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The VA established the Civilian Health and Medical Program of the Department of Veteran Affairs, or CHAMPVA, in 1973 to provide healthcare benefits to disabled veterans. As a survivor of veterans who died due to service-connected injuries or suffered from permanent and total disability due to service-connected injuries at the time of their death, CHAMPVA benefits may be available to you.
CHAMPVA covers healthcare services and supplies at no cost to eligible beneficiaries through the VA. The Veterans Affairs Department’s Health Administration Center (HAC) is responsible for the administration of this program. As part of CHAMPVA activities, the HAC verifies applicants’ eligibility, authorizes benefits and services for eligible individuals, certifies and approves vendors, and authorizes medical supplies and services.
Furthermore, CHAMPVA-eligible dependents of qualified veterans cannot be covered by TRICARE. It is common for CHAMPVA and TRICARE (a program of the Department of Defense) to be confused due to their similarity. Military and veteran members and their families and survivors can take advantage of TRICARE, a regionally managed healthcare program.
Veterans Affairs oversees CHAMPVA. Many veterans can be eligible for both the CHAMPVA and the TRICARE programs. However, veterans who have retired from the military (in the absence of any service-connected disability) or the spouses of military personnel who were killed in the line of duty are only eligible for TRICARE benefits and do not have the option to choose between CHAMPVA and TRICARE.
If you are a veteran with a bad credit history, read our blog on housing assistance for veterans with bad credit.
CHAMPVA And The Affordable Care Act
In March 2010, President Barack Obama signed the Affordable Care Act into law. Informally referred to as “Obamacare,” the Patient Protection and Affordable Care Act focuses on expanding access to health insurance for millions of Americans without health coverage.
Insurers were prohibited from denying coverage because of preexisting conditions under the new law, which expanded Medicaid eligibility, created health insurance exchanges, and mandated Americans obtain health insurance.
A minimum standard for health coverage, also known as minimum essential coverage, will be required under the health care law. As required by the health care law, CHAMPVA provides minimum essential coverage. Visit the VA website for additional information about the Affordable Care Act.
To meet healthcare law coverage standards, CHAMPVA members do not have to take any additional steps. A copy of IRS Form 1095-B, Health Insurance Coverage, will be sent to the IRS annually by CHAMPVA. The benefits and out-of-pocket costs of CHAMPVA will remain the same under the ACA.
For veterans struggling financially and in desperate need of house repairs, read our guide on home improvement grants for low-income veterans.
What Benefits CHAMPVA Offers
What is your relationship with a disabled veteran or a veteran who has passed away? Are you their spouse, surviving spouse, or child?
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) may be able to cover you if you don’t qualify for the TRICARE healthcare program for active-duty and retired military personnel. Some of the healthcare services and supplies you need are covered by this program. The process is referred to as cost sharing.
CHAMPVA covers most medically and psychologically necessary healthcare services and supplies. A CHAMPVA Program Guide will be sent to you upon confirmation of eligibility that details the covered services and supplies and the ones that are not covered. In the CHAMPVA Policy Manual, you will find a complete listing of the services and supplies that are not covered.
Does CHAMPVA Cover Dental Care?
A certain degree of dental care is covered by CHAMPVA for eligible beneficiaries, along with various approved healthcare services and supplies. In addition to cleanings, fillings, and extractions, CHAMPVA covers preventive, diagnostic, and restorative dental services. Cosmetic dentistry, such as teeth whitening and orthodontic services, are not covered by CHAMPVA.
Every covered service must be provided by a dentist who CHAMPVA approves. For a maximum benefit of $2,000 per year, CHAMPVA covers dental exams and yearly cleanings for veterans.
CHAMPVA Eligibility Criteria
Only people who do not qualify for TRICARE and meet one of the following descriptions are eligible for health care through CHAMPVA.
- The spouses and children of veterans whom a VA regional office has rated as permanently and completely disabled due to a service-connected disability, or
- The spouses or children who survive veterans who have died as a result of any service-connected disability that was rated by the VA, or
- The surviving spouses and children of veterans who had been rated as permanently disabled by the VA at the time of their death, or
- The surviving spouses and children of military personnel either died or were killed during their active duty. Families in these situations are usually eligible for TRICARE, not CHAMPVA.
Service-connected disabilities are those that have been caused or exacerbated by active-duty service. Permanent disabilities aren’t expected to improve. A Veteran who is also the CHAMPVA sponsor for their family may also be eligible for the VA health care program due to their Veterans status.
CHAMPVA benefits may now be available for two spouses who are both veterans who qualify as CHAMPVA sponsors. Their CHAMPVA coverage or the VA health care program can be used whenever they need medical care.
In the event of remarriage, surviving spouses are ineligible for CHAMPVA unless they are 55 years of age or older. The child’s eligibility remains the same if the spouse divorces or remarries, except for stepchildren.
CHAMPVA is not available to stepchildren who leave a sponsor’s household. If you remarry, and later your spouse dies, you get a divorce or annul your remarriage; you may reestablish your eligibility for CHAMPVA if you are a survivor of a qualifying sponsor.
Upon reaching 18, CHAMPVA-eligible beneficiaries must provide proof of full-time enrollment in school. If a veteran’s primary family caregiver is not covered by another health plan, they can qualify for CHAMPVA.
Check out the rest of the Gov-Relations blog posts if you are interested in government and private assistance programs. If you are a US army veteran and cannot afford to send your kids to college, read our guide on scholarships for children of veterans.