Health care is an especially hot topic right now. As Affordable Care Acts credits expire, getting access to health insurance seems like an uphill battle. If you’re the spouse or dependent of a disabled veteran, the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) may supplement the health insurance marketplace.
CHAMPVA is a healthcare benefit for disabled veterans’ dependents and spouses. Veterans do not qualify for CHAMPVA, as it was designed to support the needs of the dependents of Veterans.
Who Is Eligible for CHAMPVA?
Spouses, dependents, and caregivers can qualify for coverage if the veteran:
- has been rated at 100% P&T or
- passed away from a VA-related service-connected disability or
- passed away in line of duty without misconduct,
Spouses:
- must provide marriage status (i.e. marriage certificate) upon requesting
Dependent Children:
- must be 18 years or younger of age, and
- If the child is a student, extension is granted until age 23 with proof of higher education enrollment.
- Must not be married.
Caregiver (CHAMPVA for Primary Family Caregiver Program):
- must be at least 18 years old,
- must be approved as a designated primary provider of personal care for the veteran,
- must be a spouse, child, parent, stepfamily member, or extended family member of the veteran, and
- must live or be willing to live with the veteran full time.
Individuals who meet the criteria above, but qualify for TRICARE benefits, are not eligible for CHAMPVA.
How Much Do I Need to Pay?
Unlike private or employer-sponsored health insurance, there is no monthly premium that needs to be paid. Receiving care with CHAMPVA coverage is not all free; there are some deductibles and copay requirements for every visit or service provided.
- The annual deductible is $50 per person or $100 for the whole family (meaning, you will spend AT LEAST $50 or $100 per year if covered by CHAMPVA.)
- CHAMPVA will cover 75% of the allowed amount. Beneficiaries are responsible for the remaining 25% of the allowed amount.
- The Maximum Out-of-Pocket per family is $3,000. This means if a veteran’s family reached $3,000 for the year in paid medical expenses with CHAMPVA coverage, CHAMPVA will cover all medical expenses at 100% from that point.
Which Services am I Covered For?
CHAMPVA only covers services that are deemed medically necessary, which includes preventative services. Some services will require pre-authorization. For the full scope of covered services, please refer to the CHAMPVA Guidebook (pg. 11-43).
What If I Already Have Health Insurance?
For a free legal consultation, call (800) 562-9830
You don’t have to opt-out of your health insurance to get CHAMPVA benefits. In fact, CHAMPVA will pay as a secondary or tertiary. This means that your commercial health insurance(s) will be billed first, then the leftover amount will be billed to CHAMPVA. In most cases, CHAMPVA covers the remaining of the balance leaving no cost to you at all.
How Can I Enroll in CHAMPVA?
To sign up for CHAMPVA, complete VA Form 10-10D and submit it along with the required documentation to the VA. If you are enrolled in a health insurance policy and would like to enroll in CHAMPVA as your secondary insurance provider, you will need to complete VA Form 10-7959c and submit that to the VA to enroll in CHAMPVA.
The processing time for your application is anywhere from 2-8 months. Your identification card and any related materials will be delivered upon your approval for the program.
Verdict
Most veterans don’t know about CHAMPVA benefits for their dependents. We believe it’s our duty to keep our veterans informed and ensure their families receive the support they deserve. For more information on CHAMPVA benefits, contact the CHAMPVA help line at 800-733-8387.
Increasing your Veteran’s Affairs P&T rating can provide a big advantage for your dependents. If you need support to increase your P&T rating, reach out to our experienced VA attorneys today at 713-358-8448. Your benefits matter – let us help you secure them.
Call or text (800) 562-9830 or complete a Free Case Evaluation form
