What is CHAMPVA?

CHAMPVA is a secondary insurance option for military families who don’t qualify for TRICARE. You can use CHAMPVA with Medicare when you’re eligible to do so, and it’ll cover most of your out-of-pocket costs.

The Civilian Health and Medical Program of the Department of Veterans Affairs is a health care program for veterans’ family members. Unlike TRICARE, it’s an independent system that services military personnel as well. 

What services does CHAMPVA cover?

CHAMPVA is a health insurance program that costs you nothing. You only have to spend your $50 deductible before the plan kicks in and pays for 75% of services, leaving you with 25%. This includes all covered medical expenses such as hospital stays or visits to specialists.

Covered services include:

  • hospital stays
  • primary care doctor visits
  • specialist visits
  • lab work
  • skilled nursing care
  • home care
  • ambulance transportation
  • mental health services
  • prescription drugs

Hospice care is fully covered by CHAMPVA, regardless of the provider. If you use the VA Meds By Mail program to fill your prescriptions, then that will be covered as well.

If you’re enrolled in both CHAMPVA and another health insurance plan, including Medicare coverage, your other insurance will usually cover the majority of costs. However, if these fees are high or out-of-pocket medical expenses for copayments or coinsurance amounts start to mount up then it may be worth exploring using CHAMPVA as a secondary payer while still on your primary policy.

Am I eligible for CHAMPVA?

To be eligible for CHAMPVA, the beneficiary cannot be eligible for TRICARE. CHAMPVA provides coverage to the spouse or widow(er) and to the children of a Veteran who: 

  • is permanently and totally disabled (P&T) because of an adjudicated service-connected disability, or 
  • died as a result of an adjudicated service-connected disability or who at the time of death was rated P&T due to service-connected conditions, or 
  • died while in an active duty status and in the line of duty, not due to misconduct. The term “active duty” may include periods of inactive duty for training

You can apply for CHAMPVA at any time without worrying about the cost. You’ll need to send in an application along with documents that prove your eligibility – these might include: service records, marriage records, birth certificates; you may also have other insurance plans and will need to provide information on those too. Generally the process takes 3-6 weeks (depending) but once approved you’ll receive a card within one week of approval called “CHAMPVA” which is valid immediately after it arrives by mail so there’s no waiting period!

How does CHAMPVA work with Medicare?

Since 2001, CHAMPVA beneficiaries have been able to use their coverage after turning age 65. You’ll need to be enrolled in Medicare for that though, which is a good thing because having both can help you save on your health care costs! Here are the rules for how that works:

  • If you turned age 65 before June 5, 2001, and did not have Medicare Part B at the time, you only need to be enrolled in Medicare Part A to keep your CHAMPVA coverage.
  • If you turned age 65 before June 5, 2001, and were already enrolled in Part B at that time, you need to be enrolled parts A and B to keep your CHAMPVA coverage.
  • If you turned age 65 after June 5, 2001, you need to be enrolled in parts A and B to keep your CHAMPVA coverage.

People who enrolled in Medicare at age 65 or older are not allowed to drop their Part B coverage and keep their CHAMPVA (Health care program for military members) insurance. If you’re eligible only for the A part of Medicare, then your eligibility for CHAMPVA is determined by that plan’s rules.

You can use CHAMPVA alongside:

  • Medicare parts A and B, together known as original Medicare
  • Medicare Part C, also called Medicare Advantage
  • and Medicare Part D, which is prescription drug coverage

If you have CHAMPVA, it won’t cover your Part B premium and if that’s not enough of a deterrent to keep on using VA facilities for medical care, they also note in their disclaimer that once enrolled with Medicare then all use of Veterans Affairs’ hospitals or providers is prohibited.

Who pays first for healthcare costs?

Medicare and CHAMPVA work as a team to help you get the care that you need. Medicare is your primary insurer with any other health coverage, so it will cover any copays or coinsurance amounts for services done inside this network of hospitals. This leaves less out-of-pocket costs for yourself – giving peace of mind knowing there’s no surprises when receiving those preventative checkups!

