Dependents and survivors of veterans may be eligible for health insurance benefits through programs offered by the Department of Veterans Affairs (VA) and the Department of Defense (DoD). These benefits can help cover medical costs, providing essential support for families who have served or are currently serving in the military. Two of the primary health insurance options available are CHAMPVA and TRICARE.

In this blog, we will explain what CHAMPVA and TRICARE are, who is eligible for these programs, the benefits they provide, and how dependents and survivors can enroll.

Overview of Health Insurance Options for Dependents and Survivors

The VA and DoD offer two main health insurance programs to provide coverage for dependents and survivors of veterans:

1. CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs)
2. TRICARE

Both programs are designed to ensure that eligible family members have access to quality healthcare, but they differ in terms of eligibility, coverage, and administration. Understanding the differences between these programs is key to determining which one is right for you and your family.

What Is CHAMPVA?

CHAMPVA is a comprehensive health insurance program that provides coverage to the spouses, children, and surviving family members of certain veterans. CHAMPVA is managed by the VA and is intended for families who do not qualify for TRICARE. It helps cover the cost of healthcare services, including doctor visits, hospital stays, prescription medications, mental health services, and more.

Eligibility for CHAMPVA

To qualify for CHAMPVA, you must meet one of the following criteria:

• You are the spouse or child of a veteran who has been rated permanently and totally disabled due to a service-connected condition.
• You are the surviving spouse or child of a veteran who died from a service-connected disability.
• You are the surviving spouse or child of a veteran who was rated permanently and totally disabled at the time of death, even if the cause of death was not service-connected.
• You are the surviving spouse or child of a service member who died in the line of duty, and you are not eligible for TRICARE.

Benefits Covered Under CHAMPVA

CHAMPVA provides a wide range of healthcare benefits, including:

• Doctor visits (primary care and specialist services)
• Hospital stays and surgical procedures
• Prescription medications
• Mental health services (therapy, counseling, and inpatient treatment)
• Preventive care (vaccinations, screenings, and wellness exams)
• Medical equipment and supplies (e.g., wheelchairs, oxygen tanks)

CHAMPVA beneficiaries typically share the cost of care, with CHAMPVA covering 75% of the allowable amount and beneficiaries responsible for the remaining 25% (known as cost-sharing). There is also an annual out-of-pocket maximum, which limits the amount beneficiaries need to pay each year.

How to Enroll in CHAMPVA

To apply for CHAMPVA, eligible dependents and survivors must complete VA Form 10-10d (Application for CHAMPVA Benefits). The application can be submitted via mail, along with required documents, such as:

• Proof of marriage or birth certificates (for spouses and children)
• VA disability rating decision or veteran’s death certificate

Mail the application to: CHAMPVA P.O. Box 469028 Denver, CO 80246-9028

You can download the application form from the VA’s website, or you can call 1-800-733-8387 to request a copy by mail.

What Is TRICARE?

TRICARE is a health insurance program administered by the Department of Defense (DoD) that provides coverage to active-duty service members, retirees, and their families. Unlike CHAMPVA, which is available through the VA, TRICARE is available primarily to dependents and survivors of service members who are currently serving or have served in the military.

Eligibility for TRICARE

Eligibility for TRICARE is determined by the sponsor’s status (the service member or veteran). The following dependents and survivors may be eligible:

• Spouses and children of active-duty service members
• Spouses and children of retired service members
• Surviving spouses and children of service members who died in the line of duty
• Surviving spouses and children of service members who died from a service-connected condition
• Medal of Honor recipients and their families

Benefits Covered Under TRICARE

TRICARE offers a variety of plans, each providing different levels of coverage and benefits. Some of the most common TRICARE plans include:

• TRICARE Prime: An HMO-style plan that requires enrollment and offers care through a network of healthcare providers. Beneficiaries generally have lower out-of-pocket costs but need referrals to see specialists.
• TRICARE Select: A PPO-style plan that offers more flexibility in choosing providers but may have higher out-of-pocket costs than TRICARE Prime. No referrals are needed to see specialists.
• TRICARE for Life: Secondary coverage for Medicare-eligible beneficiaries. TRICARE for Life works in conjunction with Medicare Part A and Part B to cover healthcare costs.

TRICARE covers a broad range of healthcare services, including:

• Medical and surgical care
• Hospital stays
• Prescriptions
• Mental health services
• Maternity care
• Preventive services (immunizations, screenings, and wellness exams)

How to Enroll in TRICARE

Enrollment in TRICARE depends on the sponsor’s military status and the type of plan you are eligible for. Here’s how you can get started:

1. Visit the TRICARE website at tricare.mil to explore the available plans.
2. Register in the Defense Enrollment Eligibility Reporting System (DEERS). DEERS is the DoD’s database for managing eligibility and enrollment. Dependents and survivors must be registered in DEERS to receive TRICARE benefits.
3. Choose a TRICARE plan and complete the necessary enrollment steps. For TRICARE Prime, beneficiaries must enroll online, by mail, or by phone. TRICARE Select does not require an official enrollment but does require annual fee payments.

For assistance with enrollment, beneficiaries can contact the TRICARE regional contractor serving their area or call the TRICARE Support Center.

Key Differences Between CHAMPVA and TRICARE

It is important to understand the differences between CHAMPVA and TRICARE to determine which program is right for you:

Tips for Managing Health Insurance Enrollment

Navigating the enrollment process for health insurance can sometimes be complex. Here are some tips to help dependents and survivors manage their applications smoothly:

1. Gather Required Documentation Early

Both CHAMPVA and TRICARE require various forms of documentation to verify eligibility, such as marriage certificates, birth certificates, and VA disability ratings. Gather these documents early to ensure a smooth application process.

2. Stay Informed About Program Changes

Eligibility criteria and benefits can change over time, so it’s important to stay informed about any updates. Regularly check the VA and TRICARE websites for the latest information on benefits, plan changes, and enrollment deadlines.

3. Use Online Resources and Support Services

The VA and TRICARE offer online resources to help you understand the programs and manage your benefits. If you need additional assistance, consider reaching out to a VA representative or TRICARE Support Center for guidance.

4. Update Your Information in DEERS Regularly

If you are a TRICARE beneficiary, it’s essential to keep your information up to date in DEERS. Report any changes to your address, family status, or contact information promptly to avoid interruptions in coverage.

Conclusion

Health insurance is a vital part of maintaining the well-being of dependents and survivors of veterans. Programs like CHAMPVA and TRICARE provide comprehensive coverage, ensuring that families have access to quality healthcare services. Understanding eligibility requirements, enrollment procedures, and benefits will help you make the best choice for your family’s needs.

If you or your family members are eligible, don’t hesitate to take advantage of these valuable benefits. Contact the VA or TRICARE to learn more about how to enroll, and make sure you have the coverage you need to stay healthy and secure.