Written By: Camryn Keeble
CHAMPVA Benefits
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program for eligible family members of certain disabled veterans. The program provides medical coverage to those ineligible for TRICARE or Department of Defense (DoD) health care programs.
Reviewed By
Retired LCDR Carl Jewett
VA-Accredited Claims Agent
Reviewed By
Retired LCDR Carl Jewett
VA-Accredited Claims Agent
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Important Facts About CHAMPVA Benefits
- Family members (spouses and dependent children) of veterans with a permanent 100% disability rating are eligible for CHAMPVA. Since veterans with mesothelioma almost always receive a 100% disability rating from the VA, their family members are usually eligible for CHAMPVA.
- Surviving spouses and dependent children of veterans can qualify for CHAMPVA if the veteran died from a service-connected disability, or the veteran died from a non-service-connected disability but was rated 100% disabled for another disability at the time of death.
- Spouses can continue to use CHAMPVA even if they are on Medicare, as long as they enroll in Medicare Part B. CHAMPVA is always a secondary payer in these cases.
- Surviving spouses who remarry before their 55th birthday are no longer eligible for CHAMPVA.
- Primary caregivers participating in the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) may qualify for CHAMPVA as long as they are not entitled to any other health care program such as TRICARE, Medicare or Medicaid.
What is CHAMPVA?
The Department of Veterans Affairs (VA) offers many benefits for veterans with mesothelioma, including CHAMPVA, a type of VA health care specifically for the immediate family members, such as spouses or children, of disabled veterans. This program supports dependents’ need for health care by covering a variety of medical services.
There are certain medical providers who participate in the CHAMPVA program. Some are VA-affiliated medical providers, which means CHAMPVA enrollees are not required to pay any out-of-pocket fees for medical services. However, some CHAMPVA medical providers are not VA-affiliated and may require payment.
CHAMPVA benefits are also available to family members enrolled in Medicare. Some stipulations with combining Medicare coverage and CHAMPVA benefits require coordination between the family member, their medical providers and medical centers.
Although CHAMPVA is primarily designed for immediate family members of veterans, some veteran caregivers may also be eligible to receive health care through the VA. If the caregiver is enrolled in the Program of Comprehensive Assistance for Family Caregivers (PCAFC), they may be eligible for CHAMPVA benefits.
For assistance filing for CHAMPVA or other questions regarding VA benefits, contact VA-Accredited Claims Agent, retired LCDR Carl Jewett.
CHAMPVA Eligibility Criteria
Veterans with mesothelioma are often eligible to receive VA Disability Compensation, which means their dependent family members may be eligible for CHAMPVA benefits. The main criteria for CHAMPVA eligibility is being the spouse or dependent child of a veteran with a permanent 100% disability rating due to a service-connected disability, such as mesothelioma.
To qualify for CHAMPVA, you must be one of the following:
- The spouse or dependent child of a veteran who has been given a permanent 100% disability rating for a service-connected disability by the VA
- The surviving spouse or dependent child of a veteran who died from a VA-rated service-connected disability, such as mesothelioma
- The surviving spouse or dependent child of a veteran who – at the time of death – had a permanent 100% disability rating due to a service-connected disability
What Does CHAMPVA Cover?
CHAMPVA covers a wide variety of services, including:
- Ambulance service
- Ambulatory surgery
- Durable medical equipment (DME)
- Family planning and maternity
- Hospice
- Inpatient services
- Mental health services
- Outpatient services
- Pharmacy (prescription medicines)
- Skilled nursing care
- Transplants
CHAMPVA Medical Providers
Once an eligible family member is enrolled in CHAMPVA, they can receive medical care by choosing a CHAMPVA-participating medical provider.
The VA allows CHAMPVA enrollees to seek treatment at a VA Medical Center or another medical clinic if the specific location participates in the CHAMPVA Inhouse Treatment Initiative (CITI). If you live near a participating VA Medical Center or clinic, you can receive treatment with zero out-of-pocket expenses, as there is no cost share and no deductibles. Over 50% of all VA Medical Centers and clinics participate in the CITI program.
To receive care, the enrollee must present their CHAMPVA identification card and any necessary authorization forms to the healthcare provider. The provider will then bill CHAMPVA directly for covered services. It is important to carefully review their CHAMPVA benefits and understand their responsibilities for cost-sharing and prior authorization requirements.
VA Medical Providers
The VA provides CHAMPVA enrollees with the option to seek treatment at a VA Medical Center or clinic if the specific location participates in the CHAMPVA Inhouse Treatment Initiative (CITI). If you live near a participating VA Medical Center or clinic, you can receive treatment with zero out-out-pocket expenses, as there is no cost share and no deductibles. More than 50% of all VA Medical Centers and clinics participate in the CITI program.
CHAMPVA and Medicare
Once a CHAMPVA enrollee becomes eligible for Medicare Part A, they must enroll in Part B to keep their CHAMPVA coverage.
