CHAMPVA Eligibility: Health Coverage for Dependents and Survivors

CHAMPVA stands for the Civilian Health and Medical Program of the Department of Veterans Affairs. It shares the cost of health care with the spouse or child of a veteran in specific circumstances. It is not the same thing as TRICARE, it is not VA health care for the veteran themselves, and it carries no monthly premium.

For a surviving spouse without employer coverage, or a family living on a disabled veteran's income, CHAMPVA can be the difference between having health coverage and going without.

Who is eligible

You may qualify for CHAMPVA if you are the spouse or dependent child of a veteran and at least one of the following is true:

• The veteran has been rated permanently and totally disabled from a service-connected disability
• The veteran died from a service-connected disability
• The veteran was, at the time of their death, rated permanently and totally disabled from a service-connected disability

There are also pathways for primary family caregivers enrolled in VA's caregiver program, and for the families of certain service members who died in the line of duty.

Note the second and third items carefully. A veteran who held a permanent and total rating and then died of an unrelated cause can still leave their family CHAMPVA eligible. Families frequently rule themselves out on the assumption that the death itself had to be service-connected.

The TRICARE rule

If you're eligible for TRICARE, you can't get CHAMPVA. The two programs are mutually exclusive, and this is the most common reason an application is denied. TRICARE generally covers the families of career military retirees, so a family connected to a military retirement is usually on the TRICARE side of the line.

The programs are often confused because they sound similar and both involve military families. They're administered separately and have different eligibility rules entirely.

What CHAMPVA costs

There is no monthly premium. What you pay is a deductible plus a share of the cost of covered care:

• Annual deductible: $50 per person, up to $100 per family, per calendar year. It applies to outpatient care such as office visits
• Cost share: after the deductible is met, you generally pay 25% of the CHAMPVA allowable amount for covered services
• Catastrophic cap: $3,000 per household per calendar year. Once your household reaches it, you pay no further cost share for covered services for the rest of that year

There's no deductible for inpatient hospital stays. And if you carry other health insurance, CHAMPVA generally pays after that insurance, which often means you owe little or nothing out of pocket.

The Medicare requirement at 65

This one has cost families their coverage. If you're 65 or older, you must have Medicare Part A and Part B, or a Medicare Advantage plan, to keep CHAMPVA eligibility. CHAMPVA then works alongside Medicare rather than replacing it.

If you're approaching 65 on CHAMPVA, enroll in Medicare Part B when you become eligible. Declining Part B to avoid its premium can end your CHAMPVA coverage.

How to apply

You apply with VA Form 10-10d, the Application for CHAMPVA Benefits. You'll generally need to provide proof of your relationship to the veteran, such as a marriage or birth certificate, and for applicants 65 and older, proof of Medicare enrollment.

Once enrolled, you can generally see any provider who accepts CHAMPVA. There's also a program called CITI that allows CHAMPVA beneficiaries to be seen at participating VA medical facilities, though not every facility participates.

Where CHAMPVA fits with other survivor benefits

The circumstances that make a family CHAMPVA eligible, a permanent and total rating or a service-connected death, are the same circumstances that often open the door to DIC and to dependents' education assistance under Chapter 35. Families who qualify for one frequently qualify for all three, and just as frequently claim none of them.

Check what your family may qualify for

VetGap's free questionnaire has a path built specifically for surviving spouses and dependents. It takes about three minutes, asks nothing that would identify you, and flags which survivor and dependent benefits may apply, with the next step for each and how to reach a VSO who will help you file at no cost.