CHAMPVA: Who Qualifies, What It Covers, and How to Apply

CHAMPVA is the VA’s health insurance program for the families of certain disabled or deceased veterans. If you are the spouse, child or survivor of a veteran with a permanent and total service-connected disability, CHAMPVA can pay most of your medical bills, even though you never served.

The program shares the cost of care with you: a small yearly deductible, a 25% cost share, and a $3,000 yearly cap for the whole household. This guide covers who qualifies, what CHAMPVA covers and costs, how it works with Medicare, and how to apply, using the VA’s own CHAMPVA pages.

Key Takeaways

• CHAMPVA covers the spouse, children and survivors of a veteran rated permanently and totally disabled from a service-connected condition, or who died from one. You cannot have CHAMPVA if you are eligible for TRICARE.
• You pay a $50 deductible per person ($100 per family) each calendar year for outpatient care, then 25% of the CHAMPVA allowable amount. There is no deductible for a hospital stay.
• Your household’s deductibles and cost shares stop at $3,000 in a calendar year. Charges above VA’s allowable amount, and care it does not cover, do not count toward that cap.
• If you have Medicare, you must keep Part A and Part B to stay on CHAMPVA. CHAMPVA then pays second, and you usually pay nothing for covered care.
• Apply online, by mail or by fax with VA Form 10-10d. VA mails a welcome letter and a CHAMPVA ID card once you are approved.

What is CHAMPVA?

CHAMPVA stands for the Civilian Health and Medical Program of the Department of Veterans Affairs. VA shares the cost of covered care with eligible family members of veterans. In most cases VA sets its allowable amount at what Medicare or TRICARE would pay, and you pay a 25% share of it, up to a yearly cap.

CHAMPVA is not VA health care for the veteran. The veteran, called the sponsor, gets care through VA. CHAMPVA covers the family. It works like regular insurance: you see doctors in your community, and you or your provider send the bill to VA.

There is no provider network. VA says you can see any provider who agrees to accept the program, and you can also use a VA medical center that takes part in a program called CITI, covered below.

It is also different from TRICARE. TRICARE is the military’s health plan for service members, retirees and their families. VA’s program exists for families who do not qualify for TRICARE.

Who qualifies for CHAMPVA?

You may qualify if you are the spouse or dependent child of a veteran rated permanently and totally (P&T) disabled from a service-connected condition, or the survivor of a veteran who died from one or was rated P&T at death. You also cannot be eligible for TRICARE.

VA’s eligibility page lists these groups:

• Spouse or child of a P&T veteran. The veteran has been rated permanently and totally disabled from a service-connected disability.
• Survivor of a veteran who died from a service-connected disability. This covers the surviving spouse and dependent children.
• Survivor of a veteran rated P&T at death. The death itself does not have to be service-connected.
• Survivor of a service member who died in the line of duty, not due to misconduct, in certain cases. VA’s guidebook notes that most of these families get TRICARE instead.

VA also covers one more group: the primary family caregiver of a veteran, if the caregiver has no other health insurance. Caregivers do not use VA Form 10-10d. They apply for the Program of Comprehensive Assistance for Family Caregivers, and VA enrolls them in CHAMPVA automatically if they qualify.

The TRICARE rule

VA is direct about this: if you are eligible for or enrolled in TRICARE, you cannot get this coverage. The two programs never overlap. If you become eligible for TRICARE later, your eligibility here ends.

The guidebook gives a common example. If the veteran is a retired National Guard member or reservist, the family can become TRICARE eligible when the veteran starts receiving retired pay at age 60. At that point, the family moves to TRICARE.

What “permanent and total” means for your family

A 100% rating is not always a permanent and total rating. A P&T rating means VA does not expect the condition to improve. You can find the P&T status on the veteran’s VA benefit summary letter or rating decision. Our guide to VA disability rates explains how ratings and monthly pay work.

CHAMPVA for children: age limits and students

A child’s CHAMPVA coverage ends at 18 unless the child is enrolled in school or permanently disabled. Full-time students keep CHAMPVA until they leave school or turn 23, whichever comes first. A child who became permanently unable to support themselves before 18 can keep CHAMPVA past 18.

Here, a child includes a birth child, an adopted child, a stepchild, or a helpless child as decided by a VA regional office. Students must send a school certification letter as proof of enrollment and recertify once a year.

Coverage also ends if a child marries or becomes eligible for TRICARE. Stepchildren have one more rule: a stepchild who leaves the veteran’s household because of a divorce or remarriage no longer qualifies. The guidebook makes an exception for stepchildren 18 to 23 living in campus housing during school terms.

Surviving spouses and remarriage

A surviving spouse who remarries on or after their 55th birthday keeps coverage. One who remarries before 55 loses it on the date of the remarriage. If that later marriage ends, they may qualify again from the first day of the month after it ends.

