CHAMPVA benefits | Veterans Affairs (2024)

Are you the spouse or surviving spouse of—or a child of—a Veteran with disabilities or a Veteran who has died? If you don’t qualify for TRICARE (the Department of Defense’s health care program for active-duty and retired service members and their families), you may be able to get health insurance through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Through this program, we cover the cost of some of your health care services and supplies. This is called cost sharing. Find out if you qualify for CHAMPVA and how to apply.

Am I eligible for health care through CHAMPVA?

You may only be eligible forhealth care through CHAMPVA if you don’t qualify for TRICARE and at least one of these descriptions is true for you.

At least one of these must be true:

  • You’re the spouse or child of a Veteran who’s been rated permanently and totally disabled for a service-connected disability by a VA regional office, or
  • You’re the surviving spouse or child of a Veteran who died from a VA-rated service-connected disability, or
  • You’re 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
  • You’re the surviving spouse or child of a service member who died in the line of duty, not due to misconduct (in most of these cases, family members qualify for TRICARE, not CHAMPVA).

A service-connected disability is a disability that we’ve concluded was caused—or made worse—by the Veteran’s active-duty service. A permanent disability is one that’s not expected to improve.

Note: A Veteran who’s the qualifying CHAMPVA sponsor for their family may also qualify for the VA health care program based on their own Veteran status. If 2 spouses are both Veterans who qualify as CHAMPVA sponsors for their family, they both may now qualify for CHAMPVA benefits. Each time they need medical care, they may choose to get care through the VA health care program or using their CHAMPVA coverage.

What else might affect whether I can get CHAMPVA benefits for myself or a family member?

There are other factors that may affect whether you or other family members qualify for CHAMPVA. Please click on the description that matches your status to learn more:

A new or expectant parent

If you’re expecting a baby, you’ll need to take the 2 steps listed here before you can apply for CHAMPVA for your newborn:

  • You’ll need to get a Social Security number for your baby by applying at the nearest Social Security Administration office, and
  • You’ll need to set up the baby’s status as a dependent of the Veteran sponsor by contacting your nearest VA regional office.

Medical claims can’t be paid until you sign your baby up under CHAMPVA, so please get them a Social Security number and set their status as a dependent as soon as possible.

Find a Social Security office near you

Find a VA regional office near you

A surviving spouse who’s currently remarried

If you’re the surviving spouse of a qualifying CHAMPVA sponsor and you remarry before age 55, you no longer qualify for CHAMPVA as of midnight on the date of your remarriage.

If you remarry on or after your 55th birthday, you can keep your CHAMPVA benefits.

A surviving spouse whose remarriage has ended by death, divorce, or annulment

If you’re the surviving spouse of a qualifying CHAMPVA sponsor and you remarry, but the remarriage ends by death, divorce, or annulment, you may qualify again for CHAMPVA.

The first date that you qualify again is the first day of the month after your remarriage ends or December 1, 1999—whichever date is later. You’ll need to provide us with copies of your marriage certificate and death, divorce, or annulment documents (as appropriate).

An 18-to-23-year-old dependent child of a Veteran

If you’re covered under CHAMPVA and you turn 18 years old, you’ll need to send us proof that you’re enrolled in college or another educational institution to keep getting benefits.

Download our fact sheet on school enrollment certification requirements for CHAMPVA benefits (PDF)

A Veteran’s stepchild who leaves the Veteran’s household

If you were covered under CHAMPVA as the stepchild of a Veteran, and you leave the Veteran’s household because of a divorce or remarriage, you no longer qualify for CHAMPVA.

A primary family caregiver of a Veteran with injuries and/or disabilities

If you’re a family member caring for a Veteran with disabilities, and you’re not entitled to care or services through another health plan, you may qualify for CHAMPVA.

Download a fact sheet on CHAMPVA for primary family caregivers (PDF)

Get more information about CHAMPVA for primary family caregivers

If the Veteran you are caring for sustained or aggravated a serious injury (or illness) in the line of duty in the active military, naval or air service during any service era, you may qualify for health care benefits and other caregiver support through the Program of Comprehensive Assistance to Family Caregivers.

Find out if you qualify for this program and how to apply

A CHAMPVA beneficiary who’s 65 years old or older—or who qualifies for Medicare at any age

CHAMPVA is always the second payer to Medicare. Here are some requirements you need to know:

If you’re under 65 years old, you’re eligible for CHAMPVA if you meet both of these requirements.

