VA Medical Care for Family insurance programs organized by the VA are available for eligible family members of particular veterans entitled the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Once a veteran is enrolled in CHAMPVA, it operates similarly to Medicare in that the veteran pays an annual deductible and a co-pay for medical care they receive.
Many health care services and supplies considered medically and psychologically necessary are covered by the CHAMPVA program. CHAMPVA covers such things as:
- Ambulance cost
- Ambulatory surgery
- Durable medical equipment (DME)
- Family planning and maternity, hospice, inpatient services
- Mental health services
- Outpatient services
- Nursing care
The VA determines whether the treatment is medically or psychologically necessary so the program may not cover all medical procedures. These uncovered procedures may include:
The CHAMPVA benefit doesn’t take care of long-term care, or custodial care, that is generally provided in nursing homes, assisted living facilities, adult day care, or in a patient’s home. Custodial care concerns assistance with activities of daily living or management of an individual mentally debilitated. As a result of not covering long-term custodial care, CHAMPVA can be expensive.
Those that qualify for the following criteria are eligible for CHAMPVA:
- The spouse or child of a veteran who has been rated 100 percent permanently disabled for a service-related disability
- The surviving spouse or child of a veteran who died as a result of a VA-rated service-related disability
- The surviving spouse or child of a veteran who was rated permanently and completely disable as a result of a service-related disability at the time of death
- The surviving spouse or child of a military service member who died in the line of duty, not due to misconduct.
Qualifying children include those who are unmarried under the age of 18, or 23 if attending university and those who developed mental or physical incapacities rendering them unfit for self-support before the age of 18.
Surviving spouses who remarry before the age of 55 lose their benefits unless they terminate their remarriage.
Veterans do not qualify for CHAMPVA if they’re eligible for TRICARE.
Individuals age 65 and older, eligible for Medicare are required to enroll in Medicare Part B to resume eligibility for their participation in CHAMPVA. If this is the case, Medicare becomes the primary insurer while CHAMPVA covers the costs Medicare doesn’t cover.
Individuals looking to enroll in CHAMPVA are required to complete VA Form 10-10d, Application for CHAMPVA benefits. This form is available at any VA regional office or for download at https://www.va.gov/vaforms/medical/pdf/vha-10-10d-fill.pdf.