CHAMPVA Healthcare for Dependents

What is CHAMPVA?

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) provides comprehensive healthcare coverage to the spouse and dependent children of veterans who are permanently and totally disabled due to service-connected conditions, or who died from service-connected disabilities.

CHAMPVA fills a critical gap in healthcare coverage for veteran families. While veterans with service-connected disabilities can access VA healthcare, their dependents generally cannot. CHAMPVA provides high-quality, affordable healthcare coverage for these family members, recognizing the sacrifice of both veterans and their families.

Unlike many civilian health insurance plans, CHAMPVA has no monthly premiums. You pay only a small annual deductible ($50 per person, $100 per family in 2025) and cost-share percentages, with an annual out-of-pocket cap of $3,000 per family. This makes CHAMPVA one of the most affordable healthcare options available.

Who Qualifies for CHAMPVA?

To qualify for CHAMPVA, you must be the spouse or dependent child of a veteran who meets one of these criteria:

Veteran Must Be:

• Permanently and totally disabled: Rated 100% disabled by the VA with a designation of "permanent and total" (P&T)
• Died from service-connected condition: Death was caused by a service-connected disability or while rated permanently and totally disabled
• Died on active duty: Death occurred in the line of duty (but not from willful misconduct) - dependents may qualify for TRICARE instead
• Missing in action or POW: Listed as missing in action or prisoner of war for more than 90 days

TDIU Counts as P&T

Veterans receiving TDIU (Total Disability Individual Unemployability) are considered permanently and totally disabled for purposes of CHAMPVA eligibility. If you receive TDIU benefits that pay at the 100% rate because you cannot work, your dependents qualify for CHAMPVA even if your schedular rating is below 100%.

Who Cannot Receive CHAMPVA

You are not eligible for CHAMPVA if:

• You are eligible for TRICARE (active-duty family member or military retiree family member)
• You are eligible for Medicare Part A and fail to enroll in Medicare Part B (65+ must have both parts A and B)
• You remarried before age 55 (surviving spouses only - remarriage after 55 does not affect eligibility)
• The veteran's P&T rating is later reduced below 100%

Eligible Dependents

The following dependents may qualify:

• Spouse: Lawfully married to the veteran (no minimum marriage length requirement)
• Children: Biological children, adopted children, and stepchildren under age 18, or up to age 23 if full-time student
• Disabled children: Children over 18 who are permanently incapable of self-support due to disability that occurred before age 18
• Surviving spouse: Widow/widower of veteran who meets qualifying criteria (unless remarried before age 55)

What Does CHAMPVA Cover?

CHAMPVA provides comprehensive healthcare coverage similar to traditional health insurance. Covered services include:

Medical Services

• Primary care physician visits
• Specialist consultations (referrals not required)
• Hospital inpatient care
• Outpatient surgery
• Emergency room visits
• Urgent care services
• Ambulance services
• Diagnostic testing (lab work, X-rays, MRI, CT scans)

Prescription Medications

• Retail pharmacy prescriptions (30-day supply): $12 generic, $15 brand name
• CHAMPVA Meds by Mail (90-day supply): $9 generic, $12 brand name
• Most medications covered on formulary
• Mail-order pharmacy for maintenance medications (free shipping)

Mental Health Services

• Outpatient mental health counseling and therapy
• Inpatient psychiatric care
• Substance abuse treatment
• Psychological testing

Preventive Care

• Annual physical examinations
• Immunizations and vaccines
• Cancer screenings (mammograms, colonoscopy, etc.)
• Well-child visits
• Preventive dental for children under age 18

Maternity Care

• Prenatal care
• Delivery (hospital and physician services)
• Postpartum care
• Newborn care

Other Covered Services

• Durable medical equipment (wheelchairs, walkers, oxygen)
• Home healthcare services
• Hospice care
• Physical therapy, occupational therapy, speech therapy
• Skilled nursing facility care (limited)
• Vision exams (one per year)
• Hearing exams and hearing aids (limited)

