
CHAMPVA and Medicare: Simplified
When you are trying to understand health insurance options like CHAMPVA and Medicare, things can get confusing, Civilian Health and Medical Program of Departments of Veterans Affairs is a health insurance program for the homies of veterans who are either permanently disabled or have passed away due to service-related injuries. On the other hand, Medicare is a federal health insurance program mainly for individuals over 65 or those with certain disabilities. Let’s break it down in a way that makes it easier to understand.
Who Qualifies for CHAMPVA?
CHAMPVA is a health insurance program for specific family members of veterans. Hereâs who can qualify:
Spouse, widower, or child of a veteran with permanent service-connected disabilities: If your spouse (or parent) is a veteran who became totally and permanently disabled due to an injury from their military service, you qualify for CHAMPVA.
Spouse or parent died in active military duty: If your spouse or parent passed away while serving in the military, you qualify for CHAMPVA.
Your spouse was considered totally and permanently disabled when they passed away: If your spouse was already determined to be permanently disabled from a service-related injury when they passed away, you also qualify for CHAMPVA.
For children, the rules are a bit different:
- You can qualify for CHAMPVA until you’re 18 years old unless you’re a full-time student.
- If you’re a student only, you can stay on CHAMPVA until you turn 23.
- If you get married before turning 18 or 23, you will no longer qualify.
Please Note:Â
If you already qualify for Tricare for Life, another insurance program for military families, you cannot qualify for CHAMPVA.
What Happens When Youâre Medicare Eligible?
Medicare is the government health insurance program that is mostly for people over 65 or younger with certain disabilities. When you become eligible for Medicare, here’s how it affects your CHAMPVA:
- You must get Medicare Parts A & B: To stay on CHAMPVA, you must sign up for both Medicare Part A (hospital coverage) and Medicare Part B (doctor visits and outpatient care).
- If you don’t sign up for Medicare Part B, you will lose your CHAMPVA benefits.
Here’s How The Coverage Works:
- CHAMPVA usually covers 75% of your medical costs, and you pay 25%.
- Medicare usually covers 80% of your costs, and you pay 20%. When you have both CHAMPVA and Medicare, they work together, so most of the time, you won’t have to pay anything out of pocket for doctor visits or treatments.
Please Note:Â
Once you are on Medicare, you can no longer get care from VA Medical Centers (the hospitals and clinics for veterans). You’ll need to see other doctors and hospitals that accept Medicare.
What Are Your Plan Options with CHAMPVA and Medicare?
You have a couple of options when you’re enrolled in both programs:
Option 1: Original Medicare (Parts A & B) with CHAMPVA as a Secondary Insurance.
Original Medicare is the standard health insurance most people get. Medicare Part A is free for most people, but Medicare Part B has a monthly premium (about $174.70 in 2024). With CHAMPVA as secondary insurance, Medicare covers your healthcare first, and CHAMPVA helps pay whatever is left over.
Option 2: Medicare Advantage (MA Only) Plan with CHAMPVA as a Secondary Insurance.
Medicare advantage plans with no drug coverage represent another option. Some of these insurance plans are termed as MA Only, which covers only visits to doctors and hospitals but do not include prescription drug coverage. CHAMPVA can serve as your secondary insurance to help address any coverage gaps. However, it is important to know that Medicare Plan Part C has specific networks, meaning you need to see health doctors and hospitals. Additionally, you might need prior authorization for different services, which indicates that you have to get permission before taking certain treatments or tests.
Pros and Cons of Each Scenario
Letâs look at whatâs good and not so good about each option:
Pros of Original Medicare + CHAMPVA
- No out-of-pocket costs: You usually wonât pay anything out of pocket because Medicare and CHAMPVA work together to cover your medical bills.
- No network limits: You can see any doctor who accepts Medicare without worrying about networks.
- No prior authorizations: You wonât need permission for most services or tests.
Cons of Original Medicare + CHAMPVA
- No extra benefits: Original Medicare doesnât give you extras like dental, vision, or hearing coverage.
- Part B premium: You still have to pay the $174.70 monthly premium for Medicare Part B.
Pros of MA Only + CHAMPVA
- Extra benefits: Some Medicare Advantage (MA) plans offer benefits like dental, vision, and hearing coverage.
- Lower Part B premium: Some MA plans can reduce your Medicare Part B premium to as low as $10 or $20 a month.
Cons of MA Only + CHAMPVA
- Networks: You have to stick to a certain group of doctors and hospitals, which limits your choices.
- Prior authorizations: You may need permission from your insurance plan for certain tests and treatments.
Please Note
If you have CHAMPVA, itâs best to enroll in an MA Only Plan (Medicare Advantage plan without drug coverage). If you choose a plan that includes drug coverage (MAPD Plan), youâll lose access to the CHAMPVA Meds by Mail program, which helps you get medications.
Conclusion
With CHAMPVA and Medicare, you can get a lot of your healthcare costs covered with little to no out-of-pocket expenses. But itâs important to understand how each option works and what you might need, like signing up for Medicare Parts A & B or choosing an MA Only Plan. Just remember that with networks and prior authorizations in some plans, youâll need to consider what works best for your healthcare needs.
By knowing these details, you can make sure your healthcare is covered without surprises! At LMS Insurance Group, We are available to assist you in navigating these changes and choosing your medical insurance plan wisely. Be sure to contact us for guidance services, whether you have queries about your present insurance plan or wish to consider other choices. To find out how these future modifications in insurance policies can assist you, get in touch with us right now!