Both of these must be true:

  • You have both Medicare Parts A and B, and
  • You’re otherwise eligible for CHAMPVA

If you’re 65 years old or older, you’re eligible for CHAMPVA if you’re eligible for Medicare. If you turned 65 before June 5, 2001, and you’re entitled to either Medicare Part A or B, you’ll also need to enroll in Medicare Part B to be eligible for CHAMPVA.

Note: You don’t need to enroll in Medicare Part D to qualify for CHAMPVA.

Download a fact sheet on Medicare and CHAMPVA (PDF)

What benefits do I get with CHAMPVA?

With CHAMPVA, you’ll be covered for services and supplies when we determine they are medically necessary and were received from an authorized provider. When providers are performing services within the scope of their license or certification, we consider them to be authorized.

Covered services include:

  • Ambulance service
  • Ambulatory surgery
  • Durable medical equipment (DME)
  • Family planning and maternity
  • Hospice
  • Inpatient services
  • Mental health services
  • Outpatient services
  • Pharmacy (prescription medicines)
  • Skilled nursing care
  • Transplants

When you’re signed up for CHAMPVA, you’ll get a copy of the CHAMPVA Program Guide. This guide will tell you more about covered and non-covered services and supplies.

  • Download the CHAMPVA Program Guide (PDF)

  • Download fact sheets on CHAMPVA benefits

How do I get CHAMPVA benefits?

You’ll need to apply for these benefits.

To apply, submit these required documents:

  • Application for CHAMPVA Benefits (VA Form 10-10d), and

  • Other Health Insurance Certification (VA Form 10-7959c), and

  • Documents related to your Medicare status:

    • If you qualify for Medicare for any reason, you’ll need to submit a copy of your Medicare card.

    • If you’re 65 years old or older and don’t qualify for Medicare, you’ll need to send us documentation from the Social Security Administration that confirms you don’t qualify for Medicare benefits under anyone’s Social Security number.

To speed up the processing of your application, you can also send copies (not originals) of these optional documents:

  • The page from the VBA rating decision showing your Veteran is permanently and totally disabled (or the death rating if you’re a survivor)
  • Your Veteran’s DD214 (Certificate of Release or Discharge from Active Duty)—or, if the Veteran was a World War II or Korean War Veteran, the Report of Separation. If you don’t have a copy of the necessary form, you can request it by submitting a Standard Form 180, Request Pertaining to Military Records, from the National Archives.
    Find out how to request military service records online, by mail, or by fax
  • Documents related to any dependent children you’re including in your application:
    • A copy of each child’s birth certificate or adoption papers
    • School certification of enrollment for children ages 18-23.
      Download our fact sheet on school enrollment certification requirements (PDF)

If you’re a surviving spouse who remarried but is once again single, also send a copy of the legal document that ended your marriage. This may be a divorce decree, death certificate, or annulment decree.

Be sure to sign and date your application. If your Veteran is applying for you as a spouse, be sure to also include the date of the marriage on the application.

Mail your application to:

VHA Office of Community Care
CHAMPVA Eligibility
PO Box 469028
Denver, CO 80246-9028

Or fax it to:

What happens after I apply?

Once we get your application, we’ll review it to be sure it’s complete and includes all required forms. If it’s not complete, we’ll return it to you with more instructions.

How long will it take to hear back about my application?

If you send us all required and optional documents—and if your application is complete—it’ll take about 6 weeks after we get your package until you get your CHAMPVA ID card and related materials.

If you send us only the required documents, it may take 2 to 8 months since we’ll need to confirm your information with other federal agencies.

Get more information

Get answers to frequently asked questions about CHAMPVA

Find out how to file a CHAMPVA claim

Find out if you can get care at a local VA medical center when you’re covered under CHAMPVA

Last updated:

CHAMPVA benefits | Veterans Affairs (2024)

FAQs

Can a 100 percent disabled veteran get Champva? ›

CHAMPVA eligibility

To be eligible for CHAMPVA, you cannot be eligible for TRICARE, 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.

What is the difference between Champva and Veterans Affairs? ›

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the Department of Veterans Affairs (VA) shares the cost of covered health care services and supplies with eligible beneficiaries.

Does Champva pay 100%? ›

CHAMPVA helps pay for covered medical care, but it does not cover 100% of costs. According to the CHAMPVA Guide, enrollees are responsible for an annual deductible along with their share of the "allowable amount". The deductible is $50 per beneficiary with a maximum of $100 per family, and it is applied each year.

