The short answer
Medicare pays first and CHAMPVA pays second. If you're entitled to Medicare Part A, you generally need Part B too to keep CHAMPVA, and Medicare Advantage counts. Part D isn't required. Medicare usually forwards claims to CHAMPVA automatically. If you have Medigap, the order is Medicare, then Medigap, then CHAMPVA.
Two separate questions
- Eligibility: Do you still qualify for CHAMPVA once Medicare applies to you?
- Claims: Who pays first?
Part B isn't just a way to lower your bills. For most people with Part A, it's required to keep CHAMPVA at all.
Which Medicare parts do you need?
Under 38 CFR 17.271 and VA's CHAMPVA page:
| Your situation | What it means |
|---|---|
| Under 65 and entitled to Part A | Part B required |
| Turned 65 on or after June 5, 2001, entitled to Part A | Part B required |
| 65 or older and not entitled to Part A | Keep CHAMPVA with proof, usually a Social Security Notice of Disallowance |
| Already 65 before June 5, 2001 | Special grandfather rules |
| Medicare Advantage (Part C) | Counts as A and B |
| Part D | Not required |
More here: CHAMPVA at age 65 and CHAMPVA with Medicare before 65.
How do claims flow?
Medicare → Medigap or other plan, if any → CHAMPVA
- Give the provider both cards.
- The provider bills Medicare first.
- Medicare processes the claim.
- Medicare forwards it to CHAMPVA. The CHAMPVA Guidebook says Medicare sends processed claims for CHAMPVA beneficiaries to VA electronically.
- CHAMPVA pays what's left under its own rules. VA's CHAMPVA care page says it may cover some or all of the Part B deductible.
CHAMPVA doesn't automatically pay every dollar Medicare leaves. The service still has to be covered by CHAMPVA. And a Medicare denial doesn't automatically mean CHAMPVA pays.
Don't assume the forwarding always works. If you get a Medicare notice but no CHAMPVA EOB in a few weeks, follow up.
What if you have Medigap?
It goes between Medicare and CHAMPVA. VA says you may need to file the CHAMPVA claim yourself with the Medigap EOB.
A Medigap plan isn't the same as a CHAMPVA supplement. A CHAMPVA supplement pays after CHAMPVA. More here: CHAMPVA and other health insurance.
What do you tell CHAMPVA when Medicare starts?
Send VA Form 10-7959c with a copy of the front and back of your Medicare card, and your Part D card if you have one. More here: How to report other insurance.
For providers
- Verify Medicare and CHAMPVA.
- Bill Medicare or the Medicare Advantage plan first.
- Check whether the claim crossed over to CHAMPVA.
- If not, send CHAMPVA the claim with Medicare's EOB, to payer ID 84146.
- Let Medigap process before CHAMPVA if it applies.
- Don't bill the patient until all payers have processed.
Hospitals that take Medicare must accept CHAMPVA for inpatient care. More here: When hospitals must accept CHAMPVA.
Common problems
- Part B lapsed. That can end CHAMPVA, not just raise costs.
- CHAMPVA has old insurance info. Claims can stop.
- CHAMPVA was billed before Medicare.
- The Medigap EOB was skipped.