The short answer
CHAMPVA's yearly outpatient deductible is $50 per person, and no more than $100 for the whole family. You don't pay it upfront. CHAMPVA takes it out of your first eligible claims. Some care has no deductible, including inpatient stays, Meds by Mail, care at a VA facility through CITI, listed preventive care, and hospice.
How does the deductible work?
Under 38 CFR 17.274, CHAMPVA has an outpatient deductible of:
- $50 per person each calendar year, and
- $100 maximum per family each calendar year.
It resets every January 1.
You don't send CHAMPVA a check. The CHAMPVA Guidebook says not to. CHAMPVA applies the deductible as it processes your claims.
How does the family maximum work?
Once two family members have each met $50, the family is done for the year. A third family member doesn't owe a deductible.
If only one person uses care, they owe $50, not $100.
When does the deductible apply?
To outpatient care, such as:
- office visits and other outpatient services,
- doctors' and other professionals' services,
- durable medical equipment, and
- retail pharmacy claims when CHAMPVA is your main prescription coverage.
An ER visit that doesn't lead to an admission counts as outpatient. If you're admitted, the ER charges usually become part of the hospital stay.
What has no deductible?
The regulation lists:
- care through Meds by Mail,
- care at a VA facility through CITI,
- inpatient hospital stays,
- hospice, and
- listed preventive care: colorectal, breast, cervical, and prostate cancer screenings, yearly physicals, vaccines, and well-child care from birth through age 6.
The Guidebook adds ambulatory surgery centers and partial psychiatric day programs.
More here: CHAMPVA services with no deductible or cost share.
Does no deductible mean free?
Not always. The deductible and the cost share are separate.
- Ambulatory surgery has no deductible but still has a 25% cost share.
- Inpatient stays have no deductible but have their own cost-share rules. More here: CHAMPVA inpatient costs.
- Meds by Mail, CITI, listed preventive care, and hospice have neither.
Example: what you'd owe on one visit
Say CHAMPVA is your only coverage, you haven't met your deductible, and CHAMPVA's allowable amount for a covered visit is $200.
| Step | Amount |
|---|---|
| Deductible | $50 (you pay) |
| Left over | $150 |
| Your 25% cost share of $150 | $37.50 |
| CHAMPVA's 75% of $150 | $112.50 |
| You pay in total | $87.50 |
Your next visit that year skips the deductible, so you'd pay only 25%.
If you have other insurance, the math changes, and you may owe less or nothing. More here: CHAMPVA and other health insurance.
If a claim's deductible looks wrong
Check the date of service, whether the care was outpatient, whether it's on the no-deductible list, and how much deductible your EOB says you'd already met. Then call CHAMPVA at 800-733-8387 with the EOB and the bill.