The short answer
CHAMPVA covers yearly physicals, vaccines, breast, cervical, colorectal, and prostate cancer screenings, well-child care through age 6, and other listed preventive services. Those named ones have no deductible and no cost share. Some other screenings are covered only with certain risk factors or ages. Routine adult eye and hearing exams and job physicals aren't covered.
How does CHAMPVA handle preventive care?
In an unusual way. 38 CFR 17.272(a)(30) starts by excluding preventive care, then lists exceptions "including but not limited to" the ones it names. So CHAMPVA does cover a lot of preventive care. It's just written backward.
What does the regulation list?
- Yearly physical exams
- Vaccines and immunizations
- Breast, cervical, colorectal, and prostate cancer screening
- Well-child care from birth through age 6
- School-required physicals through age 17
- Rabies vaccine after an animal bite
- Tetanus vaccine after an injury
- Rh immune globulin
- Gamma globulin
- Medically necessary genetic testing and counseling
- Chromosome testing for repeated miscarriage or infertility
What does the Guidebook add?
The CHAMPVA Guidebook lists more preventive services, many with conditions:
| Service | Condition |
|---|---|
| Mammograms | A baseline at 35 to 39, yearly at 35 to 39 if high risk, and yearly from 40 |
| Pap test and pelvic exam | 18 and older, or younger if a clinician recommends |
| Bone density | Diagnosis needs high risk or symptoms. Monitoring is once a year. |
| Diabetes screening | Certain risk factors, like high blood pressure or age and weight |
| HIV testing | Exposure, symptoms, or pregnancy |
| Cholesterol and heart screening | When medically appropriate |
| BRCA1 and BRCA2 testing | Women identified as high risk |
| Vaccines | Per current CDC recommendations |
What's free?
38 CFR 17.274 waives both the deductible and the cost share for:
- breast, cervical, colorectal, and prostate cancer screening,
- yearly physicals,
- vaccines, and
- well-child care through age 6.
That's true even outside a VA facility. For other preventive services, the Guidebook shows no patient cost when CHAMPVA is primary, but check your EOB, since the regulation names only the ones above. More here: CHAMPVA services with no deductible or cost share.
Screening vs. diagnostic: why it matters
A screening is done when nothing seems wrong. A diagnostic test checks a symptom or follows up a result. CHAMPVA handles them under different rules.
Example: a routine colonoscopy is screening and free. If you go in because of symptoms, or a polyp is found and removed, part or all of it may be billed as diagnostic, with your usual deductible and cost share.
What isn't covered just because it feels preventive?
- Job-required physicals. The regulation names them as an example of what's excluded.
- Routine adult eye and hearing exams. These have their own exclusions. More here: CHAMPVA vision coverage.
- Broad lab panels with no reason. Lab work not tied to a symptom, condition, or listed screening can be denied.
You were charged for a free screening
- Compare the EOB with what you had done.
- Ask the provider whether it was coded as screening or diagnostic.
- Check whether something else was done at the same visit.
- If it still looks wrong, call CHAMPVA at 800-733-8387.
For kids, see CHAMPVA newborn and well-child care.