The United States Department of Veterans Affairs, commonly referred to as the VA, administers a comprehensive health care program through the Health Administration Center in Denver, Colo., called the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). CHAMPVA helps spouses and other dependents of qualifying veterans by sharing the costs of eligible health care services and supplies.
Several requirements must be met to qualify for benefits under CHAMPVA. First and foremost, participants must be ineligible to receive health care benefits under TRICARE, the Department of Defense's health care program designed for active duty and retired members of the Armed Forces and their families. Once that condition is met, the spouse of a permanently and totally disabled veteran may be eligible for CHAMPVA benefits, depending on certain factors. The disability must have been rated by a regional VA office, and must have been service-connected. The surviving spouse of a deceased military member who died in the line of duty may qualify for benefits under CHAMPVA, if not otherwise qualified under TRICARE.
Benefits and Exclusions
CHAMPVA covers most medically and psychologically necessary services and supplies. There is a $50 annual deductible and a patient co-pay of 25%. If a patient has other health insurance, CHAMPVA is to be billed second, with the exception of Medicaid, Crime Compensation Programs, or other supplemental CHAMPVA policies. As with all health coverage programs, some services and supplies are excluded from coverage, such as care provided outside the scope of a provider’s license, or care for which an individual is not obligated to pay.
Medicare and CHAMPVA
Spouses who are eligible for Medicare may also be eligible to receive CHAMPVA coverage. However, the rules and requirements vary depending on your age and Medicare eligibility status. If you are under the age of 65, you must qualify for Medicare Parts A and B to be eligible for CHAMPVA. In 2001, individuals over the age of 65 became eligible for CHAMPVA coverage. However, you must carefully review the Medicare Parts A and B requirements, as certain limitations apply.
CHAMPVA is accepted at all hospitals, but is not necessarily accepted by all physicians. If a physician accepts Medicare, he must also accept CHAMPVA. Locating a participating physician should become a high priority once you determine you are a qualified spouse. You will most likely be required to make a co-payment for many services. Therefore, meeting with your physician to discuss CHAMPVA insurance coverage and filing procedures will help ensure your claims are filed properly and timely. Pharmacy benefits are available through CHAMPVA, but it is important to verify that the current medication you take is covered. Prior to submitting a prescription, make sure the pharmacy you have chosen accepts CHAMPVA.
Blyss Cruz has called Alaska home for 30 years. She has written numerous business, financial and legal documents related to her long-time employment in both the public and private financial sectors. Cruz holds a B.S. in Paralegal Studies and an MBA in business and accounting.