Overview
CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) is a health benefits program for the spouse, surviving spouse, and dependents of certain veterans. It covers most medically necessary services, similar to how TRICARE works for active-duty families.
Who Is Eligible
You may qualify for CHAMPVA if you are the spouse, surviving spouse, or dependent child of a veteran who:
- Is permanently and totally disabled due to a service-connected condition (rated 100% P&T)
- Died from a service-connected condition
- Was rated 100% at time of death from any cause
Important: If you are eligible for TRICARE, you are NOT eligible for CHAMPVA. CHAMPVA is specifically for families who do not have TRICARE access.
What CHAMPVA Covers
CHAMPVA covers most medically necessary health care, including:
- Doctor visits — primary care and specialists
- Hospital care — inpatient and outpatient
- Mental health services — therapy, counseling, psychiatric care
- Prescriptions — through the CHAMPVA Meds by Mail program
- Durable medical equipment — wheelchairs, CPAP machines, etc.
- Skilled nursing care — when medically necessary
- Preventive care — immunizations, screenings
- Maternity care
What Is NOT Covered
- Dental care (unless related to a covered medical condition)
- Long-term or custodial care
- Cosmetic procedures
- Most chiropractic care
Cost Sharing
CHAMPVA has very low costs compared to civilian insurance:
- No monthly premium — CHAMPVA is free to enroll in
- Annual deductible: $50 per person / $100 per family
- Cost share: You pay 25% of allowable charges after the deductible
- Annual cap: $3,000 maximum out-of-pocket per family per year
- VA facility care: If you receive care at a VA facility, there is NO cost share
How to Apply
- Gather proof of the veteran's status (VA rating decision, death certificate, DD-214)
- Complete VA Form 10-10d (Application for CHAMPVA Benefits)
- Mail it to the CHAMPVA Eligibility office in Denver, CO
- Processing typically takes 6-8 weeks
Tips
- Meds by Mail saves money. Use CHAMPVA's mail-order pharmacy for maintenance medications — it often costs less than retail pharmacies
- Keep your other insurance. CHAMPVA can work as a secondary payer if you have Medicare or other insurance
- If Medicare-eligible: You must enroll in Medicare Parts A and B to keep CHAMPVA. CHAMPVA then covers what Medicare doesn't
- Surviving spouses who remarry after age 55 can keep CHAMPVA eligibility
- File claims within one year of the date of service to avoid denials