CHAMPVA - Benefits and risks

Posted on: Thursday, December 08, 2011
CHAMPVA - Benefits and risks


I hope you are well. I'm rated at 100 % I/U and I'm set to go on Medicare this January when I turn 65. I have been receiving social security disability, it is my understanding that I'm automatically enrolled in the Medicare program at 65 yrs of age. I have medical coverage for both my wife and I through my job that I'm retired from. The insurance keeps going up on a regular basis. I know I'm covered by the VA. Would it make sense to apply to Champva for my wife and for me to cancel my private insurance and get all my medical treatment from the VA? Are there any draw - backs associated with Champa? Do you know if she could keep her same doctors? I have no problem going to the VA for my medical treatment. I live in the Boston area and think the medical treatment at the VA is 1st class. Thanks for any light you can shed on this and as always, thanks for what you do. USMC Viet Nam 67-68


The choices you have before you are challenging. You're very fortunate to have to choose between so many good health insurance options.

If you receive Social Security Disability (SSDI) you should already be enrolled in Medicare. I'd want to look into that were I you.

As you are 100% TDIU there is often some confusion when applying for CHAMPVA. Be prepared for a routine of questions and answers and be prepared to have to deal with the bureaucracy of it all. It's worth the effort.

The decision is a personal one and there isn't a single correct choice for all veterans who are in your situation. It will all depend on what you're comfortable with, how much risk you can tolerate and what you can afford.

The risk part of the equation is that to give up private sector civilian coverage may restrict the availability of some physicians in the future. VA doctors will see you only in the VA setting. Not all doctors will accept Medicare and CHAMPVA patients. Your spouse should ask if her preferred providers will accept the lower CHAMPVA rates. Many physicians aren't familiar with CHAMPVA so this may take some effort by you. Any provider who accepts Medicare will also accept CHAMPVA. (All civilian hospitals do accept Medicare and CHAMPVA.)

CHAMPVA is very good health care coverage once the appropriate physician is found and such things as prescriptions at the mail order pharmacy are established. I don't know of anyone who is unhappy with CHAMPVA once the usual application process is complete and the patient is settled into the routine.

Medicare Part A and Part B will often compliment the high quality VA care we receive. It's usually advised that veterans not use Medicare Part D as the VA pharmacy benefit will cover almost every possible medication.

Personally, I believe that veterans who have the choice may abandon private sector health insurance and save themselves that significant expense. I'd recommend that the veteran opt for Part B so that if necessary, the veteran may see a civilian provider when convenient. I recommend against purchase of a supplemental policy. The supplemental policies can be quite expensive over the long run.

I believe that veterans who are eligible for VA care should plan catastrophic event care to be managed by VA. This requires some thought and "what if" planning. Then any money that would otherwise be paid to a supplemental insurer should be saved in an account that you set aside for any out of pocket medical expenses that may arise. This savings could also be used for the deductibles that you'll see from CHAMPVA.

With some advance planning you'll have health care that is excellent and cost effective.

Complete Mailbag


Submitted by Harriatt on Wed, 2015-09-02 15:10

I am having trouble with a doctors billing ofc.. I have ChampVA(my spouse is a veteran 100% disability Vietnam with agent Orange/Parkinson. The billing ofc. says they have billed Medicare and Champ Va, But champ Va cannot fine a claim filed by Dr. Billing ofc.. I have repeatedly ask Doctors Billing Ofc to resend but now they say it is my responsibility..and it is ChampVa will not covering it. I have not had any problems with other Doctors Billing offices.. Help!!

Submitted by Jim Strickland on Thu, 2015-12-31 15:30

The rules covering Medicare and CHAMPVA are incredibly complex.

Without knowing what the service is that's being billed, we have no way of knowing whether it's covered by one or both of the insurers.
There are some services covered by Medicare and not by CHAMPVA.

Your best bet is to look over the Fact Sheet here:

Although it is very complex, you'll have to try to sort out the rules that apply to you.