CHAMPVA and Medicare Part D

Pharmacy dispensing medicine
Pharmacy dispensing medicine

If you are enrolled in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) program, you may choose to participate in Medicare Part D, but should you do it?

What Is Medicare Part D?

Medicare Part D is a prescription drug plan that provides beneficiaries with assistance paying for prescription drugs. To participate, beneficiaries must enroll in one of the many hundreds of Part D plans offered by private companies. If you currently are enrolled in Medicare Part D, you should review your plan each year to ensure you have the plan that best works for you. The annual open enrollment period for Part D runs from mid-October to early December. During this period, you can switch to a different Medicare Part D plan if your needs change.

Should I Participate in the Medicare Part D Drug Plan?

Whether or not to participate is a personal decision. However, we would like to remind you that Medicare Part D is considered Other Health Insurance (OHI) and will be your primary prescription insurance. After the Medicare Part D plan is billed and you pay your copayments, CHAMPVA will reimburse your copayments up to 100% of the CHAMPVA allowable amount for prescriptions. You will then be responsible for any costs not covered by Medicare and CHAMPVA.

What Are the 2024 Cost Differences Between Medicare Prescription Drug Coverage and CHAMPVA?

  Medicare Part D Primary


Cost to enroll (premiums) Approximately $10-$150 per month  -0-
Catastrophic cap (Your maximum out-of-pocket expenses, excluding premiums) $8,000 per year (prescription costs only)  $3,000 per year: All covered prescription and medical expenses apply towards the catastrophic cap. 
Prescription Copay/ Deductible Dependent on plan, however deductible can't be more than $545 for 2024

Retail: 25% copay, $100 family/$50 individual deductible; Meds by Mail: no copays and no deductibles


What Are the Medicare Prescription Drug Plan Deductibles and Copayments for the Standard Drug Benefit, and What Will I Pay?

Your Medicare deductibles and copayments are estimated to be:

  • $250-$545 deductible
  • 25% copay for prescription drugs for the first $8,000 out of pocket

Can I Enroll In Medicare Part D And Still Have CHAMPVA For Prescriptions?

Yes. Keep in mind that you may have Medicare Part D enrollment costs. Medicare will be your primary prescription coverage, and CHAMPVA will pay as secondary coverage.

If I'm Enrolled In Medicare Part D, Can I Also Participate in the CHAMPVA Meds by Mail Program?

No. Enrollment in the CHAMPVA Meds by Mail is available only for those who do not have any other prescription drug coverage. If you currently use Meds by Mail, which does not charge copays or deductibles, and elect Medicare Part D, you will no longer be eligible for Meds by Mail and must obtain the prescriptions through the pharmacies authorized by the Medicare Part D plan you choose.

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