Page Reviewed / Updated - Mar. 2016
CHAMPVA is a health insurance and care program provided by the VA for the families of veterans permanently disabled or killed in the line of duty who are not eligible for TRICARE. CHAMPVA for Life (CFL) is an extension of CHAMPVA benefits to those 65 years and older. CFL serves as the secondary payer to minimize out-of-pocket expenses by covering the Medicare’s coinsurance and deductibles.
CHAMPVA is an acronym for Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).
Like most health insurance, CHAMPVA for Life (CFL) is not a solution for long term or non-medical, aging care. However, it does help to cover some of the cost. Much like Medicare Supplemental insurance, CFL picks up where Medicare leaves off. CFL will pay co-insurance and deductibles but does not pay for monthly Medicare Part B premiums. Follows are CFL's benefits for specific types of long term care.
Assisted Living - CFL does not pay for assisted living or senior living care as defined by assistance with activities of daily living such as bathing, dressing, feeding or supervision of the cognitively impaired. This type of care is sometimes called custodial care and is not a covered benefit.
Skilled Nursing Home Care - CFL will pay for skilled nursing care to an extent. Like Medicare, there must be a medical condition that was treated in a hospital for 3 consecutive days and the senior must be admitted to a skilled nursing facility within 30 days. Medicare has a 100-day limit on skilled nursing and CFL will be the primary payer after that 100-day limit, but will not cover the full amount. Co-payment in the amount of $100-$200 / day should be expected and therefore nursing home care is a large out-of-pocket expense and CHAMPVA is not a long term solution.
Home Health Care - CHAMPVA will cover skilled care for a homebound person, but not personal / custodial care at home.
Adult Day Care - CFL does not pay for either medical care or supervision in adult day care centers.
Hospice - With prior authorization and coupled with Medicare's benefits, CHAMPVA for Life will cover hospice care for terminally ill persons with a life expectancy of less than 6 months.
Alzheimer's Care - CFL does cover inpatient mental health care which might be necessary for persons with advanced stage forms of dementia related to Alzheimer’s. Again, this is not a long term solution. Nor are CFL's benefits different for individuals with Alzheimer's or dementia specifically.
Some of the following eligibility requirements refer to the veteran and others to their spouse.
Age - The spouses of veterans must be at least 65 to be eligible for CHAMPVA for Life. Seniors that turn 65 before June 5, 2001 require only Medicare Part A. Those who turn 65 after that date are required to have both Medicare A & B.
Disabilities Requirements - The spouse of a veteran qualifies if the veteran meets one of the following three conditions:
1) Has a service-connected disability rating of 100%, meaning they are permanently and totally disabled or died with that rating.
2) Has died from a VA-rated service connected disability
3) Has died in the line of duty. Note that often these individuals are eligible for TRICARE and if so that disqualifies them for CHAMPVA.
Marital Status - A spouse will lose their eligibility for CHAMPVA for Life if they become divorced from the veteran. A widow or widower that remarries will also lose their eligibility. However, should the re-marriage terminate, they would then become eligible again.
Veteran Status - Veterans cannot have been dishonorably discharged. Also read the Disability Requirements above.
Factors Not Affecting Eligibility - The financial resources and monthly income of the spouses of a veterans or of the veteran him / herself does not impact eligibility. Nor is their geographic location or state of residence a factor in determining eligibility.
The types of care which are covered are discussed in the Overview Section above.
In addition to care, CFL also covers some durable medical equipment (DME) and home care supplies. The reasoning behind what is and what is not covered is not intuitive to policyholder. One should always check with CFL directly to determine if an item will be covered. All DME and supply purchases must be medically necessary as determined by a doctor and larger purchases require pre-authorization.
Benefits payments are made directly to the medical providers. Veterans at no point receive cash or checks from CHAMPV for Life.
There are no enrollment fees or monthly premiums for CFL. However, the spouses of veterans must purchase Medicare Part B and pay those monthly premiums to be eligible for CFL. In addition, they are responsible for co-pays.
If the individual is already a CHAMPVA beneficiary, then when they turn 65, they should provide CHAMPVA a copy of their Medicare card that shows their enrollment in Medicare Parts A & B. They also are required to provide information about any other health insurance under which they are covered. Once these forms are processed, a new CHAMPVA card is issued with an extended expiration date.
If the individual is not a CHAMPVA beneficiary, then they must complete an application, a form detailing any other health insurance they have and provide a copy of their Medicare Part A & B card. Providing copies of optional documents such as marriage licenses and terminations or the veteran’s VBA disability rating can greatly accelerate the processing time.
Detailed information regarding the application process is available on this webpage on the VA.gov website.