CHAMPVA in 2026: Who Qualifies, What You Pay, and How to Apply
CHAMPVA is VA health coverage for the spouse, children and survivors of a veteran rated permanently and totally disabled, or who died of a service-connected disability. Here is who qualifies under the regulation, the deductible, cost share and yearly cap, the rules at 18, 23, 55 and 65, and the forms VA asks for.
The bottom line up front
- 1.CHAMPVA covers the spouse, children and survivors of a veteran rated permanently and totally disabled from a service-connected disability, or who died of one, plus certain primary family caregivers (38 CFR 17.271).
- 2.Anyone eligible for TRICARE cannot have CHAMPVA. That includes a family whose reserve or Guard sponsor starts retired pay at 60.
- 3.Costs under 38 CFR 17.274: a $50.00 deductible per person ($100.00 per family) each calendar year for outpatient care, a 25% cost share, and a $3,000.00 household cap.
- 4.Once eligible for Medicare you must hold Part A and Part B to keep CHAMPVA. Medicare pays first, and CHAMPVA does not pay the Part B premium.
- 5.Apply with VA Form 10-10d. VA says it typically reviews applications within 5 business days, and the ID card can take up to 6 weeks.
CHAMPVA pays 75% of its allowable amount for most covered care once a $50.00 yearly deductible is met, and a household stops paying at $3,000.00 in a calendar year. Those figures are in the regulation, 38 CFR 17.274, and on VA's own CHAMPVA pages, which VA last updated on November 9, 2026. What is settled: who qualifies, what you pay and how to apply. Not on this page: the allowable amount for a particular service, which VA says is in most cases what Medicare or TRICARE pays.
Check TRICARE first
VA's page is direct: "If you're eligible for or enrolled in TRICARE, you can't get CHAMPVA benefits." The family of a military retiree is a TRICARE family. The Guidebook gives the case that catches people later: a family on CHAMPVA becomes TRICARE-eligible "when the qualifying Veteran sponsor is a retired reservist or National Guard member and becomes eligible to receive retired pay at age 60," and must tell VA immediately.
Who qualifies
CHAMPVA is the Civilian Health and Medical Program of the Department of Veterans Affairs. Its statute, 38 U.S.C. 1781, is headed "Medical care for survivors and dependents of certain veterans," and 38 CFR 17.271 lists who is eligible:
- The spouse or child of a veteran whom VA has rated permanently and totally disabled from a service-connected disability. VA defines that as a disability "rated as 100% disabling and that's not expected to improve."
- The surviving spouse or child of a veteran who died from a service-connected disability.
- The surviving spouse or child of a veteran who, at death, was rated permanently and totally disabled from a service-connected disability.
- The surviving spouse or child of a service member who died in the line of duty, not due to misconduct. The Guidebook adds that "in most of these cases, these family members are eligible for TRICARE, not CHAMPVA."
- A primary family caregiver approved under the Program of Comprehensive Assistance for Family Caregivers who has no other health insurance. VA enrolls that caregiver automatically.
A 100% rating by itself is not the test; VA must also have found the disability permanent. Our VA Disability Calculator shows how separate ratings combine toward 100%. Survivors can price the payments that sit beside this coverage with the Survivor & Casualty Calculator.
The age and status rules: 18, 23, 55 and 65
| What changes | What VA's page says happens |
|---|---|
| A child turns 18, is not in school and is not permanently disabled | CHAMPVA ends at 18 |
| A child aged 18 to 23 is enrolled in high school, college or another school | Coverage continues until the child leaves school or turns 23, whichever comes first, and ends on the date of a marriage. A school certification letter is due within 1 month after the first term begins, then once a year |
| A child became permanently unable to support themselves before 18 | Coverage continues after 18 and ends on marriage or on becoming self-supporting |
| A surviving spouse remarries before age 55 | CHAMPVA ends on the date of the remarriage. If that marriage ends, eligibility returns on the first day of the following month |
| A surviving spouse remarries on or after the 55th birthday | CHAMPVA continues |
| A stepchild leaves the veteran's household because of a divorce or remarriage | The stepchild no longer qualifies |
| You become eligible for Medicare, at 65 or earlier | You must have Medicare Part A and Part B to get or keep CHAMPVA. A Medicare Advantage plan meets the requirement, and Part D is not required |
What you pay
| Care | Deductible | Your share |
|---|---|---|
| Outpatient care such as office visits, and urgent prescriptions at an OptumRx network pharmacy | $50.00 per person, $100.00 per family, each calendar year | 25% of the allowable amount |
| Inpatient care (a hospital stay) | None | A cost share set by 38 CFR 17.274(e) |
| Colorectal, breast, cervical and prostate cancer screening, annual physical exams, vaccinations, well child care from birth to age six | None | Nothing |
| Hospice | None | Nothing |
| Meds by Mail, for regular prescriptions when you have no other prescription coverage | None | Nothing |
| Care at a VA facility through the CHAMPVA In-House Treatment Initiative (CITI); not open to anyone eligible for Medicare | None | Nothing |
| A pharmacy outside the OptumRx network | You pay the full price first | After you file a claim, VA pays back 75% of the allowable amount |
After a household has paid $3,000.00 in deductibles and cost shares in a calendar year, CHAMPVA pays the full allowable amount for covered care until December 31. Two kinds of spending never count toward that cap: charges above the allowable amount and services CHAMPVA does not cover.
There is no CHAMPVA network. VA's advice is to ask a new provider whether they "accept assignment," meaning they take CHAMPVA and charge only the allowable amount. Hospitals and hospital-based providers that accept Medicare must also accept CHAMPVA.
