Medical Debt Among US Veterans: Structural Barriers, Financial Strain, and Policy Recommendations

Objectives: Medical debt is a challenge for US veterans. Depending on eligibility, some veterans receive care outside the US Department of Veterans Affairs (VA) system through private health care providers, where out-of-pocket costs may be higher. We examined whether access to VA health care and TRICARE coverage (vs other types of health coverage) was associated with lower rates of medical debt and cost avoidance among veterans. Methods: This cross-sectional study used data from the 2022 National Health Interview Survey and binomial logistic regression models to examine whether access to VA care and TRICARE was associated with a lower likelihood of medical debt or cost avoidance than other types of health coverage. Models controlled for health insurance coverage, income to poverty ratio, urban or rural status, service-related disability, and overall health condition. Results: VA and TRICARE programs (vs other types of health coverage) were associated with a significantly lower likelihood of not seeing a physician (odds ratio [OR] = 0.53 and 0.23, respectively; P < .05), rationing prescriptions (OR = 0.44 and 0.22, respectively; P < .05), and not filling prescriptions (OR = 0.39 and 0.26, respectively; P < .01), but TRICARE performed significantly better and was the only program significantly associated with lower medical debt (OR = 0.37; P = .03). Conclusions: These findings suggest that health insurance–based coverage may be more effective than direct care at reducing financial barriers for veterans. Policymakers should consider expanding TRICARE eligibility or piloting new VA health insurance programs to address the financial burden veterans face when seeking care outside the VA system.