CHAMPVA: Most Common Questions Answered
Integrity Now Insurance Brokers specializes in everything Medicare. The owner is also an Air Force veteran who is 100% P&T.
He has a family that includes his wife and 4 kids.
Because of this he is always looking for ways to help his fellow veterans, find answers to many of the common and uncommon questions our family face with CHAMPVA.
We have accumulated many of the top questions asked by veterans and their families. This list will continue to grow as we discover additional questions that need to be included.
If you or your family need help with a dental, vision, and hearing plan we have a special program that bundles these together under a single plan. It can provide coverage of $1,000, $1,500 or $3,000 in annual benefits per enrolled member and can be used with any doctor. It is currently available in most of the USA. There are a few states it is not available.
What Is The CHAMPVA Payer Code?
The CHAMPVA payer code needed for the billing department to property bill CHAMPVA is: 84146
How Do I Enroll Into CHAMPVA?
Please use the following link to access the needed documents. CHAMPVA Applications
How Do I Fill My Prescription Medication?
You have two options when filling your prescription medications.
- For urgent prescription drugs, visit your local pharmacy. You will be responsible for your 20% share of the bill and your annual deductible if you have not already paid it.
- For maintenance prescription medication, have your doctor electronically submit a request into Meds By Mail. Ensure they include a 90-day supply with refills. The cost of these medications is zero. It takes 7 to 10 days to receive your drugs in the mail. You can request refills via phone or online from your MyHealthyVet portal. If by phone, make sure you call your local territory phone number located at this link. Meds By Mail Phone Number Search.
How Long Does It Take To Enroll Into CHAMPVA?
As of May 26, 2022, the current processing time from submitting your enrollment application to receiving your ID cards is about 7 months. You can either mail your application or fax it to CHAMPVA.
What Is The Fax Number For CHAMPVA?
The fax number for CHAMPVA is: 303-331-7808
What Is The Mailing Address For CHAMPVA?
The mailing address for CHAMPVA is: PO Box 469063 Denver, CO 80246-9063
What Is The Phone Number For CHAMPVA Customer Service?
CHAMPVA Help Line: 800-733-8387 Monday–Friday 8:05 a.m.–7:30 p.m., ET
I Received My Prescription Drug Card But Not My CHAMPVA Medicare ID Card.
This happens very frequently. Many CHAMPVA members have stated it can take an additional 2 weeks before they receive their Medicare ID Cards.
Does CHAMPVA Cover Telehealth?
CHAMPVA will ONLY cover video telehealth visits. CHAMPVA does NOT cover phone calls from your doctor without video.
If We Have Tricare Are We Eligible For CHAMPVA?
If your family is eligible for Tricare, they are not eligible for CHAMPVA.
Is The Veteran Eligible For CHAMPVA?
If both spouses are military veterans rated at 100% P&T, the Veteran is eligible for CHAMPVA. However, in most instances, CHAMPVA is for the veteran’s dependants only.
If I Am 100% Disabled, Does My Family Qualify For CHAMPVA?
No. You must be 100% P&T before your dependents can qualify for CHAMPVA.
Is There A CHAMPVA Support Group?
Yes. Facebook has a group that helps New and Current CHAMPVA members. Click here to access a CHAMPVA SUPPORT GROUP.
Will CHAMPVA Provide Coverage While We Wait For Proof Of Coverage?
CHAMPVA will provide medical coverage dating back to the effective date of your spouse’s 100% P&T rating. This date is found on your award letter from the VA, or by logging into your ebenefits account / VA.gov account. CHAMPVA will only reimburse the allowable amount. This amount can be 80% less than the doctor’s billable amount. If possible, have your doctor or hospital delay billing until you are fully enrolled. This will help prevent you from paying too much and not being reimbursed fully.
Do I pay any money to the doctor’s office at the time of my visit?
No. You will need to wait until you receive your CHAMPVA explanation of benefits. This document will show the allowable amount and how much you must pay. Then your doctor’s office will submit a bill to you. Make sure to confirm both documents match up with your medical cost.
Does Walgreens pharmacy accept CHAMPVA?
Yes, Walgreens and many other pharmacies accept CHAMPVA.
Which labs take CHAMPVA?
Labcorp and many others will accept CHAMPVA.
Does CHAMPVA Have An Approved List Of Doctors Who Accept CHAMPVA?
No, CHAMPVA is similar to a PPO-style plan. You will need to verify your doctor or medical facility accepts CHAMPVA. Please provide the billing department the Payer # 84146, to ensure they are verifying the correct organization. Many doctors will give a mixed answer as they confuse CHAMPVA with Tricare. In most instances, if a doctor accepts Medicare, they will accept CHAMPVA.
Does CHAMPVA Have A Deductible?
Yes, CHAMPVA may apply two separate deductibles if you are enrolling as a family. One deductible that applies for a single individual is $50 annually. The other deductible is a Family deductible of $100 annually. This means the most a family will pay in a year towards their deductible is $100. A family of six will pay $50 per person up to $100 max per family.
Does CHAMPVA Have A Max Out Of Pocket Cap?
The max out-of-pocket cost is separate from your annual deductible. The max out-of-pocket for CHAMPVA is $3,000 annually. It resents every January 1.
How Much Does CHAMPVA Cost In Monthly Premiums?
CHAMPVA does not have a monthly premium. It is provided for free, except for your deductible and max out-of-pocket obligation. CHAMPVA does not charge a monthly premium for this coverage.
I Have Health Insurance Through My Employer. Should I Keep My Employer Plan?
