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:
- The spouse or child of a veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office, or
- The surviving spouse or child of a veteran who died from a VA-rated service-connected disability, or
- The surviving spouse or child of a veteran who was at the time death rated permanently and totally disabled, or
- 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).
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.
Effect of remarriage
CHAMPVA ends on the date of remarriage unless you are 55 years or older.
Termination of remarriage
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.
Beneficiaries age 18 to 23
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.
Primary Family Caregiver
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 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.
To continue to receive CHAMPVA benefits after age 65, you must meet the following conditions:
- If you turned 65 on or after June 5, 2001, you must be enrolled in Medicare Part A and Part B to remain eligible for CHAMPVA.
- If you turned 65 or older prior to June 5, 2001, and were otherwise eligible for CHAMPVA, and were entitled to Medicare Part A coverage, then you may be eligible for CHAMPVA without having to have Medicare Part B coverage.
- If you turned 65 before June 5, 2001, and have Medicare Part A and Part B, you must keep Part A and Part B to be eligible for CHAMPVA.
- You are not required to enroll in Medicare Part D in order to become or remain CHAMPVA eligible.
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!
CHAMPVA and the Affordable Care Act
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.
Locating a CHAMPVA Provider
CHAMPVA is an open network government health benefit program and has no designated network of providers.
CHAMPVA and Other Health Insurance (OHI)
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.
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.
If you need assistance, there are three ways to contact CHAMPVA:
- Mail: CHAMPVA, PO Box 469063, Denver, CO 80246-9063
- Phone: 800-733-8387
- Internet: iris.va.gov