Perhaps the biggest myth surrounding CHAMPVA is that it doesn’t exist.
CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs) is among the many benefits not clearly understood by the veteran community. As a result, some dependents miss out on this comprehensive healthcare program and are stuck paying exorbitant rates for private insurance.
Many veterans haven’t even heard of CHAMPVA; others have likely come across misinformation. We’re setting the record straight by busting some of the most common myths about CHAMPVA. At the end of this guide, you will also find a bonus resource section with helpful CHAMPVA links and phone numbers!
- Myth 1: CHAMPVA is for veterans.
- Myth 2: I can choose between TRICARE and CHAMPVA.
- Myth 3: TRICARE and CHAMPVA are essentially the same.
- Myth 4: With CHAMPVA, I can’t choose my own providers.
- Myth 5: I must pay premiums and other hidden costs with CHAMPVA.
- Myth 6: I can choose between CHAMPVA and Medicare.
- Myth 7: It takes FOREVER to enroll in CHAMPVA.
- BONUS: Helpful CHAMPVA Resources
- NEED MORE ASSISTANCE?
Myth 1: CHAMPVA is for veterans.
CHAMPVA is only for dependents (spouse, widow, widower, and children) of veterans. It’s not for the veterans themselves.
Veterans ineligible for TRICARE but who medically retired from the military (or have a VA rating for a service-connected disability) may be eligible for care from the VA—but they do not qualify for CHAMPVA.
Myth 2: I can choose between TRICARE and CHAMPVA.
If you are eligible for TRICARE, you do not qualify for CHAMPVA.
Here are the criteria for qualifying for CHAMPVA:
- Ineligible for TRICARE
- Immediate family member (spouse or child) of a veteran who has been rated permanently and totally disabled due to a service-connected disability OR
- Immediate family member of a veteran who was rated permanently and totally disabled due to a service-connected condition at the time of death (even if the condition was not the cause of death) OR
- Immediate family member of a veteran who died of a service-connected disability OR
- Immediate family member of a veteran who died on active duty and who is not eligible for TRICARE. (This is rare as most of these dependents are eligible for TRICARE).
Dependents of both active duty and retired service members (including medically retired service members) are generally eligible for TRICARE. However, other separated service personnel typically are not.
Myth 3: TRICARE and CHAMPVA are essentially the same.
TRICARE used to be known as CHAMPUS (Civilian Health and Medical Program of Uniformed Service). Since CHAMPUS and CHAMPVA sound similar, these two programs are frequently mixed up.
While both TRICARE and CHAMPVA are comprehensive health benefits programs, they are different from each other. TRICARE is regionally managed, while the Veterans Health Administration Office of Integrated Veteran Care manages CHAMPVA.
TRICARE leverages a network of military hospitals, clinics, and civilian healthcare systems to meet its members’ needs. CHAMPVA providers are civilian doctors and, when available, VA facilities.
Myth 4: With CHAMPVA, I can’t choose my own providers.
CHAMPVA provides coverage through civilian doctors, and you can choose which participating provider you want to visit. Looking at the list of TRICARE and Medicare providers in your area is an excellent place to start locating a doctor who will accept CHAMPVA (also known as “accepting assignment”).
If a provider accepts TRICARE, there is a good chance they will also accept CHAMPVA. If they accept Medicare, they are contractually obligated to accept CHAMPVA. When you call to make an appointment with a provider, double-check that they “accept assignments” for CHAMPVA.
In addition to seeking treatment from civilian providers who accept CHAMPVA, you may also seek treatment at participating VA facilities. However, some VA facilities can’t accept dependents from the CHAMPVA program due to the volume of veterans they see.
Myth 5: I must pay premiums and other hidden costs with CHAMPVA.
There are no premiums with CHAMPVA. Basic coverage is free. However, there are copays. After an annual deductible of $50 per individual/$100 per family, you will be responsible for a copay of 25% of the covered amount. However, if you pay more than $3,000 out-of-pocket in one year, you will hit your “catastrophic cap,” and you will not be expected to pay any more. CHAMPVA will cover your copays after that.
Doctors who accept assignments with CHAMPVA will bill CHAMPVA on your behalf. This means the provider accepts CHAMPVA and agrees to accept its allowable amount as payment in full. A provider cannot bill you for the difference between the allowable amount and their normally billed amount. You are only responsible for the copay.
These three things are 100% covered under CHAMPVA (no copay):
- Hospice care
- Prescriptions IF you use the Department of Veterans Affairs Meds by Mail program.
- Preventive Services (i.e., colorectal cancer screening; prostate cancer screening; annual physical examination; cervical cancer screening; breast cancer screening; vaccinations and immunizations; well-child care)
Myth 6: I can choose between CHAMPVA and Medicare.
Once you are eligible for Medicare Parts A and B, you must enroll in these programs. To continue your CHAMPVA eligibility, in almost all cases, you must enroll in and remain in Medicare Part B.
CHAMPVA will become your secondary insurance and will cover many out-of-pocket costs not covered by these Medicare plans. CHAMPVA does not cover Medicare Part B premiums.
Myth 7: It takes FOREVER to enroll in CHAMPVA.
Well, this one is a partial myth. We have heard of instances where it takes up to eight months to enroll in CHAMPVA. We’ve also heard of the process taking several weeks when the applicant has done their due diligence.
Start by filling out VA Form 10-10d in its entirety. Make sure to include ALL supporting documents. If a reviewer looks at your application and finds it is missing supporting documents, it could delay the process.
Additional required documents:
- VA Form 10-7959c, OHI Certification (Other Health Insurance), on which you can declare any other health insurance you have.
- Copy of your Medicare card (if you are Medicare eligible). If you are 65 or older and not entitled to Medicare, you must send proof from the Social Security Administration.
Optional documents (but strongly recommended if you want to expedite your enrollment):
- VA rating decision showing that the sponsoring veteran is permanently and totally disabled (or death rating if they are deceased)
- For Vietnam Veterans, a copy of your DD214, Certificate of Release from Active Duty
- For WWII or Korean War Veterans, Report of Separation
- Your birth certificate or adoption papers
- If you are age 18-23, certification of your full-time college enrollment. (From age 18-23, you are required to show full-time school enrollment to maintain CHAMPVA benefits. Benefits terminate after age 23, regardless of school status).
- Surviving spouse: If you remarried after your military spouse’s death and are now single again, you will need to provide legal documentation of the termination of your remarriage (whether from divorce, death, annulment, etc.)*
*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.
BONUS: Helpful CHAMPVA Resources
CHAMPVA Phone Number: 1-800-733-8387
CHAMPVA Deductibles and Copay FACT SHEET
Filing CHAMPVA claims HELPFUL HINTS
Filing a CHAMPVA claim Information for Beneficiaries
CHAMPVA Provider Portal
CHAMPVA Information for Providers
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