If you are the surviving spouse (or child) of a veteran who has passed away or the spouse of a fully disabled veteran, you may be eligible to receive health insurance through CHAMPVA. Our goal at easyMed is to make finding and enrolling in Medicare easy. How do CHAMPVA and Medicare work together?  

Understanding CHAMPVA

CHAMPVA, also known as the Civilian Health and Medical Program of the Department of Veterans Affairs, is a healthcare program managed by the Veterans Health Administration Office of Community Care. Beneficiaries of CHAMPVA may include the spouses, widows/widowers, or children of totally disabled or deceased United States veterans.

Who is eligible for ChampVA benefits?

In most cases, you cannot receive benefits from both CHAMPVA and Tricare. If you do not qualify for Tricare, a health insurance program that provides wraparound Medicare coverage for eligible uniformed service members, retirees, dependents, and survivors, CHAMPVA benefits might be for you. Reasons you may be eligible for CHAMPVA include: 

• Spouse or child of a 100% disabled veteran 
• Surviving spouse or child of a veteran who has passed 
• Surviving spouse or child of a veteran who was 100% disabled at the time of their death 
• Surviving spouse or child of a veteran who died in the line of duty 

If you qualify for Medicare (age 65 years or older, 24+ months of social security disability insurance, a qualifying disease like ESRD…) then you only remain eligible for CHAMPVA benefits if you are enrolled in Original Medicare Parts A and B. Enrollment in Medicare Part B is required to keep CHAMPVA benefits, unless you were 65 or older before June 5, 2001, and only have Medicare Part A. If eligible, your CHAMPVA benefits start the same day as your Medicare Part B enrollment. 

What does CHAMPVA cover?

CHAMPVA covers most medically necessary healthcare services, including (but not limited to):

• Ambulance services
• Durable Medical Equipment
• Family planning
• Hospice care
• Inpatient and outpatient treatment services
• Mental healthcare
• Treatment at a skilled nursing facility
• Transplants

CHAMPVA will cover treatment from an authorized provider. Because of the overlap in Medicare beneficiaries and CHAMPVA patients, most Medicare providers will accept CHAMPVA patients. There may be limits to what CHAMPVA considers medically necessary. Because of that, it’s important to review your coverage carefully prior to treatment.

CHAMPVA and Medicare

When you use your CHAMPVA benefits alongside your Medicare or Medicare Advantage plan, CHAMPVA is the supporting role. This means that your healthcare bills will go through Medicare first. Medicare will pay for 80 percent of Medicare-covered services, so you may be responsible for the remaining 20% on Part B services once your deductible is paid. Instead of the remaining balance going to you, it is forwarded to CHAMPVA. For Medicare-covered services where CHAMPVA is the secondary payer, you may have no cost.

Both Original Medicare (Parts A and B) and CHAMPVA cover services deemed “medically necessary.” This excludes some important healthcare benefits. Medicare Advantage plans offer the same level of coverage as Original Medicare and may offer more. Many Medicare Advantage plans offer the following benefits (not covered by CHAMPVA):

• Dental: Routine dental care, dentures
• Vision: Eye exams, eyeglasses, contact lenses
• Hearing: Ear exams, hearing aids
• Access to fitness equipment or programs

Prescription Medications on CHAMPVA and Medicare

When you are enrolled in both Medicare and CHAMPVA, you have options when it comes to coverage for your prescription medications. If you choose not to enroll in Medicare Part D, CHAMPVA offers a program called Meds by Mail for non-urgent, maintenance medications. You cannot have Meds by Mail and Medicare Part D at the same time.

Typically, you are subject to a late enrollment penalty if you do not enroll in Part D when you are first eligible. However, if you are enrolled in CHAMPVA and switch to Part D after your original Medicare enrollment, you will not have to pay a late fee. If you enroll in Medicare Part D, prescription drug coverage offered by private insurance companies, your pharmacy may be able to work with other programs to reduce your out-of-pocket costs. Many Medicare Advantage plans include Part D prescription drug coverage.

Frequently Asked Questions

Enrollment Eligibility

e-TeleQuote Insurance Inc. (“e-TeleQuote”), an affiliate of Primerica, Inc., does business as easyMed Insurance Services in all states other than New Mexico. e-TeleQuote is a duly licensed insurance agency appointed by Medicare Advantage HMO, PPO and PFFS plans and stand-alone prescription drug plans and insurance companies holding Medicare contracts approved by The Centers for Medicare & Medicaid Services (CMS). e-TeleQuote is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Enrollment in any plan for coverage is subject to insurance company approval. Enrollment in the plan depends on the plan’s contract renewal with Medicare. By using e-TeleQuote’s easyMedicare website, you understand and agree that in New Mexico, we operate as e-TeleQuote Insurance, Inc. (Your IP address and/or location coordinates may be gathered to verify your location.) Sales agents may be compensated based on your enrollment in a health plan. Medicare Supplement plans are not connected with or endorsed by the U.S. Government or the Federal Medicare program. e-TeleQuote complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. easyMedicare.com is a non-government site, powered by e-TeleQuote Insurance, Inc. e-TeleQuote provides a secure way to purchase Medicare insurance from the comfort of your home or workplace. We do not offer every plan available in your area. Currently we represent 5 organizations which offer 3,291 products in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-Medicare (TTY users should call 1-877-486-2048) 24 hours day/7 days a week, or your local State Health Insurance Program (SHIP), to get information on all of your options. Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.