CHAMPVA can save beneficiaries a lot of money, but that doesn’t mean you no longer have to pay for your health care at all As a beneficiary of the program, your medical expenses can be summarized as follows, assuming it is your only form of health insurance. These figures are taken from the CHAMPVA Guide. published in January, 2014.1
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- An annual outpatient deductible of $50 per person, up to $100 per family.
- A cost share (also known as copayment), which is typically 25% per covered service up to a $3,000 yearly catastrophic cap.
The annual deductible, cost share and catastrophic cap may change. Contact the VA to find out what the current figures are. If you call CHAMPVA, they have an interactive voice response system (IVR) you can use to check your deductible, catastrophic cap and eligibility status among other things. You can also refer to the CHAMPVA Guide for beneficiaries and the CHAMPVA Policy Manual.
You should receive notifications from the VA of any changes if you are already enrolled in the program. Your CHAMPVA Explanation of Benefits (EOB) for each processed claim should also include information about your costs.
You may also be responsible for:
- Charges for non-covered services and supplies (i.e. if you have no other health insurance that covers them)
- Premiums, deductibles and other expenses for a CHAMPVA supplement if you have one
- Provider charges beyond the CHAMPVA allowable amount if you went to see a provider who does not accept assignment with CHAMPVA
In some situations, your cost share may be waived, such as if you meet the annual catastrophic cap or if you receive care at a CITI facility.
1.. “CHAMPVA Guide.” U.S. Department of Veterans Affairs. January, 2014. Accessed April 5, 2015. http://www.va.gov/PURCHASEDCARE/docs/pubfiles/programguides/champva_guide.pdf.
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