CHAMPVA and Medicare can work together to cover healthcare costs for specific groups of people.
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) offers additional healthcare benefits to eligible spouses, widows, and children of veterans.
This article further explains what CHAMPVA is. It also goes over how CHAMPVA and Medicare work together.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The Veterans Health Administration Office of Community Care administers the CHAMPVA program. CHAMPVA provides additional health benefits to the spouse or surviving spouse and children of disabled veterans.
Insurers and the government consider CHAMPVA to be supplementary health coverage, not primary health coverage. In other words, a CHAMPVA policy should not be a person’s only form of health insurance.
Depending on an individual’s location, they may also get healthcare at a Department of Veterans Affairs (VA) facility. This is generally based on the availability of services.
If an individual is over 65 years old, they must also enroll in Original Medicare (parts A and B) to qualify or continue to qualify for CHAMPVA.
2026 Medicare changes
We’re currently updating this article to reflect 2026 costs and other changes.
Read more: Medicare cost changes in 2026
CHAMPVA covers various health services.
Some services need preauthorization. This means that a doctor’s office or a policyholder will confirm whether a service is covered.
A doctor must also accept CHAMPVA’s allowable amount for billing. This is the amount that CHAMPVA pays for a particular service. If a doctor accepts this amount, they cannot charge more.
The following are some of the services that CHAMPVA covers:
- ambulatory services
- durable medical equipment
- home health
- hospice services
- inpatient services
- limited dental services
- mental health services
- outpatient services
- pharmacy services
- skilled nursing facility
If a person has a question about coverage for a particular service, they can consult the CHAMPVA guide or contact their plan provider.
To qualify for CHAMPVA coverage, a person must be in one of the following categories:
- the spouse or child of a veteran who is declared permanently and totally disabled due to a service-related disability
- the spouse or child of a veteran who has passed away due to a VA-rated, service-related disability
- the spouse or child of a veteran who was, at the time of their death, permanently and totally disabled due to a service-related disability
- the spouse or child of a military member whose death in the line of duty was not related to misconduct (in which case the spouse or child is ineligible for TRICARE)
A person cannot be eligible for both CHAMPVA and TRICARE, which is a government-managed health plan. It has different beneficiaries, claims, filing procedures, and preauthorization requirements than CHAMPVA.
If a person wishes to apply for CHAMPVA benefits, they can do so online or call the Veterans Health Administration Office of Community Care at 800-733-8387.
Medicare is a federal insurance program that provides hospital and medical insurance to people ages 65 years old and over.
People younger than 65 years old may also be eligible to enroll if they have end stage renal disease or amyotrophic lateral sclerosis. Other conditions or disabilities may also qualify a person for Medicare earlier.
Medicare has various parts. The main parts include:
| Medicare part | Coverage |
|---|---|
| Part A (hospital insurance) | • inpatient hospital stays • skilled nursing facilities • hospice care • some home healthcare |
| Part B (medical insurance) | • certain doctor’s services • outpatient care • medical supplies • preventive services |
| Part C (Medicare Advantage) | • combined coverage of parts A and B (Original Medicare) • prescription drug coverage typically included • possible coverage beyond Original Medicare, such as vision, dental, and hearing |
| Part D (prescription drug coverage) | the cost of prescription medications |
A person can have both Original Medicare (parts A and B) and CHAMPVA. Their CHAMPVA policy may help pay some out-of-pocket costs or services that Medicare does not cover.
In general, when a person combines the benefits of Original Medicare and CHAMPVA, they will have coverage for most medical expenses.
However, there may be some exceptions, such as cosmetic services or the purchase of eyeglasses.
Learn more about Original Medicare vs. Medicare Advantage.
For a person to be eligible for CHAMPVA, they must also be enrolled in Medicare Part B and continue to be enrolled if they:
- are under age 65 years and enrolled in Medicare Part A
- were over age 65 years when their spouse qualified for CHAMPVA
- were age 65 years or older before June 5, 2001; could otherwise be eligible for CHAMPVA; and had coverage with Medicare Part A
- turned 65 years old on or after June 5, 2001, and were eligible for Medicare Part A
To continue to be eligible for CHAMPVA after reaching 65 years old, a person must have enrolled in Medicare 90 days before their 65th birthday.
To make sure that their CHAMPVA benefits continue without a break, a person should send a copy of their Medicare card to CHAMPVA, along with a CHAMPVA Other Health Insurance Certification Form (VA Form 10-7959c).
