How to apply for CHAMPVA — health coverage for the spouse, children and survivors of a permanently and totally disabled veteran (VA Form 10-10d)
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) shares the cost of health care for the spouse or dependent child of a veteran rated permanently and totally disabled from a service-connected disability, and for the surviving spouse or child of a veteran who died from a service-connected disability or who was rated permanently and totally disabled at death. You cannot have CHAMPVA if you are eligible for TRICARE. Apply online or on VA Form 10-10d; anyone eligible for Medicare must have Parts A and B to get or keep CHAMPVA. VA mails a welcome letter and ID card on approval; CHAMPVA then pays after Medicare or other insurance.
What you'll need
- VA Form 10-10d (Application for CHAMPVA Benefits), or the online application
- VA Form 10-7959c (Other Health Insurance Certification) with copies of your health insurance, Medicare and Medicare Part D cards, if you have them
- Marriage certificate, civil union certificate or common-law affidavit for a spouse; birth certificate or adoption papers for a child; proof of the parents' marriage for a stepchild
- School certification letter for a child aged 18 to 23 in school; a disability ("helpless child") rating letter for a child unable to support themselves since before 18
- Social Security Administration notice of disallowance if you are 65 or older and not eligible for Medicare
Step-by-step
Step 1: Confirm eligibility
You may be eligible if you are the spouse or dependent child of a veteran rated permanently and totally disabled from a service-connected disability; the surviving spouse or dependent child of a veteran who died from a service-connected disability; or the surviving spouse or dependent child of a veteran who was rated permanently and totally disabled at the time of death. In some cases the survivors of a service member who died in the line of duty, not due to misconduct, also qualify. "Permanent and total" means a 100% service-connected rating that VA does not expect to improve — a 100% rating alone is not enough. You must not be eligible for TRICARE.
Reference: https://www.va.gov/family-and-caregiver-benefits/health-and-disability/champva/
Step 2: Rules that keep or end coverage
A surviving spouse who remarries at 55 or older keeps CHAMPVA; one who remarries before 55 loses it on the date of remarriage and can regain it the month after that marriage ends. Children are covered to 18, to 23 while enrolled in school (certified every year) and until marriage, or indefinitely if permanently unable to support themselves because of a disability that began before 18. A stepchild who leaves the veteran's household through divorce or remarriage loses eligibility. If both spouses are veterans, each may qualify for VA health care and CHAMPVA and choose either at each visit. A newborn needs a Social Security number and must be added as the veteran's dependent at a VA regional office before CHAMPVA can pay claims, so apply promptly. Primary family caregivers approved under the Program of Comprehensive Assistance for Family Caregivers who have no other health insurance are enrolled automatically.
Reference: https://www.va.gov/family-and-caregiver-benefits/health-and-disability/champva/
Step 3: Medicare — Parts A and B are required when you are eligible
If you are eligible for Medicare at any age, you must have Medicare Part A and Part B (a Medicare Advantage plan also satisfies this) to get or keep CHAMPVA. Submit copies of the front and back of your Medicare card — and your Part D card if you have one — with the application. If you are 65 or older and not eligible for Medicare under anyone's record, submit the Social Security Administration's notice of disallowance instead. Medicare pays first and CHAMPVA pays after it.
Reference: https://www.va.gov/family-and-caregiver-benefits/health-and-disability/champva/
Step 4: Apply online, by mail or by fax
Apply online at VA.gov and attach your documents, or complete VA Form 10-10d and VA Form 10-7959c (other health insurance) and mail them with copies of your supporting documents to VHA Office of Community Care, CHAMPVA Eligibility, PO Box 137, Spring City, PA 19475, or fax them to the number on the form. Optional documents such as the marriage certificate, the child's birth certificate, school certification or a divorce decree or death certificate for an ended remarriage speed processing. Questions: 800-733-8387 (TTY 711).
Step 5: After approval — cost sharing, providers and prescriptions
VA mails a welcome letter and a CHAMPVA ID card. CHAMPVA is cost-sharing coverage: for most care you pay an annual outpatient deductible of $50 per person ($100 per family) and 25% of the CHAMPVA allowable amount, up to a $3,000 annual catastrophic cap per family, after which CHAMPVA pays 100% of allowable charges for the rest of the year. You can use any provider who accepts CHAMPVA (most Medicare providers do); CHAMPVA pays after Medicare and other health insurance. Beneficiaries with no other prescription coverage can get maintenance medicines by mail at no cost through Meds by Mail. Report changes in insurance, school status or address after you enroll.
Reference: https://www.va.gov/family-and-caregiver-benefits/health-and-disability/champva/
Critical tips
- Check the veteran's rating letter for the words "permanent and total" — if the veteran is rated 100% but not permanent and total, the family is not eligible yet.
- CHAMPVA is secondary to Medicare and other insurance; you keep your other coverage and CHAMPVA pays what it does not.
- CHAMPVA beneficiaries can buy discounted dental insurance through the VA Dental Insurance Program (VADIP).
- Children aged 18 to 23 must send a school certification letter every year or coverage stops.
- A county veterans service officer can help with the application for free: warriorsfund.org/find-cvso.
- In crisis: dial 988 then press 1, or text 838255.