Being a spouse, dependent or even widow of someone who was once in the military deserves the right to feel secure and included somewhere within the healthcare or Medicare program. Luckily, the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a different program aside from TRICARE, exclusively for a smaller group of veteran dependents. If you’re a dependent of someone who was once in the military and you don’t qualify for TRICARE, there’s a chance you can qualify for CHAMPVA to receive help with out-of-pocket medical expenses.

What is CHAMPVA?

CHAMPVA is the government’s attempt to provide some medical coverage for veteran dependents who may not otherwise qualify for benefits. Most active duty and retired veterans enroll in TRICARE along with their beneficiaries, but there are some veterans who don’t qualify for that coverage. That means their dependents also receive no benefits from TRICARE.

If you’re the dependent of a former member of the military and are ineligible for TRICARE, you may qualify for premium-free medical care from CHAMPVA. This is a cost-sharing program designed to eliminate some of the out-of-pocket expenses that often make high-quality medical care inaccessible for some families.

What is the Difference Between CHAMPVA and TRICARE?

TRICARE is the standard medical insurance provided to the following:

  • Active and retired military members
  • Army National Guard and Reserves members
  • Medal of honor recipients
  • Spouses of military members, and spouses of deceased military members. After receiving coverage, members can then enroll their dependents to receive benefits as well.

TRICARE is limited to active military members and retirees. That eliminates those who spend some time in the military but leave due to difficult circumstances, including serious injuries and disabilities. In some cases, children of deceased military members can receive benefits through CHAMPVA because they don’t qualify for TRICARE.

If you qualify for TRICARE, you can’t receive benefits through CHAMPVA. TRICARE is the first choice, but CHAMPVA is there for dependents who may otherwise have no medical coverage from the military.

What Does CHAMPVA Cover?

When CHAMPVA is the only medical insurance policy used, it will provide comprehensive coverage that includes:

  • Visits to a primary care doctor and specialists.
  • Lab work
  • Ambulance transportation
  • Mental health care
  • Hospice is 100% covered for all members.
  • Members who use the Meds by Mail service from the VA can receive free prescription drugs as well.

Used alone, CHAMPVA is an affordable and comprehensive health insurance that covers most medical needs. When used along with another healthcare policy, it becomes the second payer. That means the other plan pays all covered expenses, and then CHAMPVA covers remaining charges up to plan limits. It can eliminate out-of-pocket expenses for many members who have other healthcare options.

What Does CHAMPVA Cost?

There are no monthly or annual premiums for CHAMPVA, but it’s not entirely free. Members are required to pay the following:

  • $50 annual deductible
  • Coinsurance

The coinsurance is typically 25% of all allowable charges for medical services. That kicks in after the annual deductible is paid by the member.

Who Qualifies for CHAMPVA?

CHAMPVA is reserved for children and other dependents of veterans who don’t qualify for TRICARE for some reason. In many cases, it comes down to the disability and/or death of a military member that leaves their dependents ineligible for standard TRICARE benefits.

Most CHAMPVA beneficiaries are the children or spouses of veterans who fit into one of these categories:

  • Permanently disabled due to service-related incidents
  • Deceased because of service-related disabilities
  • Permanently and completely disabled at the time of death
  • Died in the line of duty

Access to other healthcare benefits, income, and other personal factors aren’t considered when someone applies for CHAMPVA. Eligibility is based on a parent or spouse’s military involvement and the resulting disabilities and/or death.

How Do CHAMPVA and Medicare Work Together?

CHAMPVA serves as a secondary payment source when used along with Medicare. Medical providers are first paid up to the limits of your Medicare policy. The remaining charges are what you would normally pay out of pocket, but CHAMPVA will cover most of them for you.