The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries.
CHAMPVA is managed by the Veternas Health Administration Office of Community Care (VHA CC) in Denver, Colorado. We verify CHAMPVA eligibility, authorize benefits, and process medical claims.
To be eligible for CHAMPVA, the beneficiary cannot be eligible for TRICARE. CHAMPVA provides coverage to the spouse or widow(er) and to the children of a Veteran who:
Effective October 1, 2001, CHAMPVA benefits were extended to those age 65 and older. To be eligible for CHAMPVA, you must also meet the following conditions:
In most cases, CHAMPVA's allowable amount - what we pay for specific services and supplies - is equivalent to Medicare/TRICARE rates. CHAMPVA has an outpatient deductible ($50 per beneficiary per calendar year or a maximum of $100 per family per calendar year) and a patient cost share of 25% of our allowable amount up to the catastrophic cap ($3,000 per calendar year). Beneficiaries should NOT send checks to VHA CC for their annual deductible; as claims are processed, charges are automatically credited to individual and family deductible requirements for each calendar year.
If your provider accepts assignment, which means the provider accepts CHAMPVA, the provider agrees to accept our allowable amount as payment in full. A provider cannot bill you for the difference between our allowable amount and their normally billed amount.
If the patient has other health insurance, then CHAMPVA pays the lesser of either 75% of the allowable amount after the $50 calendar year deductible is satisfied, or the remainder of the charges and the beneficiary will normally have no cost share. See Payment Methodology Fact Sheet 01-11 for further information regarding payment on other than outpatient type of services.
Yes. If the beneficiary has other health insurance (OHI), the OHI should be billed first. The explanation of benefits (EOB) from the OHI should then be submitted with the claim for reimbursement to CHAMPVA.
By law, CHAMPVA is always the secondary payer except to Medicaid, State Victims of Crime Compensation Programs, Indian Health Services, and supplemental CHAMPVA policies.
Information about providers can be found on our Locating a Provider page.
As a result of a federal law passed June 5, 2001, CHAMPVA expanded benefit coverage to eligible family members and survivors of qualifying Veteran sponsors effective October 1, 2001.
If the beneficiary is eligible for CHAMPVA and also has Medicare Part A entitlement (premium-free hospitalization coverage) and Medicare Part B (outpatient coverage), we will cover many of the costs not covered by Medicare. CHAMPVA will pay after Medicare and any other insurance, such as Medicare HMOs and Medicare supplemental plans, for health care services and supplies.
CHAMPVA does not pay Medicare Part B premiums.
Although similar, CHAMPVA is completely separate with a totally different beneficiary population than TRICARE - a Department of Defense health care program formerly called CHAMPUS.
While the benefits are similar, the programs are administered separately with significant differences in claim filing procedures and preauthorization requirements.
There are a couple ways to obtain an Application for CHAMPVA Benefits (VA Form 10-10d):
Generally, applicants can expect to receive written notification from the VHA Office of Community Care within 45 days after mailing their application. To streamline the process, applicants are encouraged to complete the Application for CHAMPVA Benefits (see link above) in its entirety and to attach all required documents. As further explained on the application, required documents include a copy of each applicant's Medicare card (if Medicare eligible) and a School Enrollment Certification for all applicant children between the ages of 18 and 23.
CHAMPVA will deny payment on a claim if the beneficiary’s OHI denied payment because the beneficiary obtained the medical services or supplies outside the OHI (HMO, PPO, and Medicare) provider's plan.
Under the CHAMPVA Inhouse Treatment Initiative (CITI), CHAMPVA beneficiaries may receive cost-free health care services at participating VA facilities.
Although some VA facilities are not CITI participants due to the volume of Veterans they are responsible for serving, many are. To find out if your local facility is participating, view our online CITI Participating Facilities list. However, CHAMPVA beneficiaries who are also covered by Medicare cannot use a VA medical center because Medicare does not pay for services provided by a VA Medical Center.
None. CHAMPVA beneficiaries don’t pay a thing when receiving services under the CITI program.
