CHAMPVA and Medicare Prescription Drug Plan (Medicare Part D)

Medicare benefits have an impact on your CHAMPVA eligibility.  This includes the Medicare Prescription Drug Plan, also known as Medicare Part D.  It is a pharmacy coverage plan offered by many private insurance companies.  Before you enroll in Medicare Part D, make sure you are aware of the pros and cons of doing so.  The VA Health Administration Center reminds people that CHAMPVA is likely to be the more cost-effective of the two.

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How Does Medicare Part D Affect CHAMPVA Benefits?

Being enrolled in a Medicare Prescription Drug Plan will cause you to lose some CHAMPVA pharmacy benefits, namely:

  1. The use of SXC Health Solutions network of pharmacies
  2. The free Meds by Mail pharmacy mailing service

You will still be able to use basic CHAMPVA pharmacy benefits, but Medicare will pay first and CHAMPVA second.

Costs of Using Medicare Part D: Prescription Drug Plan

Because Medicare Part D is a premium plan, there are costs to using it.

  1.  You pay hundreds of dollars a year in premiums, depending on your plan.
  2. Medicare Part D has a catastrophic cap of $4,550 a year (as of 2010) and then you pay a minimum amount for both generic and brand name drugs.
  3. Your co-payment increases when you exceed the drug coverage limit, at which point you have to pay 100% of costs until you reach the catastrophic cap. (This is known as the Medicare Part D coverage gap or “donut hole.”)

In contrast, with CHAMPVA:

  1. You pay no premiums.
  2. The annual deductible of $50 per individual and $100 per family includes outpatient services, not just pharmacy
  3. The catastrophic cap is $3,000 a year and includes all covered medical expenses. After this, CHAMPVA pays 100%.

See also Medicare and CHAMPVA: Keeping Your Benefits and also the VA fact sheet on Medicare Part D.

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This website, CHAMPVAbenefits.com, is NOT affiliated with the Department of Veterans Affairs or any part of the U.S. government. Please DO NOT send us information about yourself such as your SSN, name, address, etc. for help with CHAMPVA…. The pharmacy network for CHAMPVA now is Catamaran (formerly SXC)…. Further, we cannot guarantee that the information here is accurate and up-to-date. To ensure you have the latest information, please visit the official CHAMPVA home page at http://www.va.gov/hac/forbeneficiaries/champva/champva.asp. Your use of this site means you agree to and understand this disclaimer. Thank you!

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