CHAMPVA Supplemental Insurance
I recently became 100% Permanently and Total (“P&T”) disabled veteran in August 2021. Like many US Veterans, once this happens there are a lot of things that will need to be taken care of.
I have a family of 6 that includes my wife, 3 kids under the age of 18 and one who is about to get married. I have been out of the Air Force for 20 years and had been rated at 20% this entire time.
I had some new conditions hit me in which the VA recommended I file a claim for and a VSO helped me with. To my surprise I was rated at 100% P&T. When this happened I began investigating all available benefits.
One of those benefits was CHAMPVA supplemental Insurance. As my family now qualifies for CHAMPVA, I learned that there is a CHAMPVA Supplemental Insurance coverage that helps pay for the the annual max out of pocket cost of $3,000.
How Does CHAMPVA Supplemental Insurance Work
CHAMPVA is provided to the families of a 100% P&T Veteran. This programs does not charge a monthly insurance premium which is a huge savings especially for a family of six. CHAMPVA does apply an annual max out of pocket cost of $3000 and applies a $50 individual deductible or $100 family deductible.
In reviewing these cost, I found myself considering a secondary coverage called CHAMPVA Supplemental Insurance. With this program, I can spread out my cost each month and reduce my total financial hit in the event my wife or kids ended up with some high medical bills.
CHAMPVA Supplemental Insurance offers two programs
- CHAMPVA Supplemental Insurance for VFW members
- CHAMPVA Supplemental Insurance for non VFW members
If you sign up to be a VFW member you are provided with a couple of additional benefits. Your monthly premium will be reduced and they will reduce your individual and family deductible.
The CHAMPVA Supplemental Insurance deductible is $250 individual deductible and $500 family deductible. If you join the VFW, then your deductibles will be $200/$400.
Please keep in mind that your CHAMPVA Supplemental Insurance does not remove your CHAMPVA deductible.
CHAMPVA Supplemental Insurance is not available in the following States: Maine & Washington. You may want to consider a critical illness or accident policy to help with those unexpected cost.
CHAMPVA Supplemental Insurance covers your Approved Share Amount
CHAMPVA will coverage 75% of the Allowable Amount, after the CHAMPVA Annual Outpatient Deductible of your Doctor Office Visits, Hospitalizations, and Pharmacy cost.
This means that you will be responsible for the remaining 25% of the CHAMPVA allowable amount.
It is important that your Doctor accepts CHAMPVA, to ensure they will not bill you at a higher rate than what CHAMPVA allows.
CHAMPVA is an open access plan, that most people refer to as a PPO insurance plan. This means you are not required to obtain a referral to see a specialist.
Some specialist may still require a referral from your primary care doctor before they will see you. This is a requirement of the specialist not CHAMPVA.
When you purchase a CHAMPVA Supplemental Insurance, they will cover the 25% cost minus your deductibles (CHAMPVA deductible & CHAMPVA Supplemental Insurance deductible).
How Much Does CHAMPVA Supplemental Insurance Cost
The standard cost of CHAMPVA Supplemental Insurance is broken down into age groups. If you join the VFW these rates will be slightly lower than what is shown below. It is important to mention that CHAMPVA does not have a monthly premium.
CHAMPVA deductible: $50 individual / $100 family (Applies even with the supplement insurance)
CHAMPVA Supplemental Insurance Deductibles $250 individual / $500 family
VFW CHAMPVA Supplemental Insurance $200 individual / $400 family
CHAMPVA SUPPLEMENT INSURANCE PREMIUM RATE CHART (DECEMBER 2021)
Age of Spouse, Widow(er)
First-Year Quarterly Rate*
Base Rate Quarterly Rate (After 12 months)
* First year discounted rates are not available to insureds in OH or KY.
Who Accepts CHAMPVA Supplemental Insurance Coverage
One of the most common questions new CHAMPVA recipients ask is will my doctor accept CHAMPVA Insurance.
CHAMPVA is considered an open access plan, however this means your doctor needs to be willing to accept allowable amount by CHAMPVA.
While you can still see your doctor if they don’t accept the allowable amount, this means you will need to pay the difference between the allowable amount and the amount your doctors wants to charge.
Typically, a doctor’s office that accepts Tricare or Medicare patients will also accept CHAMPVA.
We recommend talking with the billing department and providing them with the following Payer Code: 84146. This can help them quickly see if the plan is accepted.
CHAMPVA and Medicare Insurance
If you and your family have used CHAMPVA for any length of time you will eventually have questions related to signing up for Medicare.
CHAMPVA requires that you sign up for both Part A and Part B of original Medicare. Once you receive your red, white, and blue Medicare care, you will need to send a copy to CHAMPVA so they will become secondary to Medicare.
As of December 2021 CHAMPVA is 4 to 5 months behind in processing paperwork, so it will be critical to obtain your new Medicare card and send it into CHAMPVA asap. We also recommend calling CHAMPVA letting them know what you are doing in an effort to stop them from cancelling your CHAMPVA coverage.
We have found for those who have Medicare and CHAMPVA, they do not have a need for a Medigap plan or a Medicare Advantage plan. CHAMPVA recipients state that most if not all of their medical cost are covered with the combination of original Medicare and CHAMPVA.
As the prescription drug coverage is considered creditable coverage, you are not required to obtain Part D coverage from an outside private company. CHAMPVA offers Meds by Mail which comes at no cost to its members.
If you use their prescription RX card from Optum, you will be responsible for 25% of the medication cost. Use this option for urgent medications only. For Medications that you take regularly, order through Meds by Mail as it is free.
If you decide to obtain Part D coverage from a private company, you will no longer be allowed to use Meds by Mail.
Do I Pay My Part A and Part B Deductible With CHAMPVA As My Supplement
This is a great question and can be a bit confusing. The CHAMPVA fact sheet provided by the VA states the following: “At least a portion of your Medicare outpatient deductible will be covered by CHAMPVA.”
While this sounds great, “A Portion” is not clearly defined and can leave you still wondering how much of the deductible will I be responsible for.
In talking with current CHAMPVA recipients who are enrolled into Medicare, all of them have stated that CHAMPVA covers 100% of the cost of your Part A and Part B deductibles.
This is great news especially for those individuals who are newly eligible for Medicare. Based on these facts, this makes CHAMPVA equivalent to the Plan F of a Medicare Supplement Plan.
The Plan F is the most comprehensive and expensive Medigap plan and is no long available to new Medicare enrollees as of January 1, 2020. New Medicare beneficiaries only have the option of the Plan G or a lower plan that doesn’t cover your Part B deductible.
They will not cover your Part B monthly premiums.
We are here to help you obtain a CHAMPVA Supplemental Insurance Policy
Integrity Now Insurance Brokers is here to help you obtain your CHAMPVA supplemental insurance policy. By using our services you are also helping a fellow 100% P&T Veteran and his family.
We would love the opportunity to help you and your family with your health insurance needs. Currently we service, Arizona, California, Nevada, Ohio, Texas, and Washington. We are always adding new States so we recommend asking if we can help you even if you don’t see your State listed.
Please reach out to one of our licensed Insurance Agent’s.