients have both service and non-service-connected needs, this coordination creates valuable flexibility. They can choose the most appropriate care setting based on availability, location, and cost.
Why do veterans need more coverage?
To help veterans understand the value, you’ll have to illustrate clear, compelling reasons why military benefits alone might need backup. Keeping your pitch focused on some of these points can help:
Provider access: Both TRICARE and VA healthcare have network limitations. Civilian insurance expands their options, allowing access to providers who don't accept military benefits. Your rural clients or frequent travelers will thank you.
Family coverage: As veterans return home, they need coverage for their families. While some dependents qualify for TRICARE or CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), others – like adult children or new spouses – need your expertise. Present a solution for the entire family, then adjust your approach as needed.
Supplemental benefits: Extras might have been available to your clients while they were enlisted, but they don’t always stay once they transition back home. Dental and vision care, wellness programs, telehealth services, or alternative therapies are not always fully covered. This is where you can come in with plans providing those ancillary benefits.
Flexibility: Life is always easier with options. What if a client’s local veteran’s network is too narrow? What if that one office is more than a stone’s throw away? Present the need for options, particularly for those clients with limited access to care.
Tailor your approach based on the market
Your veterans might need to shop the Marketplace, or they might need some help with Medicare. Either way, you’ll need to tweak your approach to match.
Marketplace plans
Special Enrollment Periods: Transitioning from military service triggers a Special Enrollment Periods (SEP). Your clients probably don’t know about enrollment periods, so it’s important to help them get coverage during that SEP, so they don’t wind up with a coverage gap waiting for open enrollment.
Premium Tax Credits: Many veterans qualify for premium tax credits, making Marketplace plans unexpectedly affordable. VA healthcare benefits don't disqualify veterans from receiving these subsidies. And again, your clients might not be aware of the potential savings.
Cost-sharing benefits: For lower-income veterans, cost-sharing reductions can make Marketplace plans particularly valuable, reducing deductibles and copayments beyond premium subsidies.
Medicare and Related Plans
For veterans approaching 65, your knowledge on how Medicare works with military benefits will give you the edge you need.
TRICARE For Life: Military retirees with TRICARE transition to TRICARE For Life when enrolling in Medicare Parts A and B. This wrap-around coverage, with Medicare paying first and TRICARE For Life covering most remaining costs, essentially eliminates most out-of-pocket healthcare expenses.
VA and Medicare Coordination: But, VA healthcare works differently than TRICARE. VA healthcare operates independently from Medicare, rather than the primary/secondary relationship TRICARE and Medicare has. VA healthcare will cover VA services, and Medicare covers the rest.
What about Part D?: VA prescription benefits count as "creditable coverage”, so your clients can delay Part D enrollment without penalties as long as they maintain VA coverage. Some veterans benefit from having both programs depending on what drugs they need, so its always a good idea to discuss drug needs.
And Medicare Advantage or Medigap?: TRICARE For Life generally overlaps with Medigap policies. But, those primarily using VA healthcare might benefit significantly from Medicare Advantage plans providing richer benefits and network access beyond Original Medicare.
Why should a veteran trust you?
Well, most of these reasons are the same ones all your clients look for. You learn your stuff and present it well. You listen to the needs of the client and choose the options that make the most sense. You help the client see the whole cost of their coverage, not just the monthly premium. You see it through to the end, and offer up more options if needed. You follow up.
But all that occurs within your office. Don’t neglect the face of your business either. Stay updated on military benefit changes and coordination rules. Participate in the community, particularly veteran-focused community events. Building genuine connections within this community establishes credibility beyond sales.
If you live in a high volume military area, don’t be afraid to market yourself as a military benefits guru. Create guides, host webinars or events, blog about your experiences, post on social media about veterans affairs, and make it clear you are there to support.
No need to stand and wait at attention
The veteran market represents a significant opportunity for health insurance agents who take the time to understand it. By positioning yourself as a knowledgeable advisor, you provide genuine value while building a sustainable niche.
Remember that these clients have served our country, and they deserve service-oriented, ethical guidance that optimizes their healthcare access while respecting their budget constraints. If you get stuck, don’t leave your client behind. Call Action, and we can send in reinforcements.