CHAMPVA: Health Coverage for Veterans’ Dependents

What is CHAMPVA?

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) provides health insurance coverage to the spouse, surviving spouse, and dependent children of veterans who meet specific criteria.

CHAMPVA is not the same as TRICARE. It is a separate program specifically for dependents of veterans with permanent and total service-connected disabilities.

Eligibility

You may be eligible for CHAMPVA if you are the spouse, surviving spouse, or dependent child of a veteran who:

1. Is rated permanently and totally disabled due to a service-connected condition, OR
2. Died from a service-connected disability, OR
3. Was rated permanently and totally disabled at the time of death from any cause

Who is NOT eligible

• Dependents eligible for TRICARE (including TRICARE for Life)
• Anyone eligible for Medicare Part A as a result of reaching age 65 must also enroll in Medicare Part B to maintain CHAMPVA eligibility. Once enrolled in both Part A and Part B, CHAMPVA serves as secondary coverage to Medicare.

Dependent children eligibility

• Under age 18
• Ages 18-23 if enrolled full-time in an approved educational institution
• Helpless children (became permanently incapable of self-support before age 18)

What CHAMPVA covers

CHAMPVA covers most medically necessary health care services, including:

• Doctor visits — Primary care and specialist appointments
• Hospital care — Inpatient and outpatient services
• Mental health — Outpatient therapy, inpatient psychiatric care
• Prescriptions — Through the Meds by Mail program or retail pharmacies
• Preventive care — Screenings, immunizations, well-child visits
• Maternity care — Prenatal, delivery, and postnatal care
• Durable medical equipment — Wheelchairs, prosthetics, hearing aids
• Ambulance services — Emergency transport
• Skilled nursing care — When medically necessary
• Hospice care — End-of-life care services

What CHAMPVA does NOT cover

• Routine dental care (limited exceptions)
• Cosmetic surgery
• Experimental treatments
• Services not medically necessary
• Care from non-authorized providers (in most cases)

Costs

After your family reaches the $3,000 annual out-of-pocket maximum, CHAMPVA pays 100% of covered services for the rest of the calendar year.

Prescription costs (Meds by Mail)

• Generic medications: $0 copay for a 90-day supply
• Brand name medications: $0 copay for a 90-day supply through Meds by Mail
• Retail pharmacy: 25% cost share applies

How to apply

Step 1: Gather required documents

• VA Form 10-10d (CHAMPVA Application)
• VA Form 10-7959c (CHAMPVA Other Health Insurance Certification) — if you have other insurance
• Copy of the veteran’s VA rating decision showing permanent and total disability
• Marriage certificate (for spouse)
• Birth certificate (for children)
• Medicare card (if applicable)
• Divorce decree (for former spouses, if applicable)

Step 2: Submit your application

By mail: VHA Office of Integrated Veteran Care CHAMPVA Eligibility PO Box 469028 Denver, CO 80246-9028

By fax: 1-303-331-7809

Step 3: Wait for processing

Processing typically takes 6-8 weeks. You’ll receive a CHAMPVA authorization card once approved.

Using CHAMPVA with other insurance

CHAMPVA + Medicare

If you have both Medicare and CHAMPVA:

• Medicare pays first (primary)
• CHAMPVA pays most of the remaining balance (secondary)
• This combination often results in little to no out-of-pocket costs

CHAMPVA + Other Health Insurance (OHI)

If you have employer-sponsored or other health insurance:

• OHI pays first
• CHAMPVA pays the remaining covered costs up to the CHAMPVA allowable amount
• You must report other insurance to CHAMPVA using VA Form 10-7959c

Tips

1. Use Meds by Mail — Prescriptions are cheaper (usually free) through the VA’s mail-order pharmacy program
2. Keep documentation current — Report any changes in other insurance, marital status, or dependent status within 30 days
3. Pre-authorize when possible — Some services require prior authorization. Check with CHAMPVA before scheduling non-emergency procedures
4. Know your regional contractor — CHAMPVA uses regional contractors to process claims. Contact information is on your CHAMPVA card

Connection to VA disability rating

CHAMPVA eligibility is directly tied to the veteran’s disability status:

• The veteran must be rated permanent and total (P&T) — a combined 100% rating alone may not qualify if not designated as permanent
• If a veteran’s P&T status is granted retroactively, dependents may be eligible for CHAMPVA benefits back to the effective date
• Check your rating decision letter for the words “permanent and total” — if you’re 100% but not P&T, you may need to request a review

Use our VA disability calculator to understand your combined rating. If you’re close to 100%, explore whether TDIU could help you reach permanent and total status.

This content is for informational purposes only and does not constitute legal or medical advice. For personalized guidance, consult a VA-accredited VSO, attorney, or claims agent.