CHAMPVA insurance is perhaps one of the most coveted veterans’ benefits. It does not cover permanently disabled veterans themselves – unless that person is married to another qualifying sponsor – but rather their dependents. With the astronomical costs of health care in the United States, there is every reason to apply for this benefit when you know you may be eligible.
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Benefits of CHAMPVA
The Civilian Health and Medical Program of the Department of Veterans Affairs – CHAMPVA for short – provides coverage for medically necessary services, supplies and tests. As such, it is very beneficial for people with no other health coverage. This remains true even though the VA pays only 75% of what it allows providers to charge for each claim. You or your CHAMPVA supplement (if you have one) must pay a 25% cost share, but that’s still a lot smaller than the original charges without CHAMPVA.
CHAMPVA provides comprehensive coverage for normal, healthy people. If you have children, well-child visits are covered. If you are expecting a baby or if you get seriously ill, hospitalization is covered. If you have a chronic illness and have no pharmacy coverage from other insurance, you can get maintenance medicine for free via its Meds by Mail program. If you need medically necessary equipment such as a hospital bed, you can get it.
CHAMPVA is an open access type of coverage. It is not managed care like TRICARE Prime where you need permission from a Primary Care Manager (PCM) before you see a specialist. With CHAMPVA, you can see any private health care professional you want so long as you pay your cost share, if you owe any.
Another advantage of CHAMPVA is it has no preexisting condition clause. If you are successfully enrolled in the program, you are immediately covered. This is a boon for those who have an existing condition, long-term illness and the like.
If you have other health insurance, including Medicare, CHAMPVA will be secondary payer with few exceptions. It is primary to Medicaid. If you have other health coverage like that, the two should be enough to cover all or most of your costs.
Providers who accept Medicare and TRICARE usually accept CHAMPVA also. Check with yours before you agree to be seen.
But CHAMPVA does have limitations. It does not cover routine eye care, and dental care is very limited. Dental procedures are covered only when it is done in conjunction with treatment of a non-dental, otherwise covered condition. So you may need to purchase additional health insurance for these.
CHAMPVA requires you to pay a 25% cost share until your charges reach $3,000 for the same calendar year; following that, the VA will waive your copay and foot the entire allowable bill. If $3,000 is still a lot for you (as it probably is for most disabled veterans’ families), you can buy a CHAMPVA supplement from private companies. A supplement to CHAMPVA pays for the 25% cost share that you normally would answer for out-of-pocket, up to the $3,000 limit and minus deductibles.
In summary, CHAMPVA promises very good, if only partial, coverage of your health care expenses. Since it costs nothing to have (no enrollment fee or premiums save for what you pay on a supplement), there is little reason not to claim it if you believe your family is eligible.