The short answer
Yes. CHAMPVA covers hospice for someone with a terminal illness and a life expectancy of six months or less. There's no deductible and no cost share. Hospice focuses on comfort, like pain control and care at home, and includes four levels of care. If you have other insurance, it pays first, and you usually owe nothing.
Does CHAMPVA cover hospice?
Yes. The CHAMPVA Guidebook covers hospice for a terminally ill patient whose life expectancy is six months or less. It's comfort-focused care: pain control, symptom relief, home care, and support.
What does it cost?
Nothing, for covered hospice services. 38 CFR 17.274 waives both the deductible and the cost share for hospice. When CHAMPVA is the only coverage, it pays up to 100% of the allowable amount.
If there's other insurance, like Medicare, it pays first. The Guidebook says patients with CHAMPVA as secondary pay nothing in most cases.
What are the four levels of hospice care?
| Level | What it means |
|---|---|
| Routine home care | The usual level, with visits at home |
| Continuous home care | At least 8 hours of care in a 24-hour period, during a crisis |
| Inpatient respite care | A short stay so family caregivers can rest, up to 5 days |
| General inpatient care | Inpatient care for symptoms that can't be managed at home |
The hospice decides which level fits, based on what care is needed.
What isn't automatically covered?
Hospice doesn't make everything covered. CHAMPVA's general exclusions in 38 CFR 17.272 still apply to services outside the hospice plan, like stand-alone housekeeping, sitters, or companions, and personal comfort items.
Ask the hospice:
- Which services are part of the hospice plan?
- Is anything billed separately?
- Do you accept CHAMPVA assignment?
Hospice is also different from a nursing home stay. A skilled nursing stay has its own rules and costs. More here: CHAMPVA skilled nursing care.
How do hospices bill CHAMPVA?
Under 38 CFR 17.275, CHAMPVA pays hospice using Medicare's daily hospice rates.
For billing staff:
- Verify CHAMPVA eligibility for the dates of care.
- Bill Medicare or other insurance first if it's primary, and include its EOB.
- Bill the right hospice level and dates.
- Use the claim steps on VA's CHAMPVA provider page.
- Make sure you're enrolled in electronic funds transfer, which VA requires to get paid. More here: CHAMPVA provider EFT enrollment.
Before hospice starts
- Tell the hospice about CHAMPVA and any other insurance.
- Ask if they accept CHAMPVA assignment and will bill CHAMPVA.
- Ask which level of care to expect.
- Keep all the paperwork, bills, and EOBs together.
If you get a bill
Covered hospice care shouldn't leave you with a deductible or cost share. Compare any bill to the CHAMPVA EOB before paying. Ask the hospice what the charge is for and whether it's part of the hospice plan. If it still doesn't make sense, call CHAMPVA at 800-733-8387.