If you are a CHAMPVA recipient through your veteran spouse, you may have noticed that the CHAMPVA authorization card the VA sent you expires on the eve of your 65th birthday. Why is this? What’s the deal when a CHAMPVA beneficiary turns 65 years old?
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Medicare Enrollment and Its Impact on CHAMPVA Eligibility
When you turn 65 years old and become eligible for Medicare, it will have consequences for your CHAMPVA benefits. You must either take certain steps to ensure continued coverage if you do get enrolled in Medicare, or else prove that you are ineligible for Medicare. You ought to do this before your 65th birthday to avoid an interruption in your CHAMPVA benefits.
For most people, becoming eligible for Medicare Part A at age 65 means they must also enroll in Medicare Part B to keep CHAMPVA. See How Medicare Can Affect Your CHAMPVA Eligibility.
When you have both Medicare and CHAMPVA at 65 years old, the latter becomes CHAMPVA for Life and pays after the former.
Reapplying for CHAMPVA Benefits
Before you turn 65 years old, CHAMPVA will send you instructions to reapply for coverage. This time, you must satisfy the rules for keeping eligibility in spite of Medicare. As stated above, you must be enrolled in Part B as well as Part A.
To demonstrate that you have done this, send the VA a copy of your Medicare card showing enrollment in both Parts A and B along with VA Form 10-7959c: Other Health Insurance. Once that is processed, you will receive an updated CHAMPVA health card with a new expiration date. This is now CHAMPVA for Life.
If you are ineligible for Medicare, you should get a “Notice of Disallowance” from Social Security as proof you cannot enroll in Medicare Part A.
Helpless Children and Medicare
Dependent children who get rated as permanently helpless by the VA before their 18th birthday can be eligible for CHAMPVA for Life. However they too must meet the requirements for Medicare and CHAMPVA joint coverage as above.
Children rated as helpless by the VA are the only children who can possibly qualify for CHAMPVA benefits beyond 18 (or 23 if enrolled in school) years old.
What Happens When I Get CHAMPVA for Life?
Having two health coverage plans is usually a good thing. The two combined – CHAMPVA and Medicare – will often be enough to cover all your expenses, so you pay nothing from your own pocket. CHAMPVA will even pay for at least part of your Medicare outpatient deductible!
Medicare will become the primary health insurance, CHAMPVA second. Only in cases whee CHAMPVA is the only one who covers a service will it pay first.
If you have a Medicare supplement, that must also be billed before CHAMPVA.
Unfortunately, you do lose some benefits when enrolled in Medicare. You will no longer be able to use a VA medical facility through the CITI program. If you also have Medicare Part D, you lose Meds by Mail benefits.
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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