The short answer
Meds by Mail, care at a VA facility through CITI, hospice, listed preventive care, and certain birth control and sterilization services have no CHAMPVA deductible and no cost share. Inpatient stays, ambulatory surgery centers, and partial psychiatric day programs skip the deductible, but you may still owe a cost share. Check both rules separately.
Two different questions
Every CHAMPVA service has two separate cost questions:
- Does the deductible apply? ($50 per person, $100 per family each year.)
- Does the cost share apply? (Usually 25%.)
Some services skip both. Some skip only the deductible. The rules are in 38 CFR 17.274.
At a glance
| Service | Deductible? | Cost share? |
|---|---|---|
| Meds by Mail | No | No |
| Care received through CITI at a VA facility | No | No |
| Listed preventive care | No | No |
| Hospice | No | No |
| Listed birth control and sterilization services | No | No |
| Inpatient hospital stays | No | Yes, special rules |
| Ambulatory surgery centers | No | Yes |
| Partial psychiatric day programs | No | Yes |
The care still has to be covered, and other rules like preauthorization still apply.
Which preventive care is free?
The regulation names:
- colorectal cancer screening,
- breast cancer screening,
- cervical cancer screening,
- prostate cancer screening,
- yearly physical exams,
- vaccines and immunizations, and
- well-child care from birth through age 6.
You don't have to get these at a VA facility. The regulation says they're free even outside CITI. VA can add other preventive services, so if yours isn't on the list, ask CHAMPVA. More here: CHAMPVA preventive care.
Meds by Mail
Medications through VA's Meds by Mail program have no deductible and no cost share. But you can only use Meds by Mail if you don't have other prescription coverage. Retail pharmacy fills follow different rules. More here: CHAMPVA prescription coverage.
CITI care
Care you actually get at a participating VA facility through CITI, the CHAMPVA In-house Treatment Initiative, is free. VA's CHAMPVA care page says VA covers the whole cost.
But if that VA facility sends you to a community provider, VA warns you may owe part of the cost. More here: CHAMPVA CITI.
Birth control and sterilization
A 2024 VA rule, now in 38 CFR 17.274(f), removed both charges for:
- IUDs, implants, and similar devices, including putting them in and taking them out,
- diaphragms and similar devices, including fitting,
- birth control shots,
- prescription birth control,
- FDA-approved emergency contraception, prescription or over the counter,
- surgical sterilization, and
- the office visits that go with these.
VA's final rule didn't make every over-the-counter contraceptive free. More here: CHAMPVA family planning and birth control.
No deductible, but a cost share
- Hospital stays use their own cost-share formulas. More here: CHAMPVA inpatient costs.
- Ambulatory surgery centers have a 25% cost share when CHAMPVA is primary, according to the CHAMPVA Guidebook.
- Partial psychiatric day programs have no deductible, but a cost share can still apply.
Other ways your cost share can drop to $0
- Other insurance paid first. You often owe little or nothing after both plans pay.
- Your family hit the $3,000 cap. CHAMPVA pays in full for covered care the rest of the year. More here: CHAMPVA catastrophic cap.
You were charged for something that should be free
- Check what kind of service it was and where you got it.
- Look at your EOB to see whether CHAMPVA called it a deductible, a cost share, or not covered.
- If a waiver was missed, call CHAMPVA at 800-733-8387 and ask them to review the claim.