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How Will Medicare Advantage Work With CHAMPVA?

Page Reviewed / Updated - August 28, 2020

Sold by Medicare-approved private insurance companies, Medicare Advantage plans help seniors pay for expenses not covered by Original Medicare. People who are eligible for VA-administered CHAMPVA health benefits programs can use their Medicare Advantage plans in tandem with CHAMPVA to reduce medical expenses. Health care providers bill Medicare before they bill CHAMPVA.

What Is CHAMPVA?

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a Department of Veterans Affairs (VA) health care program managed by the Veterans Health Administration Office of Community Care (VHA OCC). Seniors enrolled in CHAMPVA benefit from VA payments toward some types of treatments, medicines, limited dental services and medical supplies. Diabetes patients also get vision benefits.

Only certain people are eligible for CHAMPVA. These individuals include:

  • Spouses and children of veterans with permanent service-related disabilities
  • Surviving spouses and children of veterans who died from service-related disabilities
  • Surviving spouses and children of veterans who were permanently and completely disabled when they died
  • Surviving spouses and children of military members who died in the line of duty

Family members of military personnel whose deaths in the line of duty were the result of misconduct are usually eligible for Tricare, rather than CHAMPVA. To claim CHAMPVA benefits, eligible seniors must enroll in Medicare Part A and, almost always, Part B. Individuals can use CHAMPVA coverage in tandem with Medicare Parts A and B, or they can combine CHAMPVA with Medicare Part C.

Medicare Advantage Plan Benefits

Also known as Medicare Part C, Medicare Advantage Plans are sold by Medicare-approved private insurance companies. These insurers contract with Medicare to provide seniors with Medicare Parts A and B, along with a range of additional benefits. The majority of Medicare Advantage Plans also include prescription drug coverage, eliminating the need for supplementary Medicare Part D plans.

Seniors often prefer Medicare Advantage Plans over separate Medicare Part A, B and D plans because Medicare Advantage Plans tend to be cheaper overall and are less confusing to use. Medicare Advantage Plans are not the same as Medigap plans. Also known as Medicare Supplement plans, Medigap insurance policies supplement, rather than incorporate, Medicare Parts A and B.

Medicare Advantage Plan options include Health Maintenance Organization (HMO) plans, Special Needs Plans (SNPs), Private Fee-for-Service (PFFS) plans and Preferred Provider Organization (PPO) plans. All of these plans are compatible with CHAMPVA, and health care providers bill them before they bill the VA.

Out-of-Network Providers and CHAMPVA

Doctors sometimes refer patients with HMO or PPO Medicare Advantage Plans to out-of-network providers. At other times, individuals with Medicare Part C plans need urgent medical care while visiting another state. In these situations, seniors sometimes end up accruing substantial out-of-pocket medical expenses.

Seniors who are enrolled in CHAMPVA, in addition to their HMO or PPO Medicare Advantage Plans, can use CHAMPVA to reduce these additional expenses. Out-of-network health care providers who accept regular Tricare or Medicare patients usually also accept CHAMPVA patients, making them a good option for individuals who unexpectedly require health care while away from home. CHAMPVA has a $3,000-per-year catastrophic cap, which seniors can take advantage of when major health care emergencies occur.