To regain coverage after a remarriage ends, VA suggests sending a divorce decree, annulment decree or death certificate with your application. A living spouse who divorces the veteran loses coverage when the divorce or annulment becomes final, according to the guidebook.

What does CHAMPVA cover?

The program covers most medically necessary health care services and supplies, including hospital stays, outpatient visits, mental health care, prescriptions, hospice, skilled nursing care, ambulance service and organ transplants. Most care does not need approval in advance.

VA’s page on getting care through CHAMPVA lists covered services, including:

• Inpatient care in a hospital and outpatient care, such as office visits
• Mental health and substance use disorder services
• Prescription medications, through Meds by Mail or the OptumRx pharmacy network
• Hospice, skilled nursing care, durable medical equipment and ambulance service
• Organ transplants

Care that needs approval first

In most cases you do not need preauthorization. VA lists the exceptions as inpatient mental health care, care for alcohol or substance use disorders, dental care in the limited cases it is covered, and organ transplants. The older guidebook also names residential treatment and ABA treatment.

VA says you do not need approval first for medical equipment or mental health care you get through CITI at a VA medical center. To request approval, the guidebook gives a preauthorization line at 833-930-0816.

What CHAMPVA does not cover

The program does not pay for care that is not medically necessary. VA also names eyeglasses or contact lenses (except in certain cases), GLP-1 drugs for weight loss, and Medicare Part B premiums. Federal rules exclude most dental care, hearing aids, cosmetic surgery and custodial care.

The full list of exclusions is in federal regulation 38 CFR 17.272. Other items it rules out include chiropractic care, acupuncture, routine foot care, in vitro fertilization, experimental treatments, and care from an immediate family member. If you are unsure, call VA before you get the service.

Dental care is the gap families notice most. It is paid only in limited cases tied to a covered medical condition, and those cases need preauthorization. For routine cleanings and fillings, families usually need separate dental insurance, or Medicaid if they qualify. See whether Medicaid covers dental care.

How much does CHAMPVA cost?

VA’s cost rules list no monthly premium. You pay a $50 deductible per person each calendar year, up to $100 per family, for outpatient care and urgent prescriptions. After that, you pay 25% of the CHAMPVA allowable amount. Your household’s deductibles and cost shares stop at $3,000 a year.

Cost	Amount	Applies to
Deductible	$50 per person, $100 per family, each calendar year	Outpatient care and urgent prescriptions through OptumRx
Inpatient deductible	None	Hospital stays
Cost share	25% of the CHAMPVA allowable amount	Each covered service or supply
Catastrophic cap	$3,000 per household, each calendar year	All covered services; CHAMPVA pays 100% after
Meds by Mail	$0	Maintenance drugs, if you have no other drug coverage
Care through CITI	$0	Participating VA medical centers (not available with Medicare)
Preventive care and hospice	$0 (no deductible, no cost share)	Cancer screenings, annual physical, vaccines, well-child care to age 6, hospice

Source: VA: Getting care through CHAMPVA, the CHAMPVA Guidebook and 38 CFR 17.274.

A worked example

Say a spouse with no other insurance has an outpatient visit in January with a CHAMPVA allowable amount of $400. The first $50 is the deductible. The spouse then pays 25% of the remaining $350, which is $87.50. The spouse pays $137.50 in total, and CHAMPVA pays $262.50.

For a second $400 visit later that year, the deductible is already met. The spouse pays 25%, or $100, and CHAMPVA pays $300. These amounts are our own math based on VA’s published rules; the allowable amount for a real visit depends on the service.

Prescription costs

If CHAMPVA is your only drug coverage, Meds by Mail delivers maintenance medications to your home at no cost. The guidebook says you cannot use Meds by Mail if you have other drug coverage, including a Medicare Part D plan.

At an OptumRx network pharmacy, you pay the full price until you meet the deductible, then 25% of the allowable amount. Outside the network, you pay the full cost up front and VA pays you back 75% of the allowable amount.

CHAMPVA and Medicare: the rules at 65

If you are eligible for Medicare, you must have Medicare Part A and Part B to get or keep CHAMPVA, at any age. A Medicare Advantage plan also meets this rule. Medicare pays first and CHAMPVA pays second, so in most cases you pay nothing for care both programs cover.

This is the rule that catches most families off guard. If you drop Part B, your coverage ends on the same day your Part B ends, according to the guidebook. VA does not pay your Part B premium, so budget for it. If your income is limited, Medicare Savings Programs can pay it.

Our Medicare guide covers Part B costs and enrollment periods.

The guidebook tells beneficiaries to enroll in Medicare 90 days before their 65th birthday. When your Medicare card arrives, send CHAMPVA a copy with VA Form 10-7959c, the other health insurance form. Medicare then forwards your claims to VA after it pays its share.

