Overview
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by Health Administration Center and our offices are located in Denver, Colorado.
Due to the similarity between CHAMPVA and the Department of
Defense (DoD) TRICARE program (sometimes referred to by its old name,
CHAMPUS) the two are often mistaken for each other. CHAMPVA is a
Department of Veterans Affairs program whereas TRICARE is a regionally
managed health care program for active duty and retired members of the
uniformed services, their families, and survivors. In some cases a
veterans may look to be eligible for both/either program on paper.
However, if you are a military retiree, or the spouse of a veteran who
was killed in action, you are and will always be a TRICARE beneficiary,
you can´t choose between the two.
Update 02/2012
A veteran reader emailed me to point out that in past writings I've told you that "Any provider who accepts Medicare will also accept CHAMPVA".
That statement is not correct. Hospitals will accept CHAMPVA as well as Medicare. Providers (generally physicians) may or may not accept either Medicare or CHAMPVA.
More specific information is available by clicking here.
Many thanks to the vet who alerted me to my error. I appreciate knowing that readers are paying close attention and willing to ensure that my information is correct...that helps all of us!
Eligibility
To be eligible for CHAMPVA, you cannot be eligible for TRICARE/CHAMPUS 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 from a service connected disability, 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 his or her own veteran status. Additionally, as the result of a recent policy change, 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, he or she may choose the VA health care system or coverage under CHAMPVA for his/her health care needs. If you have been previously denied CHAMPVA benefits and you believe you would now be qualified, please submit an application following the guidelines as listed on the “How to apply” section.
Benefits
In general our 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.
General Exclusions
Like all health programs there are certain services and supplies that are not covered by our program, some of these are:
- Services and supplies obtained as part of a grant, study, or research program.
- Services and supplies not provided in accordance with accepted professional medical standards or related to experimental/investigational or unproven procedures or treatment regimens.
- Care for which you are not obligated to pay, such as services obtained at a health fair.
- Care provided outside the scope of the provider's license or certification.
- Services or supplies above the appropriate level required to provide the necessary medical care.
- Services by providers suspended or sanctioned by any federal agency.
- Services provided by a member of your immediate family or person living in your household.
- CHAMPVA Mental Health and Substance Use Disorder Benefits (01-01)
For a complete listing of noncovered services and supplies please consult the CHAMVPA handbook.
Medicare Impact
CHAMPVA is always the secondary payer to Medicare. If you are eligible for CHAMPVA, under age 65 and enrolled in both Medicare Parts A&B, SSA documentation of enrollment in both Parts A&B is required.
For your benefits to be extended past age 65, you must meet the following conditions:
- if the beneficiary was 65 or older prior to June 5, 2001, and was otherwise eligible for CHAMPVA, and was entitled to Medicare Part A coverage, then the beneficiary will be eligible for CHAMPVA without having to have Medicare Part B coverage.
- if you turned 65 on/or before June 5, 2001, and have Medicare Parts A and B, you must keep both Parts to be eligible.
- if you turned 65 on or after June 5, 2001, you must be enrolled in Medicare Parts A and B to be eligible.
- you are not required to enroll in Medicare Part D in order to become or remain CHAMPVA eligible.
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