Frequently Asked Questions About CHAMPVA Insurance
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. Because of it’s similar naming with TRICARE’s previous name, it can be a bit confusing as to who is covered, and for what. Below are the basics of the CHAMPVA insurance plan, based on commonly asked questions.
What’s the difference between CHAMPVA and TRICARE (formerly called CHAMPUS)?
CHAMPVA is a VA program, administered by the Veterans Health Administration Office of Community Care (VHA CC) in Denver, Colorado. Alternately, TRICARE is a regionally managed health care program for DOD program for active duty and retried members of the uniformed services, their families, and survivors. If you are a veteran, you may appear to be eligible for both programs; however, if you are a retiree or the souse of a veteran killed in action, you will always be a TRICARE beneficiary and cannot choose between the two programs. For more information check out our article on TRICARE vs. CHAMPVA.
What does CHAMPVA cover?
CHAMPVA generally covers most health care services and supplies that are medically and psychologically necessary. This includes outpatient and inpatient procedures, medical equipment, prosthetics and orthotics, lenses and eye glasses, and more. Upon confirmation of eligibility, you will receive a CHAMPVA Program Guide that specifically addresses covered and non-covered services and supplies.
Like all health programs there are certain services and supplies that are not covered, such as:
- 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.
Who is eligible for CHAMPVA coverage?
To be eligible for CHAMPVA, the beneficiary cannot be eligible for TRICARE. CHAMPVA provides coverage to a veteran, spouse or widow(er), and children of a veteran who:
- is permanently and totally (P&T) disabled because of an service-connected disability
- who died as a result of an service-connected disability or who, at the time of death, was rated P&T, or died while in an active duty status and in the line of duty, not due to misconduct. The term “active duty” may include periods of inactive duty for training.
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.
To extend coverage to beneficiaries over the age of 65, you must meet these additional requirements:
- 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 the need for Medicare Part B coverage.
- If the beneficiary turned 65 before June 5, 2001, and had Medicare Parts A and B, the beneficiary must keep both parts to be eligible.
- If the beneficiary turned age 65 on or after June 5, 2001, the beneficiary must be enrolled in Medicare Parts A and B to be eligible.
Does CHAMPVA fulfill the coverage requirements of the Affordable Care Act?
The Affordable Care Act, also known as the health care law, was created to expand access to coverage and required that U.S. taxpayers prove that they have health coverage on their federal tax forms. The health care law designates CHAMPVA as fulfilling the minimum essential coverage requirement, and if you are enrolled in CHAMPVA, you do not need to take additional steps to meet the health care law coverage standards. The ACA does not change CHAMPVA benefits or out-of-pocket costs.
How do I apply for CHAMPVA?
It’s a good idea to consult your local Veteran Service Officer (VSO) before submitting your application. You can search online by state, or check wit your local veteran organizations that provide VSOs, including Veterans of Foreign Wars (VFW), American Legion, Military Order of the Purple Heart, Vietnam Veterans of America, Disabled American Veterans, Amvets, and Paralyzed Veterans of America.
There is a list of “required” documents and a list of “optional” documents to include in your application. The VA advises that including the optional documents most likely shortens your processing time (required-only applications typically take 2-8 months, while application including additional optional documents take around 6 weeks). Before sending your application, you should ensure the application is signed and dated. Also, if applying for a spouse, include the date of marriage on the application
Once the VHA receives your application, they review it to ensure it is complete and that all required documents are included. If your application package is not complete, they will return it with further instructions. Once approved, you are sent a CHAMPVA Identification
(ID) card, handbook, and related materials; once you receive your CHAMPVA ID card, you can begin to use CHAMPVA. For more information and mailing address, visit the VA’s How to Apply for CHAMPVA page.
How can I get more information on specific coverage or benefits?
The VA offers a library of helpful CHAMPVA FAQs that can give you more specific information. You can also contact your local VSO for guidance.