CHAMPVA Eligibility
To be eligible for CHAMPVA, you cannot be eligible for TRICARE, and you must be in one of these categories:
- 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.
- The surviving spouse or child of a Veteran who died from a VA-rated service-connected disability.
- The surviving spouse or child of a Veteran who was at the time death rated permanently and totally disabled from a service-connected disability.
- 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.
Impacts on CHAMPVA Eligibility
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:
- Obtain a Social Security number for the newborn by applying to the nearest Social Security Administration office.
- 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.
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 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.
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 benefits.
Beneficiaries Aged 18 to 23 years
When a CHAMPVA-eligible beneficiary turns 18 years old, CHAMPVA requires the beneficiary to submit proof to CHAMPVA of full-time enrollment in an accredited educational institution for benefits to continue. Information on submitting proof of enrollment can be found on our School Enrollment Certification Requirements for CHAMPVA Benefits fact sheet.
Fact Sheet: 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 Primary Family Caregiver benefits, please visit our Information for Caregivers page and the VA Caregiver Support Program website.
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. You are not required to enroll in Medicare Part D in order to become or remain CHAMPVA eligible.
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 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.
- 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.
NOTE: If you meet the criteria for CHAMPVA eligibility and are not entitled to Medicare Part A, you must submit a "Notice of Disallowance" from the Social Security Administration—indicating why you do not qualify for Medicare benefits—along with your CHAMPVA application.
Medicare with Certain Disabilities
Eligibility for CHAMPVA benefits can be impacted by approval of disability benefits. If you are approved by Social Security Administration (SSA) for disability, you may become entitled to Medicare Part A: Premium-free hospital insurance. To continue your CHAMPVA eligibility, you must enroll in, and remain enrolled in, Medicare Part B: Outpatient insurance, while you are entitled to Part A.
If you qualify for disability under End Stage Renal Disease (ESRD), you must apply for Medicare benefits. Medicare coverage begins with the third (3rd) month after the month in which a course of maintenance dialysis begins.
Termination of enrollment in Medicare Part B may result in loss of CHAMPVA benefits effective with the date of such termination.
To determine CHAMPVA eligibility, SSA documentation of enrollment in both Medicare Part A and Medicare Part B is required. Acceptable documentation includes a copy of the beneficiary Medicare card, a letter from the SSA that provides the dates of Medicare eligibility, or any valid verification from SSA.
If you do not have enough work quarters to qualify for Part A, a SSA “Notice of Disallowance” is required indicating you are not eligible for Medicare benefits under any social security number.
CHAMPVA is NOT considered primary health coverage.
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