What is CHAMPVA Health Insurance? (2024)

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which VA shares the cost of covered health care services and supplies with eligible beneficiaries.

ChampVA is a health insurance program provided by the Department of Veterans Affairs to DIC recipients. There are no premiums. The coverage is free. However there are deductibles and co-pays associated with using this coverage. After an annual deductible of $50, the participant pays 25% of the covered amount. Participating providers agree to accept 75% of the billed amount and this is called the covered amount. The covered amount is very similar to the way that Medicare pays doctors and hospitals. In fact any provider accepting Medicare has to accept champ VA. Certain VA medical centers will also accept champ VA participants and if the center does accept the insured, the medical care is free except for prescription drug co-pays.

Many survivors on DIC are leery of signing up for champ VA because of the requirement of paying 25% of the covered amount. In practice, this co-pay – as it were – is no different than any other insurance plan. Once the participant has paid $3,000 out-of-pocket, there is no cost for health services thereafter. Champ VA pays 100% of the rest.

Due to the similarity between CHAMPVA and the Department of Defense (DoD) TRICARE program (sometimes referred to by its old name, CHAMPUS) the two are often mistaken for each other. CHAMPVA is a Department of Veterans Affairs program whereas TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors.

In some cases, a veteran may look to be eligible for either program on paper. However, if you are a military retiree, or the spouse of a veteran who was killed in action, you are and will always be a TRICARE beneficiary, you can´t choose between the two.

Eligibility for CHAMPVA

To be eligible for CHAMPVA, you cannot be eligible for TRICARE/CHAMPUS and you must be in one of these categories:

• the spouse or child of a veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office, or
• the surviving spouse or child of a veteran who died from a VA-rated service connected disability, or
• the surviving spouse or child of a veteran who was at the time of death rated permanently and totally disabled from a service connected disability, or
• the surviving spouse or child of a military member who died in the line of duty, not due to misconduct (in most of these cases, these family members are eligible for TRICARE, not CHAMPVA).

Benefits

In general, the CHAMPVA program covers most health care services and supplies that are medically and psychologically necessary. Upon confirmation of eligibility, you will receive program material that specifically addresses covered and noncovered services and supplies in the form of a CHAMPVA handbook (pdf).

General Exclusions

Like all health programs there are certain services and supplies that are not covered by our program, some of these are:

• Services and supplies obtained as part of a grant, study, or research program.
• Services and supplies not provided in accordance with accepted professional medical standards or related to experimental/investigational or unproven procedures or treatment regimens.
• Care for which you are not obligated to pay, such as services obtained at a health fair.
• Care provided outside the scope of the provider's license or certification.
• Services or supplies above the appropriate level required to provide the necessary medical care.
• Services by providers suspended or sanctioned by any federal agency.
• Services provided by a member of your immediate family or person living in your household.
• CHAMPVA Mental Health and Substance Use Disorder Benefits (01-01)
• For a complete listing of noncovered services and supplies please consult the CHAMPVA handbook.
• Medicare Impact

CHAMPVA is always the secondary payer to Medicare. If you are eligible for CHAMPVA, under age 65 and enrolled in both Medicare Parts A&B, SSA documentation of enrollment in both Parts A&B is required.

For your benefits to be extended past age 65, you must meet the following conditions:

• if the beneficiary was 65 or older prior to June 5, 2001, and was otherwise eligible for CHAMPVA, and was entitled to Medicare Part A coverage, then the beneficiary will be eligible for CHAMPVA without having to have Medicare Part B coverage.
• if you turned 65 on/or before June 5, 2001, and have Medicare Parts A and B, you must keep both Parts to be eligible.
• if you turned 65 on or after June 5, 2001, you must be enrolled in Medicare Parts A and B to be eligible. you are not required to enroll in Medicare Part D in order to become or remain CHAMPVA eligible.

Notice to new & expectant parents

If you are expecting and you need to establish CHAMPVA eligibility for your new child, the following must be accomplished before you can submit an application.

• Obtain a Social Security Number for the newborn by applying to the nearest Social Security Administration office.
• Establish dependency of the newborn to the veteran sponsor by contacting the local VA regional office.

Since the payment of claims for this child is contingent upon his/her eligibility status, as new parents you are encouraged to take the above action as early as possible.

Remarried Widows/Widowers

Remarriage: Eligibility for CHAMPVA ends at midnight on the date of your remarriage if you remarry prior to age 55. If you remarry on or after your 55 th birthday, The Veterans Benefit Act of 2002, Public Law 107-330, allows you to keep your CHAMPVA benefits.

Termination of Remarriage: If you are a widow(er) of a qualifying sponsor and you remarry and the remarriage is later terminated by death, divorce, or annulment you may reestablish CHAMPVA eligibility. The beginning date of your re-eligibility is the first day of the month after termination of the remarriage or December 1, 1999, whichever date is later. To reestablish CHAMPVA eligibility, copies of the marriage certificate and death, divorce, or annulment documents (as appropriate) must be provided.

Please refer to the table of contents in the top right column of this page for more topics on Benefits for Survivors of Veterans.

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