CHAMPVA and Medicare: Can I Have Both?

CHAMPVA is a cost-sharing health coverage program for some military families who don’t qualify for TRICARE. You can use CHAMPVA with Medicare when you’re eligible for both programs.

CHAMPA will be the secondary payer to Medicare and will pay most of your out-of- pocket costs.

Since there are no additional premiums if you qualify for CHAMPVA, using it alongside Medicare can significantly lower your healthcare costs. Let’s take a look at what CHAMPVA is, who may qualify, and how it works together with Medicare.

What is CHAMPVA?

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a healthcare plan for certain dependents of veterans. CHAMPVA is a different program than TRICARE, which also services military members, veterans, and their families.

TRICARE eligibility is open to people who are:

  • active or retired uniformed service members
  • spouses or children of active or retired uniformed service members
  • members of the Army National Guard or Reserve
  • spouses or children of Army National Guard or Reserve members
  • spouses or children of deceased military members
  • former spouses of military members
  • Medal of Honor recipients
  • spouses and children of Medal of Honor recipients

You can’t use CHAMPVA if you have or are eligible for TRICARE. CHAMPVA helps cover dependents who aren’t eligible for TRICARE.

For example, service members who leave active duty under certain conditions might not qualify for TRICARE. However, if they have a disability caused by their service, their family may be able to enroll in CHAMPVA.

What services does CHAMPVA cover?

CHAMPVA is a cost-sharing health insurance program. This means that it will pay a portion of the cost of health services you receive, and you’ll pay the remaining amount.

You won’t pay a premium for CHAMPVA, but there is a deductible of $50 before CHAMPA coverage kicks in.

After you pay your deductible, CHAMPVA will pay what’s known as the “allowable amount” for all covered services. Generally, CHAMPVA will pay 75 percent of the allowable amount, and you’ll pay the other 25 percent.

Covered services include:

  • hospital stays
  • primary care doctor visits
  • specialist visits
  • lab work
  • skilled nursing care
  • home care
  • ambulance transportation
  • mental health services
  • prescription drugs

There are two other completely covered benefits. Hospice care from any provider is 100 percent covered under CHAMPVA. You can also get prescription coverage at no cost to you if you use the Department of Veteran Affairs (VA) Meds by Mail program.

Coverage works differently if you use CHAMPVA alongside another health insurance plan, including Medicare. When you use CHAMPVA with another insurance plan, CHAMPVA becomes what’s called a secondary payer.

This means your other insurance plan will be billed first, and CHAMPVA will then pay the remaining cost. This can save you a lot of money on out-of-pocket medical expenses like copayments or coinsurance amounts.

Am I eligible for CHAMPVA?

You’re eligible for CHAMPVA if you’re the dependent child or the current or widowed spouse of a veteran who meets one of these conditions:

  • is permanently and totally disabled from a service-related injury or disability
  • was permanently and totally disabled from a service-related injury or disability at the time of their death
  • died from service-related injury or disability
  • died during active duty

There is no premium cost for CHAMPVA coverage.

You can apply for CHAMPVA at any time. You’ll need to send in an application along with documents that prove your eligibility. Depending on your circumstances, these might include:

  • service records
  • marriage records
  • birth certificates

You’ll also need to send in information about any other insurance plan you currently have.

It generally takes between 3 and 6 weeks for your application to be processed. You’ll receive a CHAMPVA card in the mail if your application is approved. You can start using CHAMPVA coverage as soon as your card arrives.

How does CHAMPVA work with Medicare?

Since 2001, CHAMPVA beneficiaries have been able to use their coverage after turning age 65. This means CHAMPVA can be used alongside Medicare.

You’ll need to be enrolled in Medicare to keep your CHAMPVA coverage. Here are the rules for how that works:

For example, let’s say you turned 65 years old in 1999 and enrolled in Medicare parts A and B. You won’t be able to drop your Part B coverage and keep your CHAMPVA coverage. However, if you turned age 65 in 1999 and enrolled in only Part A, you wouldn’t need to sign up for Part B to keep your CHAMPVA coverage.

You can use CHAMPVA alongside:

  • Medicare parts A and B, together known as original Medicare
  • Medicare Part C, also called Medicare Advantage
  • and Medicare Part D, which is prescription drug coverage

It’s important to note that CHAMPVA won’t pay for the cost of your Part B premium.

You should also know that you can no longer use VA healthcare facilities or healthcare providers once you’re enrolled in Medicare.

Who pays first for healthcare costs?

