The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health insurance program in which VA pays part of the cost of certain health care services and supplies.
Who is Eligible for CHAMPVA?
To be eligible for CHAMPVA, you can't be eligible for Tricare, 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 the VA
- The surviving spouse or child of a veteran who died from a VA-rated service-connected disability
- The surviving spouse or child of a veteran who was at the time death rated permanently and totally disabled
- 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)
Effect of Remarriage
A surviving spouse's CHAMPVA eligibility ends upon remarriage unless they are 55 years or older.
NOTE: The eligibility of a child is not affected by the divorce or remarriage of the spouse except in the case of a stepchild. When a stepchild leaves the sponsor's household, the child is no longer eligible for CHAMPVA.
If you are a survivor of a qualifying sponsor and you remarry, and the remarriage is later terminated by death, divorce, or annulment, you may reestablish CHAMPVA eligibility.
Beneficiaries Age 18 to 23
When a CHAMPVA-eligible beneficiary turns 18, they must submit proof of full-time school enrollment to CHAMPVA for benefits to continue.
Primary Family Caregiver
A veteran's primary family caregiver may also be eligible for CHAMPVA if they aren't entitled to care or services under another health care plan.
CHAMPVA and Medicare
CHAMPVA is always the secondary payer to Medicare. If you are eligible for Medicare, at any age and for any reason, you must enroll in Medicare Part A and Medicare Part B to keep your CHAMPVA benefits. Social Security Administration documentation of enrollment in both Part A and Part B is required by CHAMPVA.
CHAMPVA offers medical care just like any other insurance program. It covers vision benefits for diabetes patients only. Dental benefits are limited.
For most care, including medical screening, mental health, emergency room, hospital stay, ambulance, vaccinations, office visits, etc., a CHAMPVA beneficiary would pay 25% of the cost plus a deductible of $50 per individual and $100 per family.
Meds by Mail: Meds by Mail is a voluntary service that provides a safe, easy and cost-free way for eligible CHAMPVA and spina bifida beneficiaries to receive non-urgent maintenance medications delivered to their door.
Optum RX: OptumRx electronically processes pharmacy claims nationwide, including Puerto Rico, Guam, and the Virgin Islands. Beneficiaries are serviced through a network of over 82,000 retail pharmacies. When you use a OptumRx pharmacy, the pharmacy may collect a 25% cost share (after the annual deductible has been met) before submitting the claim, saving beneficiaries time.
How to Apply for CHAMPVA
For detailed information on CHAMPVA eligibility and for instructions on how to apply for CHAMPVA, please visit VA's CHAMPVA website.
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