How much does Champva cost monthly per month? ›

Age of Spouse, Widow/erMonthlyAnnual
50 - 54$52.51$630.12
55 - 59$62.30$747.60
60 - 64$74.76$897.12
65+$94.34$1,132.08
4 more rows

What is the 70-40 rule for VA disability? ›

To be eligible for schedular TDIU benefits, a veteran must have either: a single service-connected condition with a rating of at least 60 percent; or. (the 70/40 rule) at least two service-connected conditions with a combined rating of at least 70 percent, with at least one of the conditions rated 40 percent or higher.

What are the hidden benefits of 100% VA disability? ›

What Other Benefits Are Available to Individuals with a 100% Rating?
  • CHAMPVA Benefits. ...
  • VA Health Care Benefits. ...
  • Commissary and Exchange Benefits. ...
  • Educational and Employment Benefits. ...
  • VA Home Loan Guarantee. ...
  • Free Tax Return Preparation. ...
  • Student Loan Forgiveness. ...
  • Social Security Disability Benefits.

What are the drawbacks of Champva? ›

The cons of CHAMPVA are that beneficiaries must pay 25% of the allowable amount, leading to significant out-of-pocket costs for unexpected medical bills. CHAMPVA does not cover dental, chiropractic, routine eye exams, or corrective lenses, and beneficiaries may have limited choice in how their care is provided.

What is not covered under Champva? ›

For example, CHAMPVA does not cover dental, chiropractic services, routine eye exams or corrective lenses. It is possible that Medicaid recipients could have less of a financial burden if covered by Medicaid than under CHAMPVA program.

Can Champva be used as primary insurance? ›

By law, CHAMPVA is always the secondary payer except to Medicaid, State Victims of Crime Compensation Programs, Indian Health Services, and supplemental CHAMPVA policies.

What is the max out of pocket with Champva? ›

CHAMPVA also has a catastrophic spending cap of $3,000 per calendar year, which is the maximum amount of out-of-pocket costs for CHAMPVA-covered supplies and services. After a person has spent $3,000 out of pocket for their care, CHAMPVA may not require a person to pay the cost-sharing amount.

Do all hospitals accept Champva? ›

As a rule any hospital that accepts medicare will accept CHAMPVA and all hospitals accept Medicare...

What happens to my VA disability when I turn 65? ›

After veterans reach Social Security's full retirement age, VA's disability payments continue at the same level. By contrast, the income that people receive from Social Security or private pensions after they retire usually is less than their earnings from wages and salary before retirement.

Does Champva cover emergency room visits? ›

Medical Benefits

Dental benefits are limited. For most care, including medical screening, mental health, emergency room, hospital stay, ambulance, vaccinations, office visits, etc., a CHAMPVA beneficiary would pay 25% of the cost plus a deductible of $50 per individual and $100 per family.

What is the age limit for Champva? ›

If you're 65 years old or older, you're eligible for CHAMPVA if you're eligible for Medicare. If you turned 65 before June 5, 2001, and you're entitled to either Medicare Part A or B, you'll also need to enroll in Medicare Part B to be eligible for CHAMPVA.

How long is the waiting period for Champva? ›

If you provide all of the required and optional documents, and if your application is complete, then it takes approximately six weeks after we get your package until you get your CHAMPVA identification card and related materials.

Who is not eligible for Champva? ›

When a stepchild leaves the sponsor's household, the child is no longer eligible for CHAMPVA. Spouse eligibility ends: • When the marriage to a qualified sponsor is terminated by divorce or annulment. Widow(er) eligibility ends: • When the remarriage prior to the age of 55.

Do 100% disabled veterans get free TRICARE? ›

No. The VA and TRICARE are two different government programs. Getting a disability rating from the VA doesn't mean you get TRICARE. To learn about your VA benefits, visit the U.S. Department of Veterans Affairs page.

What benefits does a 100 disabled veteran get in VA? ›

Virginia State Benefits for 100% Disabled Veterans
  • State Veterans' Cemeteries. ...
  • Income Tax. ...
  • Disabled Veterans Real Estate Tax Exemption. ...
  • Virginia Veterans Preference For State Jobs. ...
  • The Virginia Transition Assistance Program (V3 (formerly known as the VTAP program)) ...
  • Troops to Trucks.

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