The short answer
CHAMPVA is a VA health care program that helps pay for medical care for certain family members, survivors, and caregivers of Veterans. VA shares the cost of covered care with you. Most people use it with regular doctors in their community, and some can also use VA facilities or get prescriptions mailed free.
What is CHAMPVA?
CHAMPVA is a health care program run by VA for certain family members of Veterans. The name stands for the Civilian Health and Medical Program of the Department of Veterans Affairs.
It works a lot like health insurance. You see a provider, the provider bills CHAMPVA, and CHAMPVA pays its share. VA calls it a cost-sharing program, because VA and you each pay part of the cost of covered care. The rules are in 38 CFR 17.270 through 17.279.
Who is CHAMPVA for?
CHAMPVA is mainly for spouses, children, and surviving spouses of certain Veterans, plus some family caregivers.
In most cases, the Veteran has to be rated permanently and totally disabled from service-connected conditions, or have died from a service-connected condition or in the line of duty. Designated Primary Family Caregivers in VA's caregiver program can also qualify. Being related to a Veteran isn't enough on its own, and you can't have CHAMPVA if you're eligible for TRICARE.
The details matter, so we cover them separately: Who qualifies for CHAMPVA?
How do you actually get care with CHAMPVA?
There are three ways, and most people use the first one for almost everything.
1. Regular doctors and providers in your community. This is how most CHAMPVA care happens. CHAMPVA doesn't have a network, so you can see any licensed provider who agrees to bill it. More here: How to find a provider who accepts CHAMPVA.
2. A VA medical facility, through CITI. Some VA facilities take part in the CHAMPVA In-house Treatment Initiative (CITI). If yours does and has room, you can get care there, and VA covers the full cost. Not every facility takes part, and people who are eligible for Medicare can't use CITI. More here: CHAMPVA CITI.
3. Meds by Mail. This is a VA pharmacy service that mails regular, non-urgent prescriptions to your home at no cost. If you have other insurance with prescription coverage, including Medicare Part D, you generally can't use it. More here: CHAMPVA prescription drug coverage.
What does CHAMPVA cost?
There's no monthly premium. You pay a share of the cost when you use care.
For most outpatient care, there's a yearly deductible of $50 per person or $100 per family. After that, you usually pay 25% of CHAMPVA's allowable amount (the most CHAMPVA counts for a service), and CHAMPVA pays the rest. There's also a yearly cap of $3,000 per family on what you pay out of pocket for covered care. Some services cost nothing at all, like care through CITI and Meds by Mail.
If you have other health insurance, including Medicare, that plan usually pays first and CHAMPVA pays after it. Start here for the details: CHAMPVA cost share.
What CHAMPVA isn't
These mix-ups come up constantly, so it helps to clear them up early.
- It isn't TRICARE. TRICARE is the Department of Defense's health program for service members, retirees, and their families. CHAMPVA is a separate VA program, and people who are eligible for TRICARE can't use CHAMPVA. More here: CHAMPVA vs. TRICARE vs. VA health care.
- It isn't the Veteran's own VA health care. CHAMPVA covers family members and caregivers. The Veteran's care runs through VA health care, which is a different benefit.
- It isn't VA Community Care. Community Care is how VA sends Veterans to outside providers. A provider doesn't need to be in VA's Community Care Network to treat a CHAMPVA patient.
- It doesn't cover everything. CHAMPVA covers most medically necessary care, but it has exclusions, and a few services need approval ahead of time.
A simple way to think through any CHAMPVA question
Most CHAMPVA problems make more sense if you split them into five smaller questions:
- Eligibility: Is this person enrolled in CHAMPVA right now?
- Where the care comes from: A community provider, a VA facility through CITI, or Meds by Mail?
- Coverage: Does CHAMPVA cover this specific service?
- Approval and billing: Does it need preauthorization, and will the provider bill CHAMPVA?
- Who pays first: Is there Medicare or other insurance that has to pay before CHAMPVA?
A "no" on any one of these can stop a claim, so it's worth checking each one.