Can a spouse use CHAMPVA instead of private employment insurance?

Question

My wife is now eligible for CHAMPVA.  She is under 65 and working.

Does she have to maintain her private insurance through her employer in order to use CHAMPVA?  I'm thinking it would be cost effective to drop her employer's insurance and pick up a CHAMPVA Supplemental policy (those costs would be less than the costs of her policy with her employer).

Jim's Reply

No...in broad terms she isn't required to keep the more expensive private insurance. However, in the most practical terms, she will want to look at the advantages and disadvantages of each approach to her health insurance. If she has employer based health insurance, she may pay a fairly high premium but in return get better than average services. Every physician is happy to accept employer based health insurance. Not every physician is as thrilled to deal with government programs like Medicare, Medicaid, CHAMPVA, etc.

Using CHAMPVA requires that she find a physician that accepts the insurance. Physicians who accept Medicare are generally familiar with CHAMPVA and will help you get started with filing for visits and so on. There are a number of doctors and practices that don't accept Medicare so they won't accept CHAMPVA either.

Every hospital accepts Medicare so they all accept CHAMPVA. By now you may be thinking that the spouse of the disabled veteran has more health care options than the veteran does. You're right. The CHAMPVA beneficiary can choose any physician who accepts Medicare, visit specialists without referral to a "specialty clinic" 100 miles away and civilian pharmacies accept CHAMPVA so there's local service provided. Contrast that to the draconian restrictions on how a veteran is forced into the convoluted VHA system and they're light years apart.

Be on the alert for the doctor within the hospital who doesn't accept Medicare; that doctor won't accept CHAMPVA and you may or may not know what's happening until it's too late and you get the bill. CHAMPVA is as good as insurance gets if you plan carefully when choosing a doctor, pharmacy and hospital. CHAMPVA has low deductibles and covers almost everything from preventive care and exams to all sorts of medications.

Once you're established, CHAMPVA seems worry free. In your wife's case she may want to get the CHAMPVA set up and start talking with her doctor to see if they'll accept it...and then go from there.

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