CHAMPVA - Eligibility, Costs, and How to Apply

CHAMPVA at a glance

CHAMPVA is VA-provided health coverage for certain spouses, dependents, and survivors of disabled or deceased Veterans who are not eligible for TRICARE.

Who's eligible?

• Spouse or child of a Veteran rated Permanent & Total (P&T) for a service-connected condition, and not eligible for TRICARE.
• Surviving spouse or child of a Veteran who died from a service-connected disability, or who was P&T at death.
• In some cases, surviving spouse/child of a servicemember who died in the line of duty (but TRICARE-eligible survivors use TRICARE, not CHAMPVA).
• Primary Family Caregivers (PCAFC) who meet program rules and have no other health insurance.

Children 18–23 can remain covered while in school (annual student certification). A spouse who remarries at/after 55 generally keeps eligibility; remarriage earlier ends CHAMPVA (until that marriage ends).

Who's not eligible?

• Anyone eligible for TRICARE.
• People eligible for Medicare who don't keep the required parts (see below).
• Stepchildren who leave the Veteran's household (for example, after divorce/remarriage).

Costs & how billing works

• Deductible: $50 per beneficiary per year, capped at $100 per family (outpatient).
• Cost-share: After the deductible, you pay 25% of the allowed amount; CHAMPVA pays 75%.
• Catastrophic cap: $3,000 per family each calendar year — after that, CHAMPVA pays 100% of the allowed amount for the rest of that year.
• Inpatient/other services: Cost-share can differ. Many preventive services and some VA-provided CITI care have no cost share.

Medicare & CHAMPVA

If you're eligible for Medicare, you generally must have Part A and Part B (or a Medicare Advantage plan) to get/keep CHAMPVA. Medicare pays first; CHAMPVA typically covers much of the remainder. Limited grandfathered exceptions exist for certain people 65+ tied to specific dates.

What CHAMPVA covers (high level)

• Outpatient & inpatient care, surgeries, mental health, maternity, skilled nursing, ambulance, DME, and more.
• Pharmacy: Meds by Mail provides $0 maintenance meds (if you have no other RX plan). For urgent meds, you can use the OptumRx retail network — you typically pay 25% of the allowed amount.
• Dental & vision: Limited under CHAMPVA; optional discounted dental via VADIP. Glasses/contacts generally not covered unless medically indicated.
• Overseas: Covered similarly to U.S. care; reimbursement is based on reasonable & customary charges in U.S. dollars.

How to apply

1. Apply online: Use VA's CHAMPVA application (VA Form 10-10d) on VA.gov and upload documents in-app.
2. Or apply by mail: Complete VA Form 10-10d and mail to:
   VHA Office of Integrated Veteran Care
   CHAMPVA Eligibility
   P.O. Box 137, Spring City, PA 19475
   Always confirm the address on the current VA form or VA.gov page.
3. Include required docs as applicable:
   • Other Insurance / Medicare? VA Form 10-7959c (OHI Certification) and front/back of insurance / Medicare card(s). If 65+ and not eligible for Medicare, include the SSA “notice of disallowance.”
   • Spouse/child proofs: Marriage certificate/civil union or child's birth/adoption papers; stepchild requires proof of marriage to the child's other parent.
   • Students 18–23: Annual school enrollment letter.

After you apply

You'll receive a CHAMPVA ID card and the CHAMPVA Guide by mail if approved. Providers can bill CHAMPVA directly. If you need to self-file a claim:

• Online: File via VA.gov.
• By mail (claims): Send VA Form 10-7959a and supporting docs to:
  VHA Office of Integrated Veteran Care
  CHAMPVA Claims
  P.O. Box 500, Spring City, PA 19475

Pros & cons

Quick links

Frequently asked questions

Note: Addresses for eligibility vs. claims differ. Always use the address on the current VA form or VA.gov page. This guide is informational, not legal/benefits advice.