What CHAMPVA Does Not Cover

CHAMPVA does not cover:

• Cosmetic procedures (except reconstructive surgery after injury)
• Most dental care for adults (preventive dental for children is covered)
• Long-term care or custodial care
• Services received outside the United States (except emergency care)
• Experimental or investigational procedures

CHAMPVA Costs (2025)

One of the biggest advantages of CHAMPVA is the low cost. Unlike traditional health insurance, CHAMPVA has no monthly premiums. You pay only:

Annual Deductible

• $50 per person per calendar year
• $100 per family per calendar year (maximum)
• Deductible applies to outpatient services only (not inpatient)

Cost-Share for Services

• Outpatient services: You pay 25% of allowable charges after deductible
• Inpatient services: You pay 25% of allowable charges (or $50 per day, whichever is less), VA pays 75%
• Prescriptions: $12 generic / $15 brand name (retail 30-day), $9 generic / $12 brand name (mail 90-day)
• Ambulatory surgery: 25% cost-share
• Mental health outpatient: 25% cost-share (same as other outpatient services)

Annual Out-of-Pocket Cap

CHAMPVA has an annual catastrophic cap of $3,000 per family. Once you reach this amount in out-of-pocket costs (deductibles and cost-shares) in a calendar year, CHAMPVA pays 100% of covered services for the rest of the year.

This cap provides significant financial protection. Even if you have a serious illness or major surgery, your maximum annual out-of-pocket cost is $3,000 for the entire family.

Example Cost Calculation

Let's say you have outpatient surgery with an allowable charge of $10,000:

• You pay $50 deductible (if not already met)
• Remaining charges: $9,950
• You pay 25% of $9,950 = $2,487.50
• CHAMPVA pays 75% of $9,950 = $7,462.50
• Your total out-of-pocket: $50 + $2,487.50 = $2,537.50

This cost-share counts toward your $3,000 annual cap. Once you reach $3,000 in total out-of-pocket costs, all subsequent covered services are free for the rest of the calendar year.

CHAMPVA vs. TRICARE

Many people confuse CHAMPVA with TRICARE because both provide healthcare coverage to military families. However, they are separate programs serving different populations.

Key Differences

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Can You Have Both?

No. If you are eligible for TRICARE, you cannot receive CHAMPVA. TRICARE eligibility disqualifies you from CHAMPVA. However, if you lose TRICARE eligibility (e.g., military retiree turns 65, divorces, etc.), you may then become eligible for CHAMPVA if the veteran meets qualifying criteria.

CHAMPVA and Medicare (Age 65+)

When a CHAMPVA beneficiary turns 65, they become eligible for Medicare. At this point, they must enroll in both Medicare Part A and Medicare Part B to maintain CHAMPVA coverage. CHAMPVA then becomes the secondary payer to Medicare.

How Medicare + CHAMPVA Works

• Medicare pays first: Medicare is the primary payer for covered services
• CHAMPVA pays second: CHAMPVA covers most or all of what Medicare doesn't pay
• Near-zero out-of-pocket: With both programs, you typically have minimal costs
• Must maintain Part B: You must continue paying Medicare Part B premiums to keep CHAMPVA

Example: Medicare + CHAMPVA Coverage

Hospital stay with $10,000 in charges:

• Medicare pays approximately $8,000 (80%)
• CHAMPVA pays the remaining $2,000 (20%)
• You pay $0 out-of-pocket

The combination of Medicare and CHAMPVA provides exceptionally comprehensive coverage with very low out-of-pocket costs in retirement. This is one of the most valuable long-term benefits for families of 100% disabled veterans.

How to Apply for CHAMPVA

Applying for CHAMPVA requires submitting a complete application package with all required documentation. Processing typically takes 6-8 weeks.

