The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health benefits program in which the VA shares the cost of certain health care services and supplies with eligible beneficiaries.
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.
To be eligible for CHAMPVA, you cannot be eligible for TRICARE and you must be in one of these categories:
An eligible CHAMPVA sponsor may be entitled to receive medical care through the VA health care system based on their own Veteran status. If the eligible CHAMPVA sponsor is the spouse of another eligible CHAMPVA sponsor, both may now be eligible for CHAMPVA benefits. In each instance where the eligible spouse requires medical attention, they may choose the VA health care system or coverage under CHAMPVA for their health care needs.
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.
CHAMPVA ends on the date of remarriage unless you are 55 years or older.
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 reeligibility is the first day of the month after termination of the remarriage. To reestablish CHAMPVA eligibility, copies of the marriage certificate and death, divorce, or annulment documents (as appropriate) must be provided.
When a CHAMPVA-eligible beneficiary turns 18, CHAMPVA requires that the beneficiary submit proof to CHAMPVA of full-time enrollment in an educational institution for benefits to continue.
A Veteran's Primary Family Caregiver may also be eligible to receive medical care through CHAMPVA if the Primary Family Caregiver is not entitled to care or services under a health care plan.
CHAMPVA eligibility can be impacted by changes such as marriage, divorce from the sponsor, or eligibility for Medicare or TRICARE. Changes in status should be reported immediately.
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.
To continue to receive CHAMPVA benefits after age 65, you must meet the following conditions:
NOTE: CHAMPVA requires that beneficiaries eligible for Medicare, at any age and for any reason, carry both Medicare Parts A and B. Even if you are not entitled to Medicare Part A, you must purchase and keep Medicare Part B coverage, or you will lose your CHAMPVA benefits!
The Affordable Care Act (ACA) is a health care law that was created to expand access to affordable health care coverage for all Americans, lower costs, and improve quality and care coordination. Under the health care law, people will have health coverage that meets a minimum standard (called "minimum essential coverage"). The health care law designates CHAMPVA as fulfilling the minimum essential coverage requirement.
If you are enrolled in CHAMPVA, you do not need to take additional steps to meet the health care law coverage standards. The ACA does not change CHAMPVA benefits or out-of-pocket costs.
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 right to your 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 you time.
CHAMPVA is an open network government health benefit program and has no designated network of providers.
If you have any other health insurance (OHI), you must notify CHAMPVA of any changes (dropped insurance, changes in health plans, etc.) immediately upon those changes taking effect so that proper payment can be made on your claims.
If you obtain a major medical policy, you must also notify CHAMPVA that you have a new policy and when it takes effect.
For detailed information on CHAMPVA eligibility and for instructions on how to apply for CHAMPVA, please visit VA's CHAMPVA website.
If you need assistance, there are three ways to contact CHAMPVA:
|Veteran Health Care|