There are two exceptions. If you turned 65 before June 5, 2001 and have only Part A, you do not need Part B. If you are 65 or older and were never eligible for premium-free Part A, you also do not need Part B. In that case, VA asks for a “notice of disallowance” from Social Security when you apply.

Part D is optional. You do not need a Part D drug plan to stay covered, and the program’s drug coverage counts as creditable coverage, so you will not owe a late penalty if you join Part D later. Our guide to Part D costs explains what a plan would add. People with Medicare cannot use CITI at VA medical centers.

This Medicare rule dates to the Veterans’ Survivor Benefits Improvements Act of 2001, which let people 65 and older with Medicare keep CHAMPVA as a second payer starting October 1, 2001. Before that law, coverage ended at 65 for most beneficiaries.

CHAMPVA with other insurance, Medicaid or a Marketplace plan

If you have other health insurance, such as a job-based plan, that plan pays first and CHAMPVA pays second. CHAMPVA pays first only when your other coverage is Medicaid, Indian Health Service, a state victims of crime compensation program, or a CHAMPVA supplemental policy.

When CHAMPVA pays second, the guidebook says you pay nothing in most cases, and CHAMPVA pays up to 100% of its allowable amount. Report any new insurance by calling 800-733-8387 or sending VA Form 10-7959c.

You can buy a Health Insurance Marketplace plan while on CHAMPVA, but you will not get premium tax credits or cost-sharing reductions to lower its price. If you also qualify for Medicaid, VA pays before Medicaid. Our guide to Medicaid for veterans and their families explains the income rules.

Finding providers, CITI and claims

You can see any provider who accepts CHAMPVA. Hospitals that accept Medicare, and the providers who work for them, must also accept CHAMPVA for hospital stays. The guidebook says most other Medicare providers accept CHAMPVA too, but they are not required to.

Ask before your appointment whether the office accepts CHAMPVA and will bill CHAMPVA directly. If a provider does not accept it, you can pay and file a claim yourself, and VA pays you back 75% of its allowable amount.

CITI, the CHAMPVA In-house Treatment Initiative, lets you get care at a participating VA medical center. VA covers the entire cost of care you get through CITI, with no deductible or cost share. More than half of VA medical centers take part, according to the guidebook. Call your local VA medical center to ask.

Claim deadlines

You must file a claim within one year of the date you got care, or within one year of the discharge date for a hospital stay. Use VA Form 10-7959a, or file online on VA’s CHAMPVA claims page. If VA approves you with retroactive coverage, you have 180 days after your first ID card is issued to file older claims.

How to apply for CHAMPVA

Apply with VA Form 10-10d, the Application for CHAMPVA Benefits, online on VA.gov, by mail or by fax. Include VA Form 10-7959c if you have other health insurance or Medicare, plus any supporting documents. VA mails a welcome letter and a CHAMPVA ID card once you are approved.

1. Confirm the veteran’s rating. You need the sponsor’s P&T rating or, for a survivor, proof of a service-connected death or a P&T rating at death.
2. Fill out VA Form 10-10d. Apply online on VA.gov, or download the form.
3. Add VA Form 10-7959c if anyone has other insurance or Medicare, with copies of the front and back of each insurance card.
4. Attach supporting documents. A marriage certificate for a spouse, a birth certificate or adoption papers for a child, proof of the marriage for a stepchild, and a school letter for a student 18 to 23. Some are optional but speed up processing.
5. Send it. Mail it to VHA Office of Community Care, CHAMPVA Eligibility, PO Box 137, Spring City, PA 19475, or fax it to 303-331-7809.

After you apply, VA says you do not need to do anything unless it sends a letter asking for more information. VA does not publish a standard processing time. For questions, call CHAMPVA at 800-733-8387 (TTY: 711), Monday through Friday, 8:00 a.m. to 7:30 p.m. ET.

Once approved, you get a CHAMPVA ID card in the mail. Show it to your providers and keep the welcome letter with your records.

CHAMPVA vs TRICARE: side by side

Question	CHAMPVA	TRICARE
Run by	Department of Veterans Affairs	Department of Defense
Who it covers	Families and survivors of veterans with a P&T service-connected rating, or who died of a service-connected condition	Service members, military retirees and their families
Can you have both?	No. Anyone eligible for TRICARE cannot get CHAMPVA.
Outpatient deductible	$50 per person, $100 per family	Depends on the TRICARE plan
Yearly cap	$3,000 per household	Depends on the TRICARE plan
With Medicare	Part A and Part B required; CHAMPVA pays second	Separate TRICARE For Life rules

Source: VA: CHAMPVA benefits.

Next steps

If the veteran in your family has a permanent and total service-connected rating, check the rating letter, then apply with VA Form 10-10d. If anyone in the household is 65 or older, sign up for Medicare Part A and Part B first, because CHAMPVA requires them.

For more help for veteran families, see our veterans benefits hub and disability benefits hub, and our guide to HUD-VASH housing vouchers for veterans facing homelessness.