Retired LCDR Carl Jewett
VA-Accredited Claims Agent
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Important Facts About CHAMPVA Benefits
- Spouses and dependent children of veterans with a permanent 100% disability rating are eligible for CHAMPVA.
- Surviving spouses and dependent children of veterans can qualify for CHAMPVA if the veteran died from a service-connected disability, or the veteran died from a non-service-connected disability but was rated permanently and totally disabled for another disability at the time of death.
- Spouses can continue to use CHAMPVA even if they are on Medicare, as long as they enroll in part B. CHAMPVA is always a secondary payer in these cases.
- Surviving spouses who remarry before their 55th birthday are no longer eligible for CHAMPVA.
- Primary caregivers participating in the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) may qualify for CHAMPVA as long as they are not entitled to any other health care program such as TRICARE, Medicare or Medicaid.
What is CHAMPVA?
The Department of Veterans Affairs (VA) offers many benefits for veterans. CHAMPVA is a type of VA health care specifically for dependents, such as spouses or children, of disabled veterans. This health care program supports dependents’ need for health care by covering a variety of medical services.
There are certain medical providers who participate in the CHAMPVA program. Some are VA medical providers, which means CHAMPVA enrollees are not required to pay for medical services out of pocket. However, some CHAMPVA medical providers are not VA-affiliated, so they may require some form of payment.
CHAMPVA benefits are also available to dependents enrolled in Medicare. There are some stipulations with combining Medicare coverage and CHAMPVA benefits, which requires coordination between the dependent, their medical providers and medical centers.
The VA also offers an assistance program for veteran caregivers called the Program of Comprehensive Assistance for Family Caregivers (PCAFC). Caregivers receiving these benefits may also be eligible for CHAMPVA.
For assistance filing a VA claim for CHAMPVA or other questions regarding VA benefits, contact VA-Accredited Claims Agent, retired LCDR Carl Jewett.
CHAMPVA Eligibility Criteria
To be eligible for CHAMPVA, you must be the spouse or dependent child of a veteran who has been given a permanent 100% disability rating by the Department of Veterans Affairs (VA). Veterans with mesothelioma often receive disability compensation from the VA, which means their dependents may be eligible for CHAMPVA benefits.
If the veteran has passed away, you may still be eligible for CHAMPVA if:
- The death was caused by a service-connected disability, or
- The veteran was rated as permanently and 100% disabled at the time of their death for a disability that did not cause their death.
What Does CHAMPVA Cover?
CHAMPVA covers a wide variety of services, including:
- Inpatient services
- Outpatient services
- Ambulance services
- Durable medical equipment
- Hospice care
CHAMPVA Medical Providers
Once an eligible family member is enrolled in CHAMPVA, they can get their medical care by choosing a provider participating in the CHAMPVA program. However, it is important that you ensure that the provider you choose accepts CHAMPVA coverage before receiving services.
To receive care, the enrollee must present their CHAMPVA identification card and any necessary authorization forms to the healthcare provider at the time of service.
The provider will then bill CHAMPVA directly for covered services. It is important to carefully review their CHAMPVA benefits and understand their responsibilities for cost-sharing and prior authorization requirements.
VA Medical Providers
The VA provides CHAMPVA enrollees with the option to seek treatment at a VA Medical Center or clinic if the specific location participates in the CHAMPVA Inhouse Treatment Initiative (CITI). If you live nearby a participating VA Medical Center or clinic, you can receive treatment with zero out-out-pocket expenses, as there is no cost share and no deductibles. More than 50% of all VA Medical Centers and clinics participate in the CITI program.
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CHAMPVA and Medicare
Once a patient who is covered under the VA’s CHAMPVA program becomes eligible for Medicare Part A, they must enroll in at least Part B to keep their CHAMPVA coverage.
CHAMPVA is a secondary payer to Medicare, which means Medicare will be the primary payer for covered medical expenses. CHAMPVA will then cover any remaining costs not covered by Medicare.
It is important for patients who are covered under both CHAMPVA and Medicare to understand how their benefits will change once they are on Medicare. They should also review their CHAMPVA benefits and understand their cost-sharing responsibilities, as they may still be responsible for paying some out-of-pocket expenses.
It is also important for patients to carefully coordinate their benefits between CHAMPVA and Medicare to ensure they are receiving the maximum coverage for their medical expenses. This may involve working with healthcare providers to understand which services are covered by each program and how the programs interact with each other. By carefully coordinating their benefits, patients can maximize their coverage and minimize their out-of-pocket expenses.
CHAMPVA Coverage for Primary Caregivers
The VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) is a support and financial assistance program for family caregivers of eligible veterans who were injured in the line of duty on or after September 11, 2001. The program provides a range of services and benefits to help family caregivers manage the care of their loved ones, including financial stipends, access to health insurance, training, counseling and respite care.
In addition, caregivers enrolled in PCAFC may also qualify for CHAMPVA health coverage as long as they do not qualify for other health coverage such as Tricare, Medicare and Medicaid. This allows non-dependent adult children and other relatives who provide care to the veteran to receive CHAMPVA health coverage as long as they don’t qualify for any other coverage.
Frequently Asked Questions About CHAMPVA Benefits
What is CHAMPVA?
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program available to eligible dependents and survivors of certain disabled veterans. The program provides medical coverage to those ineligible for TRICARE or Department of Defense (DoD) health care programs.
How Do I Qualify for CHAMPVA?
To qualify for CHAMPVA, you must be the spouse or dependent child of a veteran with a permanent 100% disability rating or the surviving spouse or dependent child of a veteran whose death was caused by a service-connected disability. You can also qualify if the veteran was permanently rated at 100% at the time of their death for a disability that did not cause the veteran’s death. There are other benefit programs for primary caregivers, such as the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC). Caregivers enrolled in PCAFC may also qualify for CHAMPVA.
How Does Medicare Affect My CHAMPVA Coverage?
Beneficiaries enrolled in CHAMPVA who become eligible for Medicare Part A must enroll in at least Medicare Part B to keep their CHAMPVA coverage. CHAMPVA is a secondary payer to Medicare, which means Medicare will be the primary payer for covered medical expenses. CHAMPVA will then cover any remaining costs not covered by Medicare. Patients should review their benefits and understand how they may change.
Sources & Author
- CHAMPVA Benefits. U.S. Department of Veterans Affairs. Retrieved from: https://www.va.gov/health-care/family-caregiver-benefits/champva/ Accessed on: 05/03/2023.
- CHAMPVA Eligibility. U.S. Department of Veterans Affairs. Retrieved from: https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp Accessed on: 05/03/2023
- CHAMPVA Supplement Insurance Plan. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Retrieved from: https://champva.us/ Accessed on: 05/04/2023
- CHAMPVA Benefits Civilian Health and Medical Program. Retrieved from: https://nvf.org/champva-civilian-health-and-medical-program/ Accessed: 05/04/2023
- Health Care Benefits for Dependents CHAMPVA. Retrieved from: https://www.benefits.gov/benefit/318 Accessed on: 05/04/2023