How Do You Qualify for CHAMPVA?

If you are a spouse or dependent of a veteran, you might be eligible for healthcare benefits under CHAMPVA. Understanding the qualifications and application process is crucial to accessing the care you deserve. This guide covers everything you need to know about qualifying for CHAMPVA.

What is CHAMPVA?

CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) is a healthcare program that provides coverage for eligible family members of veterans. Unlike TRICARE, which is for active-duty families, CHAMPVA is designed for dependents of veterans with service-connected disabilities or who have passed away due to a service-related condition.

Who Administers CHAMPVA?

The Department of Veterans Affairs (VA) manages CHAMPVA. This program ensures that eligible dependents receive medical care similar to private health insurance coverage. However, CHAMPVA works differently from other VA healthcare programs.

Who is Eligible for CHAMPVA?

To qualify for CHAMPVA, you must not be eligible for Tricare and must fall into one of the following categories:

• A spouse or child of a veteran who has been rated permanently and totally disabled due to a service-connected disability by the VA.
• A surviving spouse or child of a veteran who died as a result of a VA-rated service-connected disability.
• A surviving spouse or child of a veteran who was rated permanently and totally disabled at the time of their death.
• A surviving spouse or child of a military member who died in the line of duty, as long as the death was not due to misconduct (however, in most cases, these family members qualify for Tricare instead of CHAMPVA).

Beneficiaries Aged 18 to 23

Once a CHAMPVA-eligible beneficiary turns 18, they must provide proof of full-time school enrollment to continue receiving benefits.

Primary Family Caregiver

A veteran’s primary family caregiver may qualify for CHAMPVA if they are not covered under another healthcare plan.

CHAMPVA and Medicare

CHAMPVA acts as the secondary payer to Medicare. If you qualify for Medicare—regardless of age or reason—you must enroll in both Medicare Part A and Part B to maintain your CHAMPVA benefits. CHAMPVA requires official documentation from the Social Security Administration confirming enrollment in both parts.

CHAMPVA Benefits

Medical Benefits

CHAMPVA provides medical coverage similar to a standard insurance plan. However, vision benefits are only available for individuals with diabetes, and dental coverage is very limited.

Beneficiaries are responsible for 25% of medical costs plus an annual deductible of:

• $50 per individual
• $100 per family

Covered services include:

• Medical screenings
• Mental health services
• Emergency room visits
• Hospital stays
• Ambulance services
• Vaccinations
• Office visits

Pharmacy Benefits

Meds by Mail
This optional service allows eligible CHAMPVA and spina bifida beneficiaries to receive non-urgent maintenance medications delivered to their home at no cost.

OptumRx
OptumRx processes pharmacy claims nationwide, including in Puerto Rico, Guam, and the U.S. Virgin Islands. Beneficiaries can access a network of over 82,000 retail pharmacies.

At an OptumRx pharmacy, beneficiaries may be required to pay a 25% cost share (after meeting the annual deductible) before the claim is submitted, helping to streamline the process.

Need help? Call Brady Insurance Marketing: 801-347-2087. Our assistance is at no cost to you