CHAMPVA is a secondary payer to Medicare, which means Medicare will be the primary payer for covered medical expenses. CHAMPVA will then cover any remaining costs not covered by Medicare.
Each enrollee’s circumstances are different, so coverage may vary for each individual. However, when enrolling in both CHAMPVA and Medicare, benefits will change based on Medicare coverage. Reviewing CHAMPVA benefits and understanding the cost-sharing responsibilities is crucial, as enrollees may be responsible for paying some out-of-pocket expenses.
Patients must carefully coordinate their CHAMPVA and Medicare benefits to ensure they receive the maximum coverage for their medical expenses. Consulting with health care providers to understand which services each program covers and how the programs interact is beneficial. By carefully coordinating their benefits, patients can maximize their health coverage and minimize out-of-pocket expenses.
Assistance for Primary Family Caregivers of Veterans With Mesothelioma
Aside from CHAMPVA, the VA offers additional benefits to veteran caregivers through the Program of Comprehensive Assistance for Family Caregivers (PCAFC), a support and financial assistance program specifically for family caregivers of eligible veterans.
PCAFC offers a range of services and benefits to help family caregivers manage the care of their loved ones, including financial stipends, access to health insurance, training, counseling and respite care.
In addition, caregivers enrolled in PCAFC may also qualify for CHAMPVA health coverage if they do not qualify for other health coverage such as Tricare, Medicare and Medicaid. This allows non-dependent adult children and other relatives who provide care to the veteran to receive CHAMPVA health coverage as long as they don’t qualify for any other coverage.
VA MISSION Act Expands Coverage of PCAFC
PCAFC was initially intended for veterans who were injured in the line of duty on or after Sept. 11, 2001. In cases of mesothelioma, “injured” means when they were diagnosed with the cancer by a doctor, and the VA determined their cancer was service-connected.
However, a new law called the VA MISSION Act expanded coverage to include caregivers of veterans of all eras, regardless of the date they were injured.
The VA announced that as of Oct. 1, 2022, the PCAFC program was open to family caregivers of all eligible veterans regardless of the date they were injured thanks to the passing of the MISSION Act.
Frequently Asked Questions About CHAMPVA Benefits
What is CHAMPVA?
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program available to eligible family members of certain disabled veterans. The program provides medical coverage to those ineligible for TRICARE or Department of Defense (DoD) health care programs.
How Do I Qualify for CHAMPVA?
To qualify for CHAMPVA, you must be the spouse or dependent child of a veteran with a permanent 100% disability rating from the VA or the surviving spouse or dependent child of a veteran whose death was caused by a service-connected disability. You can also qualify if the veteran was permanently rated at 100% at the time of their death for a disability that did not cause the veteran’s death. Since veterans with mesothelioma almost always receive a 100% disability rating from the VA, the family members or surviving dependents may qualify for CHAMPVA.
Are There VA Health Care Benefits for Caregivers of Veterans with Mesothelioma?
Yes. There are benefits specifically for primary caregivers through the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC). This program was originally intended for family caregivers of veterans injured on or after Sept. 11, 2001, but it was expanded to veterans of all eras with the passing of the VA MISSION Act. Caregivers enrolled in PCAFC may also qualify for CHAMPVA.
How Does Medicare Affect My CHAMPVA Coverage?
Beneficiaries enrolled in CHAMPVA who become eligible for Medicare Part A must enroll in at least Medicare Part B to keep their CHAMPVA coverage. CHAMPVA is a secondary payer to Medicare, which means Medicare will be the primary payer for covered medical expenses. CHAMPVA will then cover any remaining costs not covered by Medicare. Patients should review their benefits and understand how they may change.
Sources & Author
- CHAMPVA Benefits. U.S. Department of Veterans Affairs. Retrieved from: https://www.va.gov/health-care/family-caregiver-benefits/champva/ Accessed on: 05/03/2023.
- CHAMPVA Eligibility. U.S. Department of Veterans Affairs. Retrieved from: https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/champva-eligibility.asp Accessed on: 05/03/2023
- CHAMPVA Supplement Insurance Plan. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Retrieved from: https://champva.us/ Accessed on: 05/04/2023
- CHAMPVA Benefits Civilian Health and Medical Program. Retrieved from: https://nvf.org/champva-civilian-health-and-medical-program/ Accessed: 05/04/2023
- Health Care Benefits for Dependents CHAMPVA. Retrieved from: https://www.benefits.gov/benefit/318 Accessed on: 05/04/2023
- Caregiver Support Program MISSION Act Frequently Asked Questions. U.S. Department of Veterans Affairs. Retrieved from: https://www.caregiver.va.gov/docs/Caregiver-Support-Program-FAQ_10172019.pdf. Accessed: 02/17/2024.
- The Program of Comprehensive Assistance for Family Caregivers. U.S. Department of Veterans Affairs. Retrieved from: https://www.va.gov/family-member-benefits/comprehensive-assistance-for-family-caregivers/. Accessed: 02/19/2024.
