TRICARE vs. CHAMPVA
The United States Armed Forces prides itself on having the world’s most elite Military Health System (MHS), both on and off the battlefield. As such, they know that this means more than just combat medicine, but ensuring that active duty members, veterans, and their dependents can receive high-quality medical care, at affordable rates, anywhere in the world.
In addressing the needs of a wide range of servicemembers and veterans, there are several plans available, both through the MHS and the Department of Veterans Affairs (VA). The two main programs – TRICARE and CHAMPVA – are often confused but are completely separate programs. The key takeaway is that if you are eligible for TRICARE, you are not eligible for CHAMPVA.
The health programs TRICARE and TRICARE for Life are the two main programs provided to active duty members and most retired military personnel and their dependents. The programs’ previous name – the Civilian Health and Medical Program of Uniformed Service (CHAMPUS) – is part of the confusion with the VA’s health program, CHAMPVA.
The TRICARE programs leverage military hospitals and clinics, as well as civilian health care networks, and meet the requirements for minimum essential coverage under the Affordable Care Act. The three main tiers of TRICARE – Prime, Standard, and Extra – provides comprehensive health coverage, including prescription drugs. There are numerous plans within each category that offer special customization, including those for young adults aging out of their dependent status, military retirees, participants living overseas, and dental plan options (Note: dental is not typically covered in most TRICARE plans without an additional purchase). Eligibility requirements, benefits, and cost-sharing requirements vary by each TRICARE plan. For more information, see the Military Health System’s TRICARE Web site.
TRICARE for Life
Additionally, TRICARE for Life (TFL) is a Medicare supplement entitlement program for Medicare-eligible TRICARE beneficiaries. For those enrolled in Medicare Part A and B, they are automatically enrolled in TFL; all you need to present is your Medicare card and Military ID as proof of coverage.
This program has no enrollment fees or premiums (other than the Medicare Part B premium, which is based on your income) and includes creditable drug coverage for Medicare Part D. With TFL you can seek care from any Medicare-participating or nonparticipating provider, or at a military hospital or clinic on a space-available basis. TFL is available worldwide; in the U.S. and its territories, TFL pays after Medicare; in all other OCONUS areas TFL is the first payer.
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care insurance in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. In general, the 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 non-covered services and supplies in the form of a CHAMPVA handbook.
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 of 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).
If yo are enrolled in Medicare, CHAMPVA is always the secondary payer. If you are eligible for Medicare, at any age and for any reason, you must enroll in Medicare Part A and Medicare Part B to keep your CHAMPVA benefits. Social Security Administration documentation of enrollment in both Part A and Part B is required by CHAMPVA. For more information, visit the VA’s CHAMPVA website and read through some frequently asked questions about CHAMPVA.