CHAMPVA Benefits: Health Coverage for Families of Disabled and Deceased Veterans

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health benefits program in which VA shares the cost of covered care for certain family members of veterans. It is authorized by 38 U.S.C. 1781 and run by VHA's community care office, not by the VA medical center down the road. There is no monthly premium. You see civilian doctors, VA pays its share of the allowable amount, and you pay the rest.

3 things CHAMPVA is not:

• It is not TRICARE. VA's own answer: CHAMPVA "is a VA program" while "TRICARE is a Defense Department (DOD) program." TRICARE sponsors are active duty, retired, and National Guard and Reserve members, and the sponsor's service decides who is eligible through the Defense Enrollment Eligibility Reporting System (DEERS). If you are eligible for TRICARE, you cannot get CHAMPVA.
• It is not VA health care. The veteran's own care comes through VA health care enrollment. CHAMPVA covers the family, and the veteran cannot use it.
• It is not a network plan. There is no CHAMPVA provider list. You can see any provider who agrees to take it.

CHAMPVA counts as minimum essential coverage under the Affordable Care Act, so it satisfies the coverage requirement on its own.

The veteran (the "sponsor") sets the door. You may be eligible for CHAMPVA benefits if at least 1 of these is true:

• you are the spouse or dependent child of a veteran VA has rated permanently and totally disabled from a service-connected disability, or
• you are the surviving spouse or dependent child of a veteran who died from a service-connected disability, or
• you are the surviving spouse or dependent child of a veteran who was rated permanently and totally disabled at the time of death, or
• you are the surviving spouse or dependent child of a service member who died on active duty, in the line of duty and not due to their own misconduct.

And in every case, you must not be eligible for or enrolled in TRICARE. The full list is in 38 CFR 17.271, which also covers Primary Family Caregivers in VA's caregiver program.

The word that trips families up is "permanent." A 100% rating, including through Total Disability Individual Unemployability (TDIU), is not enough unless VA has also found the disability permanent and total (P&T). The total disability guide explains how VA makes that finding and how to read it on the rating decision.

Survivors of a veteran who died from a service-connected disability usually also qualify for Dependency and Indemnity Compensation (DIC), a monthly payment. CHAMPVA and DIC are separate applications.

CHAMPVA follows your relationship to the sponsor and the sponsor's rating. It ends when either changes.

Source: https://www.va.gov/family-and-caregiver-benefits/health-and-disability/champva/ and https://www.va.gov/files/2026-03/CHAMPVA-Guidebook_3-2026.pdf, checked September 2026.

The children's health coverage guide covers the school certification letters VA needs each term for students 18 to 23. If CHAMPVA ends, the spouse health coverage guide covers Marketplace and other options.

CHAMPVA covers most medically necessary care. VA's list includes family planning and maternity care, hospice, inpatient care, mental health care, outpatient visits and procedures, skilled nursing care, ambulance services, medical equipment your provider prescribes, organ transplants and prescription medications.

What it does not cover, or covers only narrowly:

• Dental. Covered only in limited cases. If you are enrolled in CHAMPVA you can buy dental insurance through the VA Dental Insurance Program (VADIP).
• Eyeglasses and contact lenses. Not covered except in certain cases.
• GLP-1 drugs. Covered only when prescribed for FDA-approved conditions such as type 2 diabetes, not for weight loss alone.

Most care needs no approval in advance. Preauthorization is required for inpatient mental health care, care for alcohol or substance use disorders, organ transplants and the limited dental benefit.

The rules are in 38 CFR 17.274. None of these figures carry a rate year; the $3,000 cap is set by regulation and is not adjusted annually.

Source: https://www.ecfr.gov/current/title-38/chapter-I/part-17/subject-group-ECFR6c9c741d1d5a11f/section-17.274 and https://www.va.gov/resources/champva-care/, current as of September 2026.

The same figures apply on the spouse health coverage guide, which focuses on the P&T question for married couples.

Inpatient care works differently. There is no deductible for a hospital stay. At hospitals paid under the diagnosis-related group (DRG) system, you owe the lesser of 3 numbers: a per-day amount times the days you stayed, 25% of the hospital's billed charges, or the base CHAMPVA DRG rate.

Some care has no cost share at all. Hospice, care through the CHAMPVA In-house Treatment Initiative (CITI), preventive services such as cancer screenings, vaccinations and annual physicals, family planning services, and supplies through Meds by Mail are exempt under 17.274.

"Allowable amount" and "accepts assignment." The allowable amount is the most CHAMPVA will pay for a service, and CHAMPVA treats it as payment in full. A provider who accepts assignment agrees to that amount and cannot bill you for the difference between it and their usual charge.

CHAMPVA is almost always the last payer. Any other health insurance you have, including an employer plan, pays first, and CHAMPVA pays second. You report other coverage on VA Form 10-7959c, CHAMPVA Other Health Insurance (OHI) Certification, with your application and again whenever that coverage changes.

Medicare has a hard rule. VA's page: "If you're eligible for Medicare, you must have Medicare Part A and Part B in order to get or keep CHAMPVA benefits. A Medicare Advantage plan (also called Part C) also meets this requirement." Medicare pays first and CHAMPVA pays second.