Who is the primary payer?
CHAMPVA is the secondary payer to Medicare. This means that Medicare will pay its portion of coverage first. Then, the doctor’s office or healthcare organization will bill CHAMPVA, which will cover its portion of the costs.
Any remaining payment amount will be the policyholder’s responsibility.
However, there may be some times when Medicare covers a service but CHAMPVA does not. In this instance, a person will pay their Medicare copay.
If Medicare does not cover a service but CHAMPVA does, the person will be responsible for the cost-sharing percentage.
CHAMPVA and Medicare Advantage (Part C) can work together.
Medicare Advantage is an alternative to Original Medicare that private insurance companies offer.
Medicare Advantage plans may have different copays, deductibles, and coinsurances than Original Medicare. These plans may also offer expanded benefits, including vision and hearing coverage.
Medicare Advantage providers often designate in-network doctors. If a person is enrolled in both a Medicare Advantage plan and CHAMPVA, they must find a healthcare professional who accepts both.
Read about the pros and cons of Medicare Advantage.
Who is the primary payer?
Medicare Advantage is the primary payer when a person has both CHAMPVA and Medicare Advantage.
CHAMPVA is almost always the secondary payer, except when a person uses any of the following:
- Indian Health Services
- Medicaid
- State Victims of Crime Compensation programs
- supplemental CHAMPVA policies
CHAMPVA is, for the most part, a cost-sharing insurance plan, and it does not have a monthly premium. However, a person will have an annual outpatient deductible of $50.
The percentage a person pays usually depends on the services. The table below shows examples of some costs covered by CHAMPVA, according to the VA.
| Benefits | Is there a deductible? | What CHAMPVA pays | What a person pays |
|---|---|---|---|
| outpatient services | yes | 75% of the allowable amount after the deductible | 25% of the allowable amount |
| pharmacy services | yes | 75% of the allowable amount after the deductible | 25% of the allowable amount |
| durable medical equipment | yes | 75% of the allowable amount after the deductible | 25% of the allowable amount |
| services through the CITI program or Meds by Mail | no | 100% of the VA cost | $0 |
| preventive services | no | 100% of CHAMPVA allowable amount | $0 |
These costs are subject to change by CHAMPVA.
CHAMPVA also has a catastrophic spending cap of $3,000 per calendar year, which is the maximum amount of out-of-pocket costs for CHAMPVA-covered supplies and services.
After a person has spent $3,000 out of pocket for their care, CHAMPVA may not require a person to pay the cost-sharing amount.
Original Medicare and CHAMPVA
If a person has both Original Medicare and CHAMPVA, they will usually have few out-of-pocket costs. This is because CHAMPVA often pays coinsurance or copayments after Medicare pays.
For example, a doctor may charge $200 for a visit. The doctor will then bill Medicare, which will pay 80% ($160) of this cost. The doctor will then bill CHAMPVA for the 20% copay (the remaining $40).
CHAMPVA and Part D
Medicare Part D is the prescription drug coverage portion of Medicare. CHAMPVA generally pays the copays on covered prescriptions.
If a Part D plan does not cover a particular medication, CHAMPVA will typically pay 75% of the prescription’s costs.
CHAMPVA and Medicare Advantage
Medicare Advantage plans cover at least the same benefits as Original Medicare. However, a person may have a different copay or coinsurance. For example, they may pay a set cost for seeing their primary care professional or specialist.
Depending on a person’s plan, CHAMPVA will usually cover the costs of copays or coinsurances related to the Medicare Advantage plan.
A person may get some help paying out-of-pocket costs through the following programs:
| Program | How it helps |
|---|---|
| Extra Help | This helps individuals with limited resources with the cost of prescription drugs, deductibles, and copays. |
| Medigap | Also known as Medicare supplement insurance, this covers gaps in Original Medicare coverage and helps pay for costs that Original Medicare does not cover. |
| Medicare savings programs | These are income-based programs that may help pay for Original Medicare premiums, deductibles, and coinsurance payments. CHAMPVA does not help pay for Medicare Part B premiums, which means these programs may help reduce costs for individuals with CHAMPVA. |
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
CHAMPVA provides healthcare payment assistance for the spouses, surviving spouses, or children of disabled veterans.
The coverage can help a person reduce out-of-pocket costs when they are enrolled in Original Medicare (Part A and Part B) or Medicare Advantage (Part C) policies.
CHAMPVA will usually be the second payer on any healthcare costs unless Medicare does not cover them.