If you are the spouse or child of a veteran with disabilities or a veteran who has died, you may be eligible for health benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). This program is for people who do not qualify for TRICARE, which is for active duty and retired military personnel and their family members.
You may qualify for CHAMPVA benefits if you do not qualify for TRICARE and you meet at least one of the following conditions:
- You are the spouse or child of a veteran with a service-connected disability
- You are the surviving spouse or child of a veteran who died from a service-connected disability, or who was at the time of death permanently disabled from a service-connected disability
- You are the surviving spouse or child of a service member who died in the line of duty, not due to misconduct
Note: A service-connected disability is a disability that the U.S. Department of Veterans Affairs (VA) The Department of Veterans Affairs (VA) is a federal government agency that provides benefits to veterans and their families. These benefits include (but are not limited to) pensions, educational stipends, and health care services. See also: Veterans Affairs (VA) Benefits. concluded was caused—or made worse—by the veteran’s active-duty service. A permanent disability is one that is not expected to improve.
If you are eligible for CHAMPVA benefits, you must apply with the VA to be enrolled in the program. If you are also eligible for Medicare, whether due to age or disability, you must enroll in both Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care. and Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. to be covered by CHAMPVA.
Note: If your 65th birthday was before June 5, 2001, you can keep CHAMPVA benefits if you only have Part A and not Part B.
If you have both Medicare and CHAMPVA, they will work together to cover your health care costs. Medicare will pay first, and CHAMPVA is always the secondary payer. CHAMPVA will help pay out-of-pocket costs Out-of-pocket costs are health care costs that you must pay because Medicare or other health insurance does not cover them. , such as deductibles and coinsurances.
Keep in mind that CHAMPVA beneficiaries with Medicare cannot receive Medicare-covered care at a VA Medical Center, because Medicare does not pay for any care that you receive at a VA facility.
CHAMPVA benefits offer creditable drug coverage. This means that if you are enrolled in CHAMPVA drug coverage, you can delay Medicare Part D enrollment without incurring a late enrollment penalty (LEP).