If you're the spouse, dependent or survivor of a veteran who meets certain service-connected disability requirements and you're enrolled in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), 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 to participate is a personal decision. However, keep in mind 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 2026 Cost Differences Between Medicare Prescription Drug Coverage and CHAMPVA?
| Medicare Part D Primary | CHAMPVA Primary | |
|---|---|---|
| Cost to enroll (premiums) | Dependent on plan. Averages $34.50 per month in 2026 | -0- |
| Catastrophic cap (maximum out-of-pocket expenses, excluding premiums) | $2,100 per year (prescription costs only) | $3,000 per year: All covered prescription and medical expenses apply toward the catastrophic cap. |
| Prescription copay/deductible | Dependent on plan; deductible may not exceed $615 for 2026. | Retail: 25% copay, $100 family/$50 individual deductible; Meds by Mail: no copays and no deductibles but not available to Part D beneficiaries. |
What Are the Medicare Prescription Drug Plan Deductibles and Catastrophic Cap for the Standard Drug Benefit?
Your Medicare deductibles and copayments are estimated to be:
- Deductible depends on plan; may not exceed $615 for 2026.
- Catastrophic cap is $2,100 per year (prescription costs only).
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.
-- Additional reporting by Jim Absher
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