What You Should Know About CHAMPVA 100% Health Coverage
CHAMPVA, short for the Civilian Health and Medical Program of the Department of Veteran's Affairs, gives health insurance to spouses and dependents of military personnel that meet specific eligibility requirements.
To make things easy to understand, if you’re the spouse or dependent of a disabled veteran, there’s a good chance you’re eligible for health insurance that covers nearly all of your medical bills.
This health insurance is available to you while the disabled veteran is alive and after he or she has passed.
This article will help you understand:
- How to become eligible for CHAMPVA coverage,
- What CHAMPVA covers,
- What it doesn’t,
- How CHAMPVA works with Medicare, and
- Which doctors accept CHAMPVA.
If you have any specific questions, we recommend that you call CHAMPVA directly – the direct line is 800-733-8387. That line is open from 8:05am-7:30pm EST, Monday through Friday.
How do I become eligible for CHAMPVA coverage?
In order to receive CHAMPVA benefits, you must be the spouse or dependent of a disabled veteran. Which brings us to our next question – how do I determine if the veteran in question is disabled?
The VA determines this. If you are a disabled veteran, you can apply for disability compensation online.
The other catch is that the veteran must be deemed 100%, fully disabled. Many families we’ve worked with have disabled veterans in the family due to Agent Orange.
Agent Orange was used during the Vietnam War from 1961-1971. The chemical was sprayed over forests and crops to eliminate forest cover for North Vietnamese and Viet Cong troops.
At the time, no one knew how damaging the chemicals were to humans, but now, we know that Agent Orange has caused:
- Many different types of cancer
- Skin conditions
- Heart disease
- Parkinson’s Disease
- Nervous system conditions
- Liver dysfunction
If your loved one was exposed to Agent Orange and has major health conditions, there’s a good chance you’ll be eligible for CHAMPVA.
Agent Orange isn’t the only reason veterans are deemed disabled, so if the veteran in your family has health issues, it’s important that you talk to a CHAMPVA representative in order to receive health benefits.
It’s also important to note that those eligible for CHAMPVA must not be eligible for TRICARE. You can read more about that here.
When would I lose my CHAMPVA coverage?
If you do receive CHAMPVA benefits, it’s important to be aware of the 6 circumstances where you could lose that coverage.
- If you’re eligible for Medicare Part A, but you either decline or drop Medicare Part B.
- If you divorce the veteran. (Note that this does not impact the eligibility of a birth or adopted child.)
- When a child turns 18, unless the child is enrolled as a full-time student.
- When a child, who has been a full-time student, turns 23 or loses full-time student status.
- When a child marries.
- If you are a stepchild of a disabled veteran, your parents divorce, and you lose dependent status.
What does CHAMPVA Cover?
CHAMPVA helps cover your major medical expenses, but it works differently depending on the other types of insurance you might have.
If you only have CHAMPVA and no other health insurance, CHAMPVA is considered your primary insurance. What this means is that you will be responsible for some of your health costs.
Those costs include:
- A 25% coinsurance
- A yearly cap of $3,000
In sum, the most you would pay in any given year is $3,000. After that, CHAMPVA covers the rest of your medical bills in full.
However, if you have two types of insurance – say CHAMPVA and Medicare – there are no deductibles or coinsurance payments.
Medicare would pay for about 80% of your medical bills, and CHAMPVA would cover the remaining amount. This means that you would not receive any medical bills.
There are a few exceptions to this rule.
- Chiropractors are not covered by CHAMPVA. If you see a chiropractor, and you’re on Medicare, you might add a Medicare Supplement to cover the costs.
- Certain drugs are not covered by CHAMPVA. For example, certain painkillers cannot be shipped through the mail. In these cases, a Part D plan is the best option. Otherwise, the Meds by Mail program, which covers prescriptions in full, would be the best option.
Important Bills CHAMPVA Doesn’t Cover
While CHAMPVA is a huge help when it comes to medical bills, there are some important things that won’t be covered.
Dental: CHAMPVA generally does not cover dental bills. If you need dental care, the physician must get advanced approval from CHAMPVA, but even then, it’s not usually covered.
Hearing: CHAMPVA does not cover hearing aids or services.
Long-term care: CHAMPVA does not pay for any kind of extended care.
Foot care: Any kind of foot care service, such as removal of corns and calluses, is not covered by CHAMPVA.
Non-medical cancer costs: Over two-thirds of costs associated with cancer are non-medical. For example, trial drugs and transportation to a specialized treatment center. CHAMPVA will not cover trial drugs or any non-medical costs.
Vision: CHAMPVA does not cover eye exams, eyeglasses, or contact lenses.
Since the coverage of CHAMPA is limited, we want you to be aware of your options.
There are plans called Dental, Vision, and Hearing (DVH for short) that offer insurance for – you guessed it – dental, vision, and hearing services. If this kind of coverage is important to you, we’d love to provide you with some quotes.
DVH insurance is generally very inexpensive. You can read about the average cost here.
Cancer is a huge concern for a lot of the seniors we talk to. Since CHAMPVA (and Medicare for that matter) don’t cover two-thirds of costs associated with cancer, we recommend a cancer policy that’s called a “lump sum” policy.
If you get diagnosed with cancer, you receive a lump sum to pay for those unexpected costs. Cancer plans are also very inexpensive. You can read more about them here.
Finally, long-term care is a huge expense that leaves you vulnerable. In fact, on the 3rd page of the CHAMPVA guide, there are some suggestions about how you can get long-term care insurance.
About 70% of seniors ages 65 and up will end up needing some extended care. Nursing homes cost upwards of $8,000 – and that’s today. In about 20 years, that cost is expected to double.
There are 3 major ways you can pay for long-term care, which include traditional long-term care insurance, short-term care insurance, or a life insurance policy that has a long-term care benefit. You can read about those 3 options here.
How Does CHAMPVA Work With Medicare?
In the last section, we briefly mentioned CHAMPVA working with Medicare, and the truth is that CHAMPVA and Medicare are a match made in heaven.
To make things easy to understand, Medicare takes the bill first, and they pay for most of it. Then, Medicare sends the rest of the bill to CHAMPVA, and they pay the rest. Keep in mind that this is only for items and services that are covered by both Medicare and CHAMPVA.
You most likely will not need a Medicare Supplement if you have both Medicare and CHAMPVA.
There is some housekeeping you need to know as soon as you turn 65. When you receive your Medicare card, send a copy with a CHAMPVA Other Health Insurance Certification Form.
Once this is taken care of, a new CHAMPVA ID card will be sent with an extended expiration date.
As far as your medications go, CHAMPVA has a wonderful program called Meds by Mail, which pays for maintenance medications at no cost to you. However, certain painkillers aren’t covered. If you find that a drug you need isn’t covered by the Meds by Mail program, you might consider getting a Medicare Part D drug plan.
Which doctors accept CHAMPVA?
If you’re not sure which doctors will accept your CHAMPVA insurance, there are 2 easy ways to find out:
- Ask your healthcare provider if they accept CHAMPVA.
- If you need to find a provider that accepts CHAMPVA, try Medicare or TRICARE providers. You can locate Medicare providers here, and you can find TRICARE providers here.
Note: The information from this article was taken from the official Department of Veterans Affairs website, www.va.gov, the literature provided by the VA and CHAMPVA, and phone calls with representatives of CHAMPVA. If you have any specific questions about CHAMPVA, we recommend calling their direct line at 800-733-8387. The CHAMPVA Guide is also extremely helpful.
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