The short answer
Hospital stays have no CHAMPVA deductible. For most hospital stays, you pay the lowest of three amounts: a daily rate times your days, 25% of the hospital's bill, or CHAMPVA's set rate for that kind of stay. Other inpatient care is usually 25% of the allowable amount. If you have other insurance, you often owe nothing.
Is there a deductible for a hospital stay?
No. 38 CFR 17.274 waives the deductible for inpatient care. But there's usually still a cost share, and it may not be a simple 25%.
How is the cost share figured?
It depends on how the hospital is paid.
Most hospital stays (DRG)
Most general hospital stays are paid by DRG, a Diagnosis Related Group. That's a set price based on the type of stay, its severity, and the procedures done, under 38 CFR 17.275.
For these stays, you pay the lowest of:
- CHAMPVA's daily rate times the number of days you were admitted,
- 25% of the hospital's billed amount, or
- CHAMPVA's base DRG rate.
This "lowest of three" rule usually works in your favor.
Other inpatient care
Some facilities aren't paid by DRG, like critical access hospitals, rehab hospitals, long-term care hospitals, and certain others. The CHAMPVA Guidebook lists these as no deductible and a 25% cost share of the allowable amount.
Inpatient mental health
- Smaller programs (fewer than 25 mental health discharges a year): you pay the lower of a daily rate times days, or 25% of the hospital's bill.
- Larger programs and residential treatment centers: no deductible and a 25% cost share of the allowable amount, per the Guidebook.
Many mental health admissions also need preauthorization. More here: CHAMPVA services that need preauthorization.
Why did I get several bills?
One stay can produce separate claims. The hospital bills for the facility. Surgeons, anesthesia, radiology, lab, and other doctors often bill separately, and their charges are priced under CHAMPVA's professional rules, not the hospital formula. Match each bill to its own line on your EOB.
What about the ER visit before admission?
The Guidebook says if you're admitted after being stabilized, the ER charges become part of the inpatient stay. If you go home from the ER, they stay outpatient, and the deductible and outpatient cost share apply.
What if I have other insurance?
It pays first. The Guidebook says that when CHAMPVA is secondary, you pay nothing in most cases. More here: CHAMPVA and other health insurance.
Can the hospital bill me more?
A hospital that takes Medicare has to accept CHAMPVA's allowable amount as payment in full for inpatient care, under 38 CFR 17.272. More here: When hospitals must accept CHAMPVA.
Your cost shares also count toward the $3,000 family cap each year. More here: CHAMPVA catastrophic cap.
How to check a hospital bill
- Were you actually admitted, or kept for observation? Observation is outpatient.
- Is this bill from the hospital or a separate doctor?
- Was other insurance billed first?
- Does your share match the EOB?
- Is your family close to the $3,000 cap?
If it still doesn't add up, call CHAMPVA at 800-733-8387 with the EOB and itemized bill.