Step 1: Gather Required Documents

You will need:

• VA Form 10-10d: Application for CHAMPVA Benefits (one form per beneficiary, or family application)
• Veteran's VA award letter: Showing 100% P&T rating (or death certificate if veteran is deceased)
• Marriage certificate: Proving relationship to veteran (for spouse)
• Birth certificates: For each dependent child
• School certification: For children ages 18-23 who are full-time students
• Medicare card: If beneficiary is 65+ or otherwise Medicare-eligible
• Other health insurance information: If beneficiary has other health insurance (CHAMPVA coordinates benefits)

Step 2: Complete VA Form 10-10d

Download VA Form 10-10d from VA.gov or request it by calling 1-800-733-8387. Complete all sections thoroughly and accurately. Sign and date the form.

Step 3: Submit Your Application

Mail your complete application package to:

VHA Office of Community Care CHAMPVA Eligibility PO Box 469028 Denver, CO 80246-9028

Currently, CHAMPVA applications can only be submitted by mail. Online application is not yet available.

Step 4: Wait for Processing

CHAMPVA will review your application and verify eligibility. Processing typically takes 6-8 weeks but can take longer during high-volume periods. You can check application status by calling 1-800-733-8387.

Step 5: Receive Your CHAMPVA Card

Once approved, you will receive a CHAMPVA authorization card for each beneficiary. Present this card when receiving healthcare services along with your photo ID.

Your CHAMPVA coverage is effective from the date you became eligible (typically the date of the veteran's P&T rating), not the date you applied. This means if the veteran was rated 100% P&T six months ago but you're just now applying, you may be able to file claims for healthcare services received during those six months.

Using CHAMPVA Healthcare

Once enrolled, using CHAMPVA is straightforward. You can see any provider who accepts CHAMPVA, and most providers do because CHAMPVA payment rates are generally favorable.

Finding Providers

• No network restrictions: You can see any licensed healthcare provider
• No referrals required: See specialists without primary care referral
• Call ahead: Confirm the provider accepts CHAMPVA before your appointment
• Most providers accept CHAMPVA: Acceptance is widespread since payment is reliable

Filing Claims

Most providers will file CHAMPVA claims directly. If they don't:

• Pay for services upfront and obtain an itemized receipt
• Complete VA Form 10-7959a (CHAMPVA Claim Form)
• Submit the claim form and receipt to the CHAMPVA claims processing address
• CHAMPVA will reimburse you for covered amounts

Using CHAMPVA Meds by Mail

For maintenance medications (90-day supply), use CHAMPVA Meds by Mail to save money:

• Costs only $9 generic / $12 brand name for 90-day supply
• Free standard shipping
• Register at www.mymilitaryrx.com
• Have your provider send prescriptions directly to mail-order pharmacy

Common CHAMPVA Questions

What Happens if the Veteran's Rating is Reduced?

If the veteran's rating is reduced below 100% P&T, CHAMPVA eligibility ends. However, you may have a grace period to find alternative coverage. If you believe the rating reduction was incorrect, appeal immediately - CHAMPVA coverage may continue during the appeal.

Can My Spouse Work and Still Have CHAMPVA?

Yes. There are no income or employment restrictions for CHAMPVA. Your spouse can work full-time and still receive CHAMPVA. However, if their employer offers health insurance, CHAMPVA coordinates benefits and may pay only after the employer insurance.

What if I Have Other Health Insurance?

You can have both CHAMPVA and other health insurance. CHAMPVA coordinates benefits, typically paying after your other insurance. The combination often results in little to no out-of-pocket costs.

Is CHAMPVA Available in All States?

Yes. CHAMPVA is available nationwide and you can use it wherever you travel within the United States. For emergency care received outside the U.S., CHAMPVA may provide limited coverage.

Next Steps

If you are the spouse or dependent child of a veteran rated 100% P&T (or who died from service-connected conditions), CHAMPVA can provide comprehensive, affordable healthcare coverage for your family. Don't delay - apply as soon as the veteran receives their P&T rating.

Remember that CHAMPVA is just one of several benefits available to families of disabled veterans. Explore other programs like Chapter 35 educational assistance, state property tax exemptions, and additional dependent benefits.