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 easyMedicare is to make finding and enrolling in Medicare easy. How do CHAMPVA and Medicare work together?
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
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, leaving you with the remaining 20 percent coinsurance. 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 OptumRx to reduce your out-of-pocket costs. Many Medicare Advantage plans include Part D prescription drug coverage.
Frequently Asked Questions
In most cases, you cannot be enrolled in Tricare and CHAMPVA at the same time. Both are considered secondary payers to Medicare and Tricare has its own eligibility requirements.
CHAMPVA has an annual deductible of $50 per beneficiary or $100 per family. If you are enrolled in Medicare, at least a portion of your annual deductible is covered by CHAMPVA. You are still responsible for your monthly Part B premium.
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Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_C