CHAMPVA vs. TRICARE: Which One Covers Your Family?

CHAMPVA and TRICARE are not the same program.

TRICARE is a Department of Defense health care program for eligible uniformed service members, retirees, certain family members, survivors, certain former spouses, Medal of Honor recipients and their families, and others registered in DEERS.

CHAMPVA is a Department of Veterans Affairs health benefits program for certain spouses, dependent children, and survivors of Veterans who meet specific service-connected disability requirements.

The biggest thing to know is this: if you qualify for TRICARE, you can't get CHAMPVA. TRICARE says the programs are mutually exclusive, and VA says CHAMPVA eligibility applies only if you don't qualify for TRICARE.

A lot of military and Veteran families hear about both programs and assume they are choosing between two similar health plans.

That is usually not how it works.

TRICARE is tied to military service status, retirement status, survivor status, certain former spouse rules, and DEERS eligibility. CHAMPVA is tied to VA eligibility rules for certain family members of Veterans who are permanently and totally disabled from service-connected conditions, died from a service-connected disability, or were rated permanently and totally disabled at the time of death.

You must also not qualify for TRICARE. VA also notes that, in certain cases, a surviving spouse or dependent child of a service member who died in the line of duty, not due to misconduct, may qualify for CHAMPVA — but not if they qualify for TRICARE.

TRICARE is for eligible people connected to military service and registered in DEERS. TRICARE lists eligible groups that include active duty service members and family members, National Guard and Reserve members and family members, retired service members and family members, survivors, children, former spouses, Medal of Honor recipients and family members, and other eligible groups.

To use TRICARE, you must be registered in the Defense Enrollment Eligibility Reporting System, or DEERS. TRICARE says sponsors are automatically registered, but sponsors must register eligible family members.

Start with this question: Are you eligible for TRICARE through DEERS?

If yes, start with TRICARE. If no, and you are the spouse, dependent child, or survivor of a Veteran who meets the VA service-connected disability requirements, look at CHAMPVA.

TRICARE's getting-started guidance is to confirm eligibility, explore health plan options, decide which plan is right for you, and enroll if required.

For CHAMPVA, VA says you can apply online, by mail, or by fax, and you should include required supporting documents with your application.

CHAMPVA is a cost-sharing program. When you enroll, VA shares the cost of certain health care services and supplies with you.

CHAMPVA covers most health care services and supplies, including family planning and maternity care, hospice care, inpatient care, mental health care, outpatient care and procedures, skilled nursing care, ambulance services, prescribed medical equipment, organ transplants, and prescription medications.

In most cases, CHAMPVA has a $50 deductible each calendar year, or $100 maximum for a family. Beneficiaries generally pay 25% of the CHAMPVA allowable amount, and the yearly household out-of-pocket maximum is $3,000. After that, CHAMPVA pays 100% for covered services.

CHAMPVA does not have a specific provider network.

When looking for a provider, VA says to ask whether the provider "accepts assignment" from CHAMPVA. That means the provider agrees to accept CHAMPVA benefits and charge only the allowable amount.

If a provider doesn't accept CHAMPVA, VA may still cover part of the cost, but you may have to pay out of pocket and file a claim for reimbursement. VA will only pay the allowable amount, so you may be responsible for charges above that amount.

VA also says hospitals and hospital-based providers that accept Medicare must accept CHAMPVA.

TRICARE is not one single plan. The right plan depends on eligibility, status, location, and life situation.

TRICARE Prime is a managed care option available in Prime Service Areas, and enrollment is required. Active duty service members have to enroll in TRICARE Prime. Others may be able to choose between TRICARE Prime and TRICARE Select.

TRICARE Select is a self-managed preferred provider organization plan available in the United States. Enrollment is required, and beneficiaries must show as eligible for TRICARE in DEERS.

TRICARE For Life is Medicare-wraparound coverage for people who are TRICARE-eligible and have Medicare Part A and Part B.

For CHAMPVA, dependent children generally lose benefits at age 18 unless they are enrolled in high school, college, or another educational institution. If enrolled in school, they may keep CHAMPVA benefits between ages 18 and 23, but they must provide school certification and recertify at least once a year.

For TRICARE, unmarried biological children, adopted children, and stepchildren are generally eligible until age 21, or age 23 if in college. Eligibility may extend beyond those limits for a severely disabled child, and at age 21 or 23, the child may qualify to purchase TRICARE Young Adult.

For CHAMPVA, if you are eligible for Medicare, you must have Medicare Part A and Part B to get or keep CHAMPVA benefits. A Medicare Advantage plan also meets this requirement. VA says you do not need Medicare Part D to get CHAMPVA.

CHAMPVA is secondary to Medicare. Medicare pays first, and CHAMPVA may cover costs that remain after Medicare pays. CHAMPVA does not cover Medicare Part B premiums.

For TRICARE, TRICARE For Life is the Medicare-wraparound option for people who are TRICARE-eligible and have Medicare Part A and Part B.

If you have no other health insurance, CHAMPVA can be your primary insurance. If you have other health insurance, CHAMPVA is usually secondary. VA says CHAMPVA is always secondary except to Medicaid, State Victims of Crime Compensation Programs, Indian Health Services, and supplemental CHAMPVA policies.

If you have other health insurance, your provider should bill that insurance first, then submit the Explanation of Benefits from that insurance along with the claim to CHAMPVA. VA also says it is important to notify CHAMPVA right away if your other health insurance changes, because missing or outdated insurance information can delay or stop claim payments.

In most cases, VA says your provider should file CHAMPVA claims for you. If you pay out of pocket, you may need to file a claim for reimbursement. Claims must be filed within one year of the date of care, or within one year of leaving the hospital for inpatient care.

VA says CHAMPVA claims take about 90 days to process. If more information is needed, VA will send an Explanation of Benefits or a letter explaining what documents are needed.

For most families, the first question is not "Which one is better?"

The first question is: Which one are you eligible for?

If you are eligible for TRICARE, start there. If you are not eligible for TRICARE, and you are the spouse, dependent child, or survivor of a Veteran who meets the VA service-connected disability requirements, CHAMPVA may be the program to look at.

The Veterans Phalanx is not VA, TRICARE, or a claims representative. This guide is meant to help families understand the difference and know where to start. For final eligibility decisions, applications, plan selection, and coverage questions, use the official VA CHAMPVA and TRICARE resources.