CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) offers healthcare support to eligible individuals who are either the spouse or child of a deceased veteran or a veteran with disabilities. Unlike TRICARE, which is designed for active-duty and retired military personnel, CHAMPVA provides coverage to those who do not qualify for TRICARE benefits. While TRICARE is regionally administered, CHAMPVA is a national program directly managed by the Department of Veterans Affairs (VA).
Through CHAMPVA, qualified beneficiaries share the cost of most medical services and supplies with the VA, which can be a lifeline for veterans’ families who need access to comprehensive healthcare.
What CHAMPVA Covers
CHAMPVA provides healthcare services for both physical and mental health needs. It covers a wide range of treatments and supplies, including hospital care, outpatient services, mental health services, prescription medications, and medical equipment. After confirming eligibility, you will receive a CHAMPVA handbook that details both covered and non-covered services. In general, most necessary medical care is covered, but some treatments require prior approval before they can be reimbursed.
While CHAMPVA does not always require pre-authorization, there are specific treatments that do require it. Always check with CHAMPVA or the healthcare provider to ensure that the treatment or service is covered and approved.
What CHAMPVA Does Not Cover
Like most health insurance programs, CHAMPVA has exclusions. Here are some examples of services and supplies that CHAMPVA does not cover:
- Medical treatments or materials funded by research studies, grants, or experimental programs.
- Services that do not meet recognized medical standards or involve experimental, unapproved, or untested treatments.
- Care provided at health fairs, where no charge is incurred.
- Treatments not covered by the provider’s licensure or certification.
- Services or supplies that are above the standard required to provide necessary medical care.
- Services provided by a family member or someone living in the same household.
- Healthcare from suppliers who have been banned or penalized by federal agencies.
CHAMPVA for Mental Health and Substance Use Disorders
CHAMPVA offers support for mental health care and substance use disorders. Mental health services such as therapy, counseling, and inpatient treatment are included in the program, as well as treatment for addiction-related issues. The program aims to provide comprehensive support to veterans’ families dealing with these challenges.
CHAMPVA Eligibility Requirements
To qualify for CHAMPVA benefits, applicants must meet specific criteria and must not be eligible for TRICARE or CHAMPUS (the former name of TRICARE). Eligible individuals typically include:
- Spouse or child of a veteran who is permanently and totally disabled due to a service-connected condition.
- Surviving spouse or child of a veteran whose death was related to a service-connected disability.
- The dependents of veterans who died while on active duty, but who are not eligible for TRICARE.
Impact of Medicare on CHAMPVA Eligibility
If you are under 65 and qualify for CHAMPVA, you must also be enrolled in Medicare Parts A and B for your benefits to continue. If you turned 65 after June 5, 2001, you must be enrolled in both Medicare Parts A and B to continue receiving CHAMPVA benefits. However, you are not required to enroll in Medicare Part D.
For beneficiaries over 65, if you are enrolled in Medicare, it will be your primary insurance, and CHAMPVA will act as the secondary payer. This means Medicare will pay first, and CHAMPVA will cover any remaining eligible costs.
In some cases, if a beneficiary also qualifies for Medicaid, CHAMPVA will be the primary payer, and Medicaid may cover additional costs.
How to Apply for CHAMPVA Benefits
To apply for CHAMPVA, gather all the necessary personal information about both the applicant and the veteran. Ensure all sections of the application are completed clearly to avoid any delays. To submit your application, you can mail it to:
CHAMPVA Eligibility
PO Box 469028
Denver, CO 80246-9028
Once your eligibility is verified, you will receive a CHAMPVA handbook that will help you navigate the benefits, services, and requirements associated with the program.
Additional VA Benefits and CHAMPVA
CHAMPVA is just one of the many benefits available to veterans and their families. If you are a veteran with a 70% disability rating or higher, you may also qualify for additional benefits, including disability compensation and healthcare services. Furthermore, VA disability pay increases are typically announced each year, and these changes will impact the amount you receive.
For instance, veterans rated at 100% permanent disability could see their benefits increase for the upcoming year, including healthcare support from CHAMPVA. These benefits are intended to provide additional financial and healthcare assistance for veterans and their families.
Combining CHAMPVA with Other Programs
Many CHAMPVA beneficiaries wonder if they can combine their benefits with other welfare programs like SNAP or Medicaid. While the rules vary depending on your specific circumstances, it is generally possible to receive CHAMPVA benefits alongside other forms of assistance. However, be mindful of income and resource limits that may apply.
If you are eligible for SNAP, you may qualify for additional help with food expenses, while Medicaid can assist with covering the cost of healthcare services not covered by CHAMPVA.
Key Takeaways
- CHAMPVA provides comprehensive healthcare benefits for spouses and children of disabled or deceased veterans who do not qualify for TRICARE.
- Services covered by CHAMPVA include a wide range of medical, mental health, and substance use disorder treatments, with some requiring prior approval.
- Eligibility for CHAMPVA depends on the veteran’s disability status and your relationship to the veteran.
- If you are under 65, you must also be enrolled in Medicare Parts A and B to continue receiving CHAMPVA benefits.
- CHAMPVA is the secondary payer when beneficiaries are covered by Medicare or Medicaid.
- To apply for CHAMPVA, send your application to the specified address with all required documentation.
By understanding how CHAMPVA works, you can ensure that you receive the healthcare support you’re entitled to as the family member of a veteran. Always check the CHAMPVA handbook and consult with the VA to confirm your benefits and eligibility.
