The short answer
VA Form 10-7959c is how you tell CHAMPVA about Medicare or any other health insurance. You send it with a paper application, when VA asks, and any time coverage starts, changes, or ends. It matters because CHAMPVA usually pays last. If CHAMPVA's record of your other insurance is wrong, your claims can be delayed or denied.
When do you need Form 10-7959c?
VA's Form 10-7959c page covers these situations:
| Situation | What to do |
|---|---|
| Applying on paper and you have other insurance or Medicare | Send it with your Form 10-10d |
| VA writes asking about other insurance after you apply | Send it on its own. Don't send a new application. |
| You're enrolled and coverage starts, changes, or ends | Send an updated one |
| You get Medicare | Send an updated one with a copy of your Medicare card |
If you're already enrolled, VA says to wait until you've received your enrollment packet before sending an update.
Use one form per person. Don't put the whole family on one form.
What counts as other insurance?
More than people expect. 38 CFR 17.270 defines it broadly, and it includes Medicare. The form asks about:
- Medicare Parts A, B, C (Medicare Advantage), and D,
- job-based insurance, yours or a spouse's,
- individual or Marketplace plans,
- Medicaid or state assistance,
- Medigap (Medicare supplement) plans, and
- limited or specialty policies, including CHAMPVA supplement policies.
Why does this affect your claims?
Because CHAMPVA usually pays after your other insurance. Under 38 CFR 17.276, CHAMPVA generally won't pay until the other plan has processed the claim and sent an explanation of benefits (EOB).
So if CHAMPVA thinks you have insurance you dropped last year, it may wait for an EOB that will never come. If CHAMPVA doesn't know about a new plan, it may pay first and later take that payment back.
VA's CHAMPVA care page says if it learns about other insurance after processing a claim, it will reprocess that claim.
When does CHAMPVA pay first?
Only with these four:
- Medicaid,
- state crime-victim compensation programs,
- Indian Health Service, and
- a policy bought specifically as a CHAMPVA supplement.
A Medigap plan is not a CHAMPVA supplement. Medigap pays before CHAMPVA. More here: CHAMPVA and other health insurance.
How do you fill it out?
- Beneficiary information. Name, contact information, and whether your address is new.
- Medicare. Each part you have, the start dates, and your Medicare number. Attach a copy of the card.
- Other policies. For each one: the insurer, start date, whether it's through a job, and whether it covers prescriptions. If you're new to CHAMPVA, list coverage back to your CHAMPVA start date.
- End dates. Enter one only if the policy has actually ended. The expiration date printed on a card that will just be reissued isn't an end date.
- Cards. Front and back of every card, including Part D.
- Sign and date. The beneficiary, the Veteran, or a legal guardian can sign.
If you have more policies than fit, attach a page with the same information.
How do you send it?
Online through VA's form page, or by mail to the address printed on the current form.
What if your other plan doesn't send EOBs?
The form's instructions say to send your current copay information, such as a copy of your card showing copays, with each claim so CHAMPVA can figure its share.
One more step
Tell your providers which plan is primary. CHAMPVA's records can be perfect and a claim can still bounce if the office bills in the wrong order.