You can expect to pay:

  • nothing out of pocket for any service that both Medicare and CHAMPVA cover
  • your Medicare coinsurance cost of 20 percent for a service Medicare covers but CHAMPVA doesn’t
  • your CHAMPVA cost sharing of 25 percent for anything CHAMPVA covers but Medicare doesn’t

If you’re getting Medicare coverage and have been approved for CHAMPVA, then it’s easy to get your prescriptions covered. Simply show them both at the pharmacy (CHAMPVA ID card +Medicare Part D) and they’ll cover 75% of what is not included in your plan!

What about Medicare Advantage?

You can use your CHAMPVA coverage with a Medicare Advantage plan. With an Advantage plan, you still meet the requirement to be enrolled in original Medicare to keep CHAMPVA once you’re age 65. Your bill will go directly through your existing primary care provider and then get processed by both Medicare Advantage and CHAMPVA- which means there’s no need for any out-of-pocket costs on most bills!

Many Medicare Advantage plans also include Part D coverage. When you use a Medicare Advantage plan that includes both CHAMPVA and Part D, your CHAMPVA benefits will pick up the cost of your prescription copayments from in-network providers while out-of network rates are reduced to match those charged by an in-network provider for prescriptions covered under the original insurance plan (Medicare or Medicaid).

CHAMPVA beneficiaries with Medicare cannot use a VAMC because Medicare will not pay the medical center for the service it provides.  If you are currently being seen at a VAMC, but will become entitled to Medicare soon, you will need to find a different provider.

CHAMPVA saves a lot of money when combined with your Medicare Advantage plan because they cover 75% of out-of network service costs. 

What are the benefits to using CHAMPVA? If you have an illness that requires costly medical treatment, then it is essential that you take advantage of this program so as not to be faced with impossible expenses due to lack in coverage for out-of services.

How do I choose the right coverage options for me?

You need to enroll in original Medicare (parts A and B) to keep your CHAMPVA coverage. You can also choose to enroll in additional Medicare parts, such as:

  • Medicare Advantage
  • Medigap
  • Medicare Part D

There are several options for Medicare coverage, such as Medigap and Medicare Advantage. Each option has different costs associated with it — to determine which is best for you, take into consideration what your needs are and how much money you can afford to spend each month on insurance premiums. For example: if the CHAMPVA program covers some of these out-of-pocket expenses already then plan B might no longer be necessary by itself.

Original Medicare + CHAMPVA

If you’ve got CHAMPVA and Medicare Parts A & B, but choose not to enroll in any other plans, this means that your primary payer will be the federal government. This simplifies things a lot for people with multiple health insurance policies because it eliminates some of the red tape involved when different companies are trying to determine who pays first, second etc. You can get prescriptions at pharmacies or “Meds by Mail” using just CHAMPVA too!

Original Medicare + Part D + CHAMPVA

You have CHAMPVA, Medicare parts A and B, and a Part D plan. You’d pay the Medicare Part B premium and the premium for your Part D plan.

Medicare would be the primary payer for services and prescriptions, and CHAMPVA would help  pick up your copayments and coinsurance amounts left behind by Original Medicare.

Medicare Advantage + CHAMPVA

If you have CHAMPVA along with a Medicare Advantage plan that includes Part D coverage. You would still pay the Medicare Part B premium plus any premium for your Medicare Advantage plan if there was one, although many Medicare Advantage plans have zero premiums.

The Medicare Advantage Plan would be the primary payer for your services and prescriptions, and CHAMPVA would pick up your copayments and coinsurance amounts. Be sure to seek medical services within the Medicare Advantage “in-network” service area.

Ways to save on Medicare coverage

It’s worth noting that you may be able to find Medicare Advantage plans in your area with $0 premiums.

Good news! You are not alone in this Medicare journey. There are advocates available to help every step of the way from shopping and comparing plans, prices, networks, and covered services before you commit to a plan.

You can also look for savings on your Medicare coverage. You might qualify for programs to help lower your costs if you have a limited income. These programs include:

  • Extra Help, which lowers your prescription drug costs
  • Medicare savings programs, which can lower your costs for parts A and B

Ultimately, the right plan for you depends on your needs and your budget. You’ll want to select a plan that includes:

  • the doctors you want to see
  • any prescriptions you take

You can also search for premiums in your price range and those with out-of-pocket costs you can manage.

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