What is CHAMPVA Coverage? Do I Also Need CHAMPVA Supplement?
What is CHAMPVA Coverage? Do I Also Need CHAMPVA Supplement?
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What is CHAMPVA Coverage? Do I Also Need CHAMPVA Supplement?

December 16, 2021

More and more Americans are getting their healthcare coverage through CHAMPVA. According to the Health Care for Dependents and Survivors of Veterans report, the number of beneficiaries enrolled in CHAMPVA increased by 396% between 2001 and 2017, going from 96,500 in 2001 to 478,600 in 2017. For hundreds of thousands of people, CHAMPVA is an essential source of health coverage, and CHAMPVA supplemental insurance plans can provide an extra layer of protection. 

What is CHAMPVA?

CHAMPVA stands for the Civilian Health and Medical Program of the U.S. Department of Veterans Affairs (VA). In this health benefits program, the Department of Veterans Affairs shares the cost of covered healthcare services and supplies for eligible beneficiaries.

Who is Eligible for CHAMPVA?

There are three ways to qualify for CHAMPVA. To be eligible for CHAMPVA enrollment, the VA says you must met one of the following criteria. 

  • You are the spouse or child or a Veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office. 
  • You are the surviving spouse or child of a Veteran who was at the time of death rated permanently and totally disabled from a service-connected disability. 
  • You are the surviving spouse or child or a service member who died in the line of duty, not due to misconduct. 

There are some other important eligibility requirements to know. If you meet the above requirements for CHAMPVA and also qualify for TRICARE, you should enroll in TRICARE, not CHAMPVA. If you are eligible for both CHAMPVA and Medicare, you can have both, but you must enroll in Medicare, and Medicare will be the primary payer. For more information on CHAMPVA eligibility and special circumstances, see the VA's page on CHAMPVA benefits

What Does CHAMPVA Cover?

CHAMPVA provides coverage for many services and supplies that are received from an authorized provider and are considered medically necessary. That includes outpatient services, inpatient services, mental health services, family planning, maternity care, skilled nursing care, hospice care, ambulance services and more. CHAMPVA also provides coverage for prescription drugs.

How Much Does Care Cost?

CHAMPVA helps pay for covered medical care, but it does not cover 100% of costs. 

According to the CHAMPVA Guide, enrollees are responsible for an annual deductible along with their share of the "allowable amount". The deductible is $50 per beneficiary with a maximum of $100 per family, and it is applied each year. Some services do not have a deductible. 

The allowable amount is the most that CHAMPVA will pay for a covered service or supply, and the beneficiary's share is usually 25%. Doctors who accept CHAMPVA agree to accept the allowable amount as payment in full. However, if your doctor does not accept CHAMPVA, you will have to pay the bill in full, and then you can file a claim to have CHAMPVA pay 75% of the allowable amount. Given this, it's important to make sure your doctor accepts CHAMPVA.

Controlling Out-of-Pocket Costs

Approximately half a million people are enrolled in CHAMPVA, and this program provides important coverage for a wide range of medically necessary services and supplies. However, it can also leave enrollees with substantial out-of-pocket costs. 

CHAMPVA pays 75% of the allowable amount. That's the lion's share, to be sure, but the 25% that the beneficiary has to pay isn't chump change. When an accident or illness leads to unexpected medical bills, that 25% can be significant. 

If this is a problem for you, a CHAMPVA supplement insurance plan can provide a solution. CHAMPVA supplement insurance is designed to work with CHAMPVA enrollment. 

Here's how it works:

  • You purchase a CHAMPVA supplement plan and play the plan's premium and deductible. 
  • The CHAMPVA supplement plan pays your cost share under CHAMPVA.

A CHAMPVA supplement may make financial sense for you if you have a chronic health condition or expect to need expensive medical care, or if you require expensive prescription drugs. 

Even is you don't think you'll require expensive medical care in the near future, you may also want to consider a CHAMPVA supplement insurance plan if you are worries about how an unexpected accident or illness could disrupt your finances. The supplemental coverage can make your out-of-pocket costs more predictable, and this can provide invaluable peace of mind. 

Want to Explore Your CHAMPVA Supplement Options?

Contact us to learn more.

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