Maybe. Depending on your overall health and monthly premium for your group health plan, it could be worth keeping it and combining it with CHAMPVA. If you rarely use your health insurance coverage, it may not be worth keeping your employer’s coverage. If you are in bad health and frequently use your employer-based health insurance, and your annual employer-sponsored plan premium is less than $3,000, we recommend keeping your employer plan.
CHAMPVA will fill in the gaps and cover the remaining costs, such as your max out-of-pocket and deductible cost of your employer plan. You could look at downgrading your employer plan to their cheapest plan, as CHAMPVA will cover all remaining costs. Many members have zero cost outside of their annual $50 CHAMPVA deductible when combined with their employer’s plan.
What Is Required When Signing Up For Medicare And I Have CHAMPVA?
To keep your CHAMPVA coverage and have Medicare, you will need to sign up for both Medicare Part A and Medicare Part B. Once you are signed up for both parts of Medicare, you must notify CHAMPVA ASAP and provide proof. Failure to notify CHAMPVA will result in you being disenrolled from CHAMPVA.
Does CHAMPVA Require Preauthorization For Medical Procedures?
In most instances, No. Some specialists may request it, but CHAMPVA does not, with very limited exceptions.
My Dependent Is Turning 18 And Is Still In High School.
It is essential that you have the school complete the CHAMPVA School-Enrollment verification form, showing they are a full-time student. This will ensure they are not dis-enrolled from CHAMPVA. Please complete and turn in this form 6 months before your dependent turns 18. I submitted one for my 11th grader on her 17th birthday as CHAMPVA is taking about 9 months to process forms as of March 17, 2023.
My Medical Bill Was Denied By CHAMPVA. What Do I Do?
Many times when you receive a denied bill from CHAMPVA, it is the result of your doctor’s office improperly billing. They may have sent the invoice to the wrong address or waited too long to bill CHAMPVA. Review the reason for the denial and either reach out to your doctor’s office and have them correct the mistake or call CHAMPVA and inquire about what happened. Ensure your doctor’s office billed the correct Payer # 84146, as this is a common mistake. We recommend adding the Payer number to your Medical ID card.
Does CHAMPVA Cover CVS Minute Clinic Visits?
Yes, CHAMPVA will cover the CVS minute clinic. Make sure the CVS minute clinic you go to will accept CHAMPVA. Please provide them with Payer Code: 84146
Can I Use CHAMPVA As My Primary Insurance?
Yes, you can use CHAMPVA as your primary or secondary insurance.
Does CHAMPVA Work As A Supplement Policy When Covered By Medicare Part A & Part B?
Yes, as long as you are enrolled in both Medicare Part A & Part B, CHAMPVA will fill in the gaps left behind by Medicare. Most CHAMPVA enrollees state they pay nothing out of pocket when they use CHAMPVA as their supplement.
Do I Need A Medicare Supplement If I Have ChampVA?
No, as long as you remain on Original Medicare your ChampVA coverage will become secondary insurance. It is equal to a Medicare Supplement Plan F meaning you will have no out-of-pocket costs.
Do I Need To Enroll In Part D If I Have CHAMPVA?
No. If you sign up for Medicare Part D, you are no longer eligible for the free Meds By Mail. Some individuals prefer a Part D plan, as they may need the additional medication options and are willing to pay the additional monthly cost and the cost to purchase the prescription drugs. If you obtain a standalone Part D plan, you will no longer be allowed to use Meds by Mail.
Should I Enroll In A Medicare Advantage Plan With ChampVA Coverage?
While some of the benefits offered by a Medicare Advantage plan may seem attractive, these benefits do not outweigh the restrictions. Because a Medicare Advantage plan will become your primary insurance if the assigned network denies coverage then your ChampVA benefits will also deny coverage.
We do not recommend enrolling in a Medicare Advantage plan.
My Spouse had Dexcom And Other Meds, And Lantus Pens Shipped By Meds By Mail. How Much Will It Cost?
All medications shipped and provided by Meds By Mail are 100% FREE. No shipping fees or costs to obtain your medicines through Meds By Mail. You only pay when getting your prescription drugs at your local pharmacy.
Does CHAMPVA cover annual Physicals?
No. It would be best if you were seen for a medical issue when requesting a physical before CHAMPVA covers it. Please ensure your doctor’s office codes it correctly and does not code it as a physical.
Can CHAMPVA Enrollees Use The VA Hospital And Medical Services?
Yes. As long as the VA Facility is part of the CITI program and accepts new patients, all services are covered at 100%. Here is a link to VA Facilities accepting CHAMPVA: CITI PROGRAM Facilities
Does Champva Covers Chiropractic Visits?
CHAMPVA does not cover chiropractor visits.
Does Champva Cover Acupuncture?
CHAMPVA does not cover acupuncture.
Are Most CHAMPVA Members Happy With Their Medical Coverage?
Yes. While there can be some difficulty in learning how best to use the coverage, most are very happy with their CHAMPVA benefits. The most extensive advice is to provide Payer # 84146 and write it onto your Medicare ID Card. This is the bulk of the issues members face.
If My Doctor Doesn’t Want To File A Claim Online, Where Do They Mail The Claims Form?
CHAMPVA’s New mailing address is PO Box 469064, Denver, CO 80246-9064. This was changed in January 2022. Please ensure your doctor’s office is using the new mailing address.
Does CHAMPVA Have An Online Portal To Enroll And View Your Medical Information?
No. They have talked about this major upgrade, and stated they may considering this upgrade in 2025. I would not hold your breath.