Medicare is the primary payer when you use it with CHAMPVA. This means Medicare will be the first to pay the cost of any service you receive, then CHAMPVA will pay the rest.

You’ll have very few out-of-pocket costs using CHAMPVA and Medicare together, since CHAMPVA will generally pay any copayments or coinsurance amounts.

You can expect to pay:

  • nothing out of pocket for any service that both Medicare and CHAMPVA cover
  • your Medicare coinsurance cost of 20 percent for a service Medicare covers but CHAMPVA doesn’t
  • your CHAMPVA cost sharing of 25 percent for anything CHAMPVA covers but Medicare doesn’t

The same rules apply to Medicare Part D. CHAMPVA will pick up your copayments on all covered prescriptions. It will also pay 75 percent of the cost of prescriptions that your Medicare Part D plan doesn’t cover.

Present both your Medicare Part D plan card and your CHAMPVA ID card at your pharmacy for coverage.

What about Medicare Advantage?

You can use your CHAMPVA coverage with a Medicare Advantage plan. Since Medicare Advantage plans replace Medicare parts A and B, having an Advantage plan still meets the requirement to be enrolled in Medicare to keep CHAMPVA once you’re age 65.

Your Medicare Advantage plan will be the primary payer, just like when you have original Medicare. CHAMPVA will pay your copayments and other out-of-pocket costs.

Your bill will go to your Medicare Advantage plan first and then to CHAMPVA. In most cases, you won’t have any out-of-pocket costs to pay.

Many Medicare Advantage plans also include Part D coverage. When you use a Medicare Advantage plan that includes Part D along with CHAMPVA, your CHAMPVA benefits will pick up the cost of your prescription copayments.

Medicare Advantage plans often have networks. The network includes all the providers that your Medicare Advantage plan will cover healthcare services from. In many cases, you’ll need to pay out of pocket for any services you receive from an out-of-network provider.

However, when you use CHAMPVA along with your Medicare Advantage plan, you can often get 75 percent of the cost of out-of-network service covered.

How do I choose the right coverage options for me?

You need to enroll in original Medicare (parts A and B) to keep your CHAMPVA coverage. You can also choose to enroll in additional Medicare parts, such as:

  • Medicare Advantage
  • Medigap
  • Medicare Part D

The best option for you will depend on your personal needs and budget.

Medicare Advantage, Medigap, and Medicare Part D plans have their own premiums, deductibles, and other costs. CHAMPVA can pick up some of these costs — but not your premiums.

You might not even need additional Medicare parts if you’re using CHAMPVA.

For example, Medigap plans are designed to cover the out-of-pocket costs of Medicare parts A and B. However, since CHAMPVA already does this when you use it alongside Medicare, you might not need a Medigap plan.

Here are some other common scenarios to consider:

Original Medicare + CHAMPVA

Let’s say you have CHAMPVA and Medicare parts A and B, and you choose to not enroll in any other Medicare plans.

You’d pay the Medicare B premium, and Medicare would be your primary payer for all covered services. You could get prescriptions for 25 percent of the allowable amount at a pharmacy or completely covered if you use the Meds by Mail program using only CHAMPVA.

Original Medicare + Part D + CHAMPVA

You have CHAMPVA, Medicare parts A and B, and a Part D plan. You’d pay the Medicare Part B premium and the premium for your Part D plan.

Medicare would be the primary payer for services and prescriptions, and CHAMPVA would pick up your copayments and coinsurance amounts.

Medicare Advantage + CHAMPVA

You have CHAMPVA and a Medicare Advantage plan that includes Part D coverage. You’d pay the Medicare Part B premium plus the premium for your Medicare Advantage plan.

Medicare would be the primary payer for your services and prescriptions, and CHAMPVA would pick up your copayments and coinsurance amounts.

Ways to save on Medicare coverage

It’s worth noting that you may be able to find Medicare Advantage or Medigap plans in your area with $0 premiums.

You can shop for plans in your area on the Medicare website and compare prices, networks, and covered services before you commit to a plan.

You can also look for savings on your Medicare coverage. You might qualify for programs to help lower your costs if you have a limited income. These programs include:

  • Extra Help, which lowers your prescription drug costs
  • Medicare savings programs, which can lower your costs for parts A and B

Ultimately, the right plan for you depends on your needs and your budget. You’ll want to select a plan that includes:

  • the doctors you want to see
  • any prescriptions you take
  • any services you need

You can also search for premiums in your price range and those with out-of- pocket costs you can manage.

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