CHAMPVA

CHAMPVA is an acronym for Citizens Health and Medical Programs of the VA. Managed by the VA’s Chief Business Office, Purchased Care, CHAMPVA is a health benefits program that allows eligible beneficiaries to share the cost of certain healthcare services and supplies with the VA.

In general, this program covers most healthcare services that are deemed medically and psychologically necessary for the recipient. CHAMPVA and Medicare work together to help entitled beneficiaries get appropriate treatment at VA and other healthcare facilities.

Eligibility for CHAMPVA

To qualify for CHAMPVA, the beneficiary cannot be eligible for TRICARE. Surviving spouses and children of veterans may be eligible for CHAMPVA if the following applies:

• The veteran’s service-connected disability gave them a permanent and total disability rating
• At the time of death, the veteran’s service connected permanent and total disability was present
• The veteran died of a service-connected disability
• The veteran died during active duty and the beneficiaries are not eligible for other Department of Defense TRICARE benefits

Due to policy change effective Oct. 1, 2001, dependents 65 years and older may also be eligible for CHAMPVA benefits, though the following conditions apply:

• The beneficiary was 65 years old prior to June 5, 2001 and would have qualified for CHAMPVA or Medicare Part A coverage; in this case the beneficiary would be eligible for CHAMPVA without needing Medicare Part B coverage
• The beneficiary turned 65 prior to June 5, 2001 and had both Medicare parts A and B; they would need to keep both parts to be eligible for CHAMPVA
• If the beneficiary turned 65 after June 5, 2001 they would need Medicare parts A and B to qualify for CHAMPVA

What Does CHAMPVA Cover?

CHAMPVA typically pays the equivalent of Medicare or TRICARE rates. There is an outpatient deductible of $50/person or $100/ family per calendar year. There is also a cost share of up to 25% of the catastrophic cap, which is not to exceed $3,000/year.

The beneficiary can have other health insurance in addition to utilizing CHAMPVA. In these cases, the other health insurance provider will be billed first, and then a claim for reimbursement will be sent in for CHAMPVA benefits.

The CHAMPVA Inhouse Treatment Initiative (CITI) states that beneficiaries can receive free healthcare at participating VA facilities.

Filing a Claim for CHAMPVA Coverage

Those wishing to claim CHAMPVA program coverage must use the VA Form 10-7959a and include an itemized billing statement from the treatment provider. Claims should be mailed to:

Chief Business Office Purchased Care
CHAMPVA
PO Box 469064
Denver, CO 80246-9064

For more information, visit the VA’s CHAMPVA webpage.