CHAMPVA Health Coverage, Benefits and Eligibility

CHAMPVA is a health coverage program for families of certain veterans.  Through the program, the VA helps pay for beneficiaries’ covered medical expenses.  CHAMPVA stands for Civilian Health and Medical Program of the Department of Veterans Affairs.

The program is available to spouses and children of veterans with permanent and total service-connected disability, and some veterans who died on active duty but ineligible for TRICARE.

Benefits of CHAMPVA Health Coverage

Below are highlights of the CHAMPVA health coverage program.

  • Covers medically necessary inpatient, laboratory, ambulatory and outpatient services
  • Free or prescription drug refills through Meds by Mail
  • Durable medical equipment (e.g. hospital beds, wheelchairs)
  • Overseas reimbursement
  • Access to VA health care system through CITI

Read more facts about the CHAMPVA program from the blog.

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Limitations of CHAMPVA Coverage

  • Pays 75% of covered health care expenses; you or a CHAMPVA supplement pays 25% until catastrophic cap is reached.
  • Has an annual deductible of $50 per person and $50 per family.
  • Has very limited dental care and vision care coverage.
  • Available only to spouses and children of permanently and totally disabled veterans.
  • Cannot be used with TRICARE.
  • Requires you to purchase Medicare Part B if you have Part A.
  • Does not have direct overseas coverage, only reimbursement.
  • Does not cover dependent children beyond 23 years of age (unless a VA-rated helpless child and unmarried)

CHAMPVA and Medicare

Medicare enrollment will have an impact on your eligibility for CHAMPVA benefits.  For most people who become Medicare-eligibile, it is necessary to enroll in Medicare Part B as well as Part A to continue CHAMPVA coverage.

If you have Medicare, you will not be eligible for the CHAMPVA Inhouse Treatment Initiative or CITI which gives beneficiaries free access to the VA health care system if it is available.  If you have Medicare Part D, you cannot use the Meds by Mail program under CHAMPVA either.

However, a benefit of having both CHAMPVA and Medicare is that you normally pay little to no out-of-pocket costs.  The two programs are often enough to cover your expenses.

Please see CHAMPVA and Medicare Eligibility: What You Need to Know to Keep Your CHAMPVA Benefits.

CHAMPVA and TRICARE

These two health coverage programs are often confused with each other, but are totally separate.   CHAMPVA is a program for veterans under the Department of Veterans Affairs (VA).  On the other hand, TRICARE is a program of the Department of Defense for active-duty and retired servicemen and women, their families and survivors, and is regionally managed (for example, TRICARE West, TRICARE North and so on).

However, CHAMPVA does pay similarly to TRICARE, and many TRICARE providers also accept CHAMPVA assignment.

When submitting health insurance information, you may notice some people think CHAMPVA and TRICARE are the same; they aren’t.  Make sure you are clear which one is your health care program. Provide the full insurance info including the claims address and phone number to prevent such confusion.  However some health care providers know the difference and just group the two programs under one category (like calling it “CHAMPVA/TRICARE”).

Find a CHAMPVA Provider

Need help finding a CHAMPVA doctor in your area?  Click here.

 

 

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