The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by the Chief Business Office Purchased Care (CBOPC) in Denver, Colorado.

Due to the similarity between CHAMPVA and the Department of Defense (DoD) TRICARE program (sometimes referred to by its old name, CHAMPUS), the two are often mistaken for each other. CHAMPVA is a Department of Veterans Affairs program; TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. In some cases a Veteran may appear to be eligible for both/either program on paper. However, if you are a military retiree, or the spouse of a Veteran who was killed in action, you are and will always be a TRICARE beneficiary; you can´t choose between the two.

Benefits

In general, CHAMPVA covers most health care services and supplies that are medically and psychologically necessary. Upon confirmation of eligibility, you will receive a CHAMPVA Program Guide that specifically addresses covered and non-covered services and supplies.

Pharmacy benefits

Meds by Mail: Meds by Mail is a voluntary service that provides a safe, easy and cost-free way for eligible CHAMPVA and Spina Bifida beneficiaries to receive non-urgent maintenance medications delivered right to your door.

OptumRx (formerly Catamaran) Retail Pharmacy Network: OptumRx electronically processes pharmacy claims nationwide, including Puerto Rico, Guam, and the Virgin Islands. Beneficiaries are serviced through a network of over 82,000 retail pharmacies. When you use a OptumRx pharmacy, the pharmacy may collect a 25% cost share (after the annual deductible has been met) before submiting the claim – saving you time.

Other Health Insurance (OHI)

If you have any other health insurance (OHI), you must notify CBOPC of any changes (dropped insurance, changes in health plans, etc.) immediately upon those changes taking effect so that proper payment can be made on your claims. If you obtain a major medical policy, you must also notify CBOPC that you have a new policy and when it takes effect.

Change of address

If you change your address, it is vital that you update your address with CHAMPVA. CHAMPVA beneficiaries have several options to update address information. You can change your address by using one of the three contact options below. Please sign and date mailed address change requests. If calling to update your address, please have available your old address information, as our customer service representatives will need to verify this infomation before updating your file.

Contacting CHAMPVA

Phone 1-800-733-83878:05 a.m. to 7:30 p.m. ESTMonday through Friday

Email Inquiry Routing & Information System (IRIS)

Mail CHAMPVA POB 469063 Denver CO 80246-9063

 

CHAMPVA eligibility

To be eligible for CHAMPVA, you cannot be eligible for TRICARE, and you must be in one of these categories:

  1. The spouse or child of a Veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office.
  2. The surviving spouse or child of a Veteran who died from a VA-rated service-connected disability.
  3. The surviving spouse or child of a Veteran who was at the time death rated permanently and totally disabled from a service-connected disability.
  4. The surviving spouse or child of a military member who died in the line of duty, not due to misconduct (in most of these cases, these family members are eligible for TRICARE, not CHAMPVA).

An eligible CHAMPVA sponsor may be entitled to receive medical care through the VA health care system based on their own Veteran status. If the eligible CHAMPVA sponsor is the spouse of another eligible CHAMPVA sponsor, both may now be eligible for CHAMPVA benefits. In each instance where the eligible spouse requires medical attention, they may choose the VA health care system or coverage under CHAMPVA for their health care needs.

NOTE: The eligibility of a child is not affected by the divorce or remarriage of the spouse except in the case of a stepchild. When a stepchild leaves the sponsor’s household, the child is no longer eligible for CHAMPVA.

New and expectant parents

If you are expecting and you need to establish CHAMPVA eligibility for your new child, the following must be accomplished before you can submit an application:

  1. Obtain a Social Security number for the newborn by applying to the nearest Social Security Administration office.
  2. Establish dependency of the newborn to the Veteran sponsor by contacting the local VA regional office.

Since the medical claims cannot be paid until the child is verified as eligible by CHAMPVA, we encourage you to take the above action as early as possible.

Remarried widows/widowers

Eligibility for CHAMPVA ends at midnight on the date of your remarriage, if you remarry prior to age 55. If you remarry on or after your 55th birthday, The Veterans Benefit Act of 2002, Public Law 107-330, allows you to keep your CHAMPVA benefits.

Termination of remarriage

If you are a widow(er) of a qualifying sponsor and you remarry, and the remarriage is later terminated by death, divorce, or annulment, you may reestablish CHAMPVA eligibility. The beginning date of your reeligibility is the first day of the month after termination of the remarriage or December 1, 1999, whichever date is later. To reestablish CHAMPVA eligibility, copies of the marriage certificate and death, divorce, or annulment documents (as appropriate) must be provided.

Beneficiaries age 18 to 23

When a CHAMPVA-eligible beneficiary turns 18, CHAMPVA requires that the beneficiary submit proof to CHAMPVA of full-time enrollment in an eductational instituton for benefits to continue. Information on submitting proof of enrollment can be found on our Fact Sheet 01-15: School Enrollment Certification Requirements for CHAMPVA Benefits.

Primary Family Caregiver

A Veteran’s Primary Family Caregiver may also be eligible to receive medical care through CHAMPVA if the Primary Family Caregiver is not entitled to care or services under a health care plan. For more information about CHAMPVA for the Primary Family Caregiver, please visit our Caregiver Support Program page.

More information on the type of Caregiver benefits and services that are available for Caregivers can be found on the VA Caregiver Support Program Support Services page.

Impact on Medicare

CHAMPVA is always the secondary payer to Medicare. If you are eligible for Medicare, at any age and for any reason, you must enroll in Medicare Part A and Medicare Part B to keep your CHAMPVA benefits. Social Security Administration documentation of enrollment in both Part A and Part B is required by CHAMPVA. For more information on Medicare, please visit the Medicare website.

To continue to receive CHAMPVA benefits after age 65, you must meet the following conditions:

  • If you turned 65 on or after June 5, 2001, you must be enrolled in Medicare Part A and Part B to remain eligible for CHAMPVA.
  • If you turned 65 or older prior to June 5, 2001, and were otherwise eligible for CHAMPVA, and were entitled to Medicare Part A coverage, then you may be eligible for CHAMPVA without having to have Medicare Part B coverage.
  • If you turned 65 before June 5, 2001, and have Medicare Part A and Part B, you must keep Part A and Part B to be eligible for CHAMPVA.
  • You are not required to enroll in Medicare Part D in order to become or remain CHAMPVA eligible.