The concept of an annual deductible is confusing to people who are new to getting health insurance. An annual deductible is NOT the same as a health insurance premium. You don’t send a check to your insurer to satisfy it. Rather, it is the medical expenses you pay out of pocket before your insurance or health coverage program (like CHAMPVA) starts to do anything. Read on to learn more about the deductible required by CHAMPVA.
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Understanding the CHAMPVA Deductible
In the case of CHAMPVA, you must spend an outpatient deductible each year before it starts to share in the cost of covered outpatient services and supplies. Presently, it is at $50 per individual and $100 for an entire household of beneficiaries.
Do not pay CHAMPVA or the VA Health Administration Center in an attempt to satisfy your outpatient deductible. That is automatically calculated into your cost share. You pay for the annual deductible directly to your provider(s).
Once the deductible is met, CHAMPVA coverage properly begins.
How to Find Your Annual Deductible
The deductible is reset each year.
Things to Know About Your Annual Deductible
- The CHAMPVA annual deductible is presently set at $50 per person and $100 per family, per calendar year.
- The deductible is reset each year.
- The deductible is NOT a premium. Do not send a check to CHAMPVA to pay your deductible. It is subtracted from your submitted claims during processing.
- The deductible applies to outpatient care, not inpatient.
Payments That Do Not Count in CHAMPVA Deductible
- Payments for non-covered services
- Payments for amount not allowed by CHAMPVA (that is, beyond the CHAMPVA allowable amount– shown as “Amount Not Covered” in CHAMPVA EOB)
- Payments for covered inpatient services (because the deductible is only for outpatient care)
Waiver of Annual CHAMPVA Deductible
The deductible is waved when you receive services through VA facilities. This happens when you use any of the following programs:
- CHAMPVA Inhouse Treatment Initiative (CITI)
- Meds by Mail (MbM)
- Durable Medical Equipment (DME)
The deductible is also not applicable toward:
- ambulatory surgeries (except professional services in approved facilities)
- partial hospitalization
- inpatient care
See also CHAMPVA glossary of terms.