Worked example
A spouse with CHAMPVA only: the first two office visits of the year, each with an allowable amount of $120.00 (an example amount, not a VA rate)
CHAMPVA pays the other $142.50 of the $240.00 allowed. If a provider does not accept assignment and bills more than the allowable amount, the extra is the spouse's to pay and does not count toward the $3,000.00 cap.
With Medicare or other insurance
CHAMPVA pays second to almost everything. VA lists four exceptions that pay after it: Medicaid, State Victims of Crime Compensation Programs, Indian Health Services and supplemental CHAMPVA policies. If both plans cover a service, VA says "you may not need to pay a cost share."
At 65 you must send VA proof of Medicare Part A and Part B, or a Social Security "notice of disallowance" showing you do not qualify for Medicare. Medicare then pays first and CHAMPVA may cover what you still owe, including some or all of the Part B deductible. CHAMPVA does not pay the Part B premium. It is the same premium a TRICARE For Life household pays, and our TRICARE For Life guide has the 2026 amounts by income.
How to apply
- 1Fill out VA Form 10-10d, the Application for CHAMPVA Benefits. Apply online at va.gov, or mail it to VHA Office of Community Care, CHAMPVA Eligibility, PO Box 137, Spring City, PA 19475.
- 2If you have other insurance, including Medicare, add VA Form 10-7959c and a copy of the front and back of each card.
- 3Send the documents that fit your case. A marriage certificate or a child's birth certificate is optional and speeds the review. Adoption papers are required for an adopted child, proof of the parents' marriage for a stepchild, and a school letter for a child aged 18 to 23.
- 4For a newborn, get a Social Security number first, then have a VA regional office add the child as the veteran's dependent. VA cannot pay a newborn's claims until the child is enrolled.
VA says it typically reviews applications within 5 business days and mails a decision letter; the ID card can take up to 6 weeks. Most providers file claims themselves. If you file your own, VA Form 10-7959A is due within 1 year of the care, or within 1 year of leaving the hospital. CHAMPVA answers at 800-733-8387, Monday through Friday, 8:00 a.m. to 7:30 p.m. ET.
What CHAMPVA does not do
- Dental. Not covered except in limited cases. Enrollees can buy a plan through the VA Dental Insurance Program.
- Vision. Coverage is limited, and eyeglasses and contact lenses are not covered "except in certain cases."
- Approval before care. Needed for inpatient mental health care, care for alcohol or substance use disorders, dental care in the limited cases it is covered, and organ transplants.
- GLP-1 medications. Covered only for the FDA-approved diagnoses VA lists, such as type 2 diabetes. VA's page states that CHAMPVA "doesn't cover prescription GLP-1 medications for weight loss."
Read on November 10, 2026
The figures here are the amounts in 38 CFR 17.274 and on VA's CHAMPVA pages as read on November 10, 2026. Military Toolkit is not part of VA. Confirm your own case with CHAMPVA at 800-733-8387.
Sources
- U.S. Department of Veterans Affairs, "CHAMPVA benefits," last updated November 9, 2026, read November 10, 2026: eligibility, the TRICARE exclusion, newborns, remarriage at 55, children aged 18 to 23, stepchildren, the Medicare Part A and Part B requirement, primary family caregivers, VA Form 10-10d and the mailing address, supporting documents (https://www.va.gov/family-and-caregiver-benefits/health-and-disability/champva/)
- U.S. Department of Veterans Affairs, "CHAMPVA care," read November 10, 2026: no provider network and "accept assignment," OptumRx pharmacies and the 75% reimbursement outside the network, the $50.00 and $100.00 deductible, the 25% cost share, the $3,000.00 catastrophic cap, Meds by Mail, CITI, dental and vision, prior approval, GLP-1 coverage, the secondary payer rule and its four exceptions, Medicare (https://www.va.gov/resources/champva-care/)
- U.S. Department of Veterans Affairs, "What to do after applying for CHAMPVA benefits," read November 10, 2026: "We typically review applications within 5 business days"; decision letter by mail (https://www.va.gov/resources/what-to-do-after-applying-for-champva-benefits/)
- U.S. Department of Veterans Affairs, "How to file a CHAMPVA claim," read November 10, 2026: VA Form 10-7959A within 1 year of the care or of leaving the hospital (https://www.va.gov/resources/how-to-file-a-champva-claim/)
- U.S. Department of Veterans Affairs, CHAMPVA Guidebook (the file VA posted in March 2026): the five eligibility groups; line of duty deaths ("in most of these cases, these family members are eligible for TRICARE, not CHAMPVA"); TRICARE eligibility when a retired reservist or National Guard sponsor reaches retired pay at age 60 (https://www.va.gov/files/2026-03/CHAMPVA-Guidebook_3-2026.pdf)
- 38 CFR 17.271, Eligibility, and 38 CFR 17.274, Cost sharing, eCFR current edition read November 10, 2026: who is eligible; the outpatient deductible "($50 per beneficiary or $100 per family)"; the "$3,000 calendar year limit"; the cost share of "25 percent of the CHAMPVA determined allowable amount in excess of the annual calendar year deductible"; services with no cost share (https://www.ecfr.gov/current/title-38/chapter-I/part-17/subject-group-ECFR6c9c741d1d5a11f)
- 38 U.S.C. 1781, Medical care for survivors and dependents of certain veterans (https://www.govinfo.gov/link/uscode/38/1781)
Figures reflect 2026 rates and regulations. This guide is general information, not personalized financial or tax advice. Always verify with your finance office or a tax professional before making a decision. How we research and source: our methodology.
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REF: Military Toolkit Guides, effective 2026
Official 2026 DoD, DFAS, DTMO, IRS, and VA sources. See each guide’s Sources list
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Reviewed by Guilherme Correia · Military Toolkit editorial