The short answer
CHAMPVA covers certain spouses, survivors, and children of Veterans. TRICARE covers active-duty service members, military retirees, and their families. VA Community Care covers Veterans themselves when VA authorizes outside care. Check the client's card and ask who the sponsor is, because billing the wrong program is a fast way to a denial.
Which program covers which client?
| CHAMPVA | TRICARE | VA Community Care | |
|---|---|---|---|
| Who it covers | Certain spouses, survivors, and children of Veterans | Active-duty members, retirees, Guard and Reserve in some cases, and their families | Veterans enrolled in VA health care |
| Run by | VA | Department of Defense | VA |
| Provider network | None | Network and non-network providers through regional contractors | Community Care Network or Veterans Care Agreements |
| Needs approval before therapy | Usually not for routine outpatient therapy | Depends on plan and provider type | Yes: VA referral and authorization |
| Client pays | Deductible and 25% cost share | Depends on plan | VA bills any copay later |
Who qualifies for CHAMPVA?
Generally, the spouse or child of a Veteran who has a permanent and total service-connected disability, or the surviving spouse or child of a Veteran who died from a service-connected condition or while rated permanently and totally disabled. They can't also be eligible for TRICARE. See 38 CFR 17.271 and Who Qualifies for CHAMPVA.
Who uses TRICARE?
Active-duty service members and their families, military retirees and their families, and some Guard and Reserve members. A Veteran who retired from the military uses TRICARE. A Veteran who served and separated without retiring usually doesn't. See TRICARE plans and eligibility.
When does VA Community Care apply?
When a Veteran enrolled in VA health care qualifies for care outside VA and VA authorizes it. It covers the Veteran only, not family members. See VA's community care eligibility page.
How do you tell which one a client has?
- Look at the card. CHAMPVA and TRICARE cards look different and name the program.
- Ask who the sponsor is and their status: active duty, retired, or a Veteran with a VA disability rating.
- For Veterans, ask whether VA referred them and whether they have an authorization number.
- Verify eligibility with the program before the first session.
A common mix-up: a Veteran's spouse says "we have VA coverage." That usually means CHAMPVA, but confirm.
How ValorWell handles this
ValorWell works with two of these programs, CHAMPVA and VA Community Care, plus the ValorWell Foundation for treatment VA won't cover. ValorWell's intake team sorts out which program applies before a client reaches you and handles the billing for it.
TRICARE is not a ValorWell pathway.
Important limits
- Eligibility belongs to the program. VA decides CHAMPVA and Community Care eligibility; the Defense Health Agency handles TRICARE.
- Some people have more than one coverage. A Veteran can have VA care and Medicare or private insurance; coordination rules apply.
- Rules change. Verify with the program's current guidance.