Watch out: Dropping Part B to save the premium ends CHAMPVA. The March 2026 CHAMPVA Guidebook is direct: cancel Part B and your CHAMPVA eligibility ends on the same day. The only exception is for people who were already 65 before June 5, 2001 with Part A only.

You do not need Medicare Part D. CHAMPVA's Meds by Mail program (below) is only open to people with no other prescription coverage, including Part D, so compare the 2 before you enroll. The Medicare coordination guide covers enrollment windows, the Part B premium and the late-enrollment penalty.

1. Confirm the sponsor's status. You need the rating decision showing the permanent and total finding, or for survivors the death certificate and the award showing a service-connected death or a P&T rating at death.
2. Gather copies of your marriage certificate (spouses), birth or adoption certificates (children), the front and back of any Medicare or other health insurance cards, and a school certification letter for any child aged 18 to 23.
3. Complete VA Form 10-10d, Application for CHAMPVA Benefits. You can apply online at VA.gov or on the paper form (revised April 2025).
4. If anyone on the application has other insurance, including Medicare, complete VA Form 10-7959c and send it with the 10-10d.
5. Mail paper applications to VHA Office of Community Care, CHAMPVA Eligibility, PO Box 137, Spring City, PA 19475, or fax them to 303-331-7807.
6. Wait for the enrollment packet and ID card. VA says it "may take up to 6 weeks to get your card after you apply." VA does not publish a separate approval time.
7. To check status, call CHAMPVA at 800-733-8387, Monday through Friday, 8:00 a.m. to 7:30 p.m. ET, or send a message through Ask VA.

Finding providers who accept CHAMPVA. VA says: "There's no specific network of CHAMPVA providers." 2 facts make the search easier. Most providers who accept Medicare also accept CHAMPVA, and "hospitals and hospital-based providers that accept Medicare must also accept CHAMPVA." Start with Medicare's Care Compare tool, then ask the office whether it accepts CHAMPVA and accepts assignment. If a provider will not take CHAMPVA, you can still get care, pay the bill yourself and file a claim for reimbursement.

Pharmacies. Fill urgent prescriptions and regular medications at any pharmacy in the OptumRx network for your cost share. At a pharmacy outside the network you pay in full and CHAMPVA reimburses 75% of the allowable amount. If you also have other drug coverage, that plan is billed first and the pharmacy can bill CHAMPVA second.

Meds by Mail. For maintenance medications you take regularly, Meds by Mail delivers to your home at no cost, with no deductible and no cost share, in 90-day supplies. It is available only if you have no other prescription coverage, including Part D. Ask your provider for a written 90-day prescription with refills.

CITI. The CHAMPVA In-house Treatment Initiative lets you get care at participating VA medical centers at no cost to you. 2 limits: not every facility takes part, and "if you're eligible for Medicare, you can't get care through CITI." Ask the medical center whether it participates.

Filing a claim yourself. When a provider bills CHAMPVA directly, you do nothing. When you paid out of pocket, or the provider will not bill VA, use VA Form 10-7959a, CHAMPVA Claim Form, on paper or through VA's online claim tool. Attach the itemized bill and, if another insurer paid first, that insurer's explanation of benefits. Mail paper claims to VHA Office of Integrated Veteran Care, CHAMPVA Beneficiary Claims, PO Box 500, Spring City, PA 19475.

Watch out: The filing deadline is 1 year from the date of service, or 1 year from the date of discharge for inpatient care. A claim that arrives later is not paid.

State family health programs sit alongside CHAMPVA rather than replacing it. Depending on where you live and your income, a spouse or child may qualify for Medicaid or the Children's Health Insurance Program (CHIP), which would pay before CHAMPVA and reduce what you owe, or for state veterans home care and property tax relief that key off the same P&T finding. Pick your state to see what applies.

Who is eligible for CHAMPVA?

The spouse or child of a veteran rated permanently and totally disabled for a service-connected condition, or the surviving spouse or child of a veteran who died from a service-connected disability or was P&T at death. You must not be eligible for TRICARE.

How much does CHAMPVA cost?

There are no premiums. You pay a $50 per person ($100 per family) annual outpatient deductible and 25% of the allowable amount for most services, up to a $3,000 catastrophic cap per family each calendar year.

Do I have to enroll in Medicare to keep CHAMPVA?

Yes. If you are eligible for Medicare you must have Parts A and B (or a Medicare Advantage plan). Medicare pays first and CHAMPVA pays second. Cancel Part B and CHAMPVA ends the same day.

How do I apply for CHAMPVA?

Apply online at VA.gov, or mail VA Form 10-10d with copies of your marriage or birth certificate, Medicare or other insurance cards, and school certification for children 18 to 23 to VHA Office of Community Care, CHAMPVA Eligibility, PO Box 137, Spring City, PA 19475.

When do children lose CHAMPVA?

At 18, or at 23 if enrolled full time in school, and at marriage. A child who became permanently unable to support themselves because of a disability that began before 18 can keep coverage after 18.