Know the Rules: ChampVA 100% Coverage for Veteran Spouses

The Civilian Health and Medical Program of the Department of Veteran's Affairs (VA) (CHAMPVA) provides veteran health insurance for spouses of military personnel who meet specific eligibility requirements. These benefits help protect the spouses and/or children of disabled personnel both during the disabled veteran’s lifetime and after he/she has passed on.

However, while CHAMPVA can provide excellent benefits, it alone may not be enough to provide the comprehensive coverage that some military spouses need. If your clients or their spouses have CHAMPVA, it’s up to you as their insurance agent to inform them of their veteran health insurance options, and often, describe why Medicare Supplement insurance is necessary for total health coverage.

CHAMPVA Requirements

CHAMPVA is a type of veteran health insurance provided to the spouses of service personnel who are deemed 100 percent service-connected disabled. Meeting this requirement usually involves diagnosing service personnel with a combination of health conditions that may include diabetes, heart conditions, hearing loss, and more. Different percentages of disability are applied to a person based on his/her unique health condition, but only service people deemed 100 percent disabled qualify for CHAMPVA.

It’s also important to note that those eligible for CHAMPVA must not be eligible for Tricare.

CHAMPVA Coverage

When service personnel qualify for CHAMPVA, their spouses receive insurance benefits. An important distinction is that while the active service person will receive health benefits through the VA, only the spouse receives CHAMPVA benefits.

In most cases, VA benefits are enough to cover the service personnel’s medical expenses. However, spousal coverage through CHAMPVA is more limited. Although CHAMPVA covers the spouse for life and allows spouses to receive care at any hospital or facility in the Medicare program, CHAMPVA comes with certain restrictions:

  • $50 deductible
  • $3,000 out-of-pocket cap

In addition, the disabled veteran themselves have specific coverage restrictions. Namely, VA benefits can only be claimed at VA-approved facilities. Although the CHAMPVA-covered spouse may go to any civilian hospital, the veteran’s choices are limited.

This benefit restriction on top of the coverage limitations of CHAMPVA make Medicare supplements a common option for disabled veterans and their spouses looking for comprehensive insurance coverage.

Selling Medicare Supplements

As CHAMPVA has some limits, many who receive its benefits elect to purchase supplemental Medicare insurance. This allows veterans to receive services in more convenient, citizen health facilities as well as filling in the gaps that CHAMPVA doesn’t cover.

So, when dealing with clients who receive CHAMPVA benefits, there are several important selling points for agents to remember:

  • CHAMPVA coverage includes deductibles and out-of-pocket costs – these costs can be offset by Medicare supplement plans with rates that may be more affordable to the beneficiaries financial situation

  • Medicare supplements give disabled veterans access to civilian health facilities, removing the inconvenience of seeking out VA hospitals

  • Although free for qualifying spouses, CHAMPVA coverage is limited – Medicare Parts A and B are necessary to provide the full range of coverage required by most individuals as they age

Speak with your clients about their options regarding supplemental Medicare coverage. In many cases, they may not be aware of CHAMPVA’s limitations and will want to stick with the free benefits they receive. While possible for some, agents should stress the drawbacks of this limited coverage and detail how supplemental Medicare plans can offer more comprehensive care.

 

More information: VHA Office of Community Care
Medicare and CHAMPVA Fact Sheet


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