Civilian Health and Medical Program (CHAMPVA) helps veterans and their families get health care. It covers many medical services. This program is for those who do not qualify for other VA health benefits. CHAMPVA pays for hospital visits, doctor appointments, and some medications. To be eligible, you must meet certain requirements. The program aims to support veterans and their loved ones in accessing necessary health care.
The CHAMPVA customer service number is 800 733-8387, 8:05 a.m. to 7:30 p.m. EST Monday through Friday. This number can be difficult to get through on, so keep redialing.
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is an extensive health care initiative in which the VA collaborates with eligible beneficiaries to share the costs of covered health care services and supplies. This program is managed by the Health Administration Center, with its offices situated in Denver, Colorado.
CHAMPVADue to the similarity between CHAMPVA and the Department of Defense (DoD) TRICARE program (sometimes referred to by its old name, CHAMPUS) the two are often mistaken for each other. CHAMPVA is a Department of Veterans Affairs program whereas TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors.
In some cases a veteran may look to be eligible for both/either program on paper. However, if you are a military retiree, or the spouse of a veteran who was killed in action, you are and will always be a TRICARE beneficiary, you can´t choose between the two.
Eligibility for CHAMPVA Benefits
To be eligible for CHAMPVA, you cannot be eligible for TRICARE/CHAMPUS and you must be in one of these categories:
The CHAMPVA program is designed to provide essential health care benefits to specific family members of veterans and military personnel. This includes the spouse or child of a veteran who has been rated as permanently and totally disabled due to a service-connected disability by a VA regional office. Additionally, it extends to the surviving spouse or child of a veteran who has passed away as a result of a VA-rated service-connected disability. Furthermore, it also encompasses the surviving spouse or child of a veteran who was rated as permanently and totally disabled at the time of their death due to a service-connected disability. Lastly, the program includes the surviving spouse or child of a military member who died in the line of duty, provided that the death was not due to misconduct. It is important to note that in most of these cases, the family members may be eligible for TRICARE rather than CHAMPVA.
When it comes to benefits, the CHAMPVA program generally covers a wide range of health care services and supplies that are deemed medically and psychologically necessary for eligible individuals. Once your eligibility is confirmed, you will receive comprehensive program materials that detail the specific services and supplies that are covered, as well as those that are not covered. This information is provided in the form of a CHAMPVA handbook, which is available in PDF format. This handbook serves as a valuable resource, ensuring that you have a clear understanding of the benefits available to you and your family, helping you navigate the health care system with confidence and ease.
General Exclusions
Like all health programs there are certain services and supplies that are not covered by our program, some of these are:
Resources and materials acquired through a grant, research project, or study initiative.
Services and supplies that do not follow accepted medical standards are not covered. This includes experimental, investigational, or unproven treatments.
Care for which you are not obligated to pay, such as services obtained at a health fair.
Care provided outside the scope of the provider’s license or certification.
Services or supplies above the appropriate level required to provide the necessary medical care.
Services by providers suspended or sanctioned by any federal agency.
Services provided by a member of your immediate family or person living in your household.
CHAMPVA Mental Health and Substance Use Disorder Benefits (01-01)
For a complete listing of noncovered services and supplies please consult the CHAMPVA handbook.
Medicare Impact
CHAMPVA is always the secondary payer to Medicare. If you are eligible for CHAMPVA, under age 65 and enrolled in both Medicare Parts A&B, SSA documentation of enrollment in both Parts A&B is required.
For your benefits to be extended past age 65, you must meet the following conditions:
- if the beneficiary was 65 or older prior to June 5, 2001, and was otherwise eligible for CHAMPVA, and was entitled to Medicare Part A coverage, then the beneficiary will be eligible for CHAMPVA without having to have Medicare Part B coverage.
- if you turned 65 on/or before June 5, 2001, and have Medicare Parts A and B, you must keep both Parts to be eligible.
- if you turned 65 on or after June 5, 2001, you must be enrolled in Medicare Parts A and B to be eligible. you are not required to enroll in Medicare Part D in order to become or remain CHAMPVA eligible.
Notice to new & expectant parents
If you are expecting and you need to establish CHAMPVA eligibility for your new child, the following must be accomplished before you can submit an application.
- Obtain a Social Security Number for the newborn by applying to the nearest Social Security Administration office.
- Establish dependency of the newborn to the veteran sponsor by contacting the local VA regional office.
Since the payment of claims for this child is contingent upon his/her eligibility status, as new parents you are encouraged to take the above action as early as possible.
Remarried Widows/Widowers
Remarriage: Eligibility for CHAMPVA ends at midnight on the date of your remarriage if you remarry prior to age 55. If you remarry on or after your 55 th birthday, The Veterans Benefit Act of 2002, Public Law 107-330, allows you to keep your CHAMPVA benefits.
Termination of Remarriage: If you are a widow(er) of a qualifying sponsor and you remarry and the remarriage is later terminated by death, divorce, or annulment you may reestablish CHAMPVA eligibility. The beginning date of your re-eligibility is the first day of the month after termination of the remarriage or December 1, 1999, whichever date is later. To reestablish CHAMPVA eligibility, copies of the marriage certificate and death, divorce, or annulment documents (as appropriate) must be provided.
How to Apply
We strongly recommend that you enlist the services of a Veteran Service Officer before you submit your application. They will review your application, helping ensure it has all the information the VA requires. If you do not have a VSO yet, the NVF will help you find one. Simply call us at 888-777-4443.
The DVA’s How to Apply for CHAMPVA page has additional information you might find helpful.