CHAMPVA care
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a VA health benefits program. CHAMPVA is for the spouses, dependents, and survivors of Veterans who meet certain service-connected disability requirements.
Keep reading on this page to learn about how to find providers who accept CHAMPVA, fill prescriptions, understand your costs, and use your benefits.
Changes to CHAMPVA coverage for GLP-1 medications
CHAMPVA now covers prescription GLP-1 medications only when prescribed for FDA-approved reasons and criteria:
- If you have a type 2 diabetes diagnosis, we’ll cover Mounjaro, Ozempic, Rybelsus, Trulicity, and Victoza
- If you have a moderate to severe obstructive sleep apnea diagnosis, we’ll cover Zepbound
- If you have a metabolic-associated steatohepatitis (MASH) or prevention of major adverse cardiovascular events (MACE) diagnosis with prior events, we’ll cover Wegovy
Note: CHAMPVA doesn’t cover prescription GLP-1 medications for weight loss.
If you have questions about this change, call us at
Finding providers who accept CHAMPVA benefits
There’s no specific network of CHAMPVA providers.
When you find a new provider, ask if they “accept assignment” from CHAMPVA. This means they agree to accept CHAMPVA benefits and to charge only the allowable amount.
If you go to a provider who doesn’t accept CHAMPVA, we may still cover some of the cost. You’ll need to pay the provider out of pocket and then file a claim for reimbursement. But we’ll only pay our allowable amount. You’ll need to pay any costs above that amount.
Hospitals and hospital-based providers that accept Medicare must also accept CHAMPVA. So, you may want to search for a hospital or provider through Medicare.
Prescriptions through CHAMPVA
CHAMPVA covers both urgent prescriptions and prescriptions you take regularly. Learn how to fill a prescription, what you’ll pay, and how CHAMPVA works with other prescription coverage.
Filling a prescription
You can fill urgent prescriptions and prescriptions you take regularly at any pharmacy in the OptumRx network. The network includes most local pharmacies.
Find an OptumRx network pharmacy on the OptumRx website
Bring your OptumRx prescription card to the pharmacy. If you don’t have your card, you can print a temporary card online. You can also call OptumRx Beneficiary Services at
Print a temporary prescription card on the OptumRx website
If the pharmacy has questions about processing a CHAMPVA prescription, ask them to call the OptumRx Pharmacy Technical Help Desk at
You can also fill your prescription at a pharmacy outside the OptumRx network. You’ll pay the full cost up front. Then, you can file a claim, and we’ll pay you back for 75% of the CHAMPVA allowable amount. This is the amount we approve for the prescription.
Learn how to file a CHAMPVA claim
If CHAMPVA is your only prescription coverage
If you haven’t met your annual CHAMPVA deductible, you’ll pay the full prescription cost until you meet it. The deductible is $50 per person or up to $100 per family each calendar year.
After you meet your deductible, you’ll pay 25% of the CHAMPVA allowable amount.
The CHAMPVA catastrophic cap is the most your household will pay out of pocket for covered services in a calendar year. The cap is $3,000. After your household reaches this limit, you won't pay a cost share for covered services for the rest of the year.
For non-urgent prescriptions you take regularly, you can also use Meds by Mail. We’ll deliver your medications to your home at no cost to you. You can use Meds by Mail only if you have no other prescription coverage.
If you have other insurance with prescription coverage
If you have another prescription plan, that plan pays first and CHAMPVA pays second.
Tell the pharmacy that you have both CHAMPVA and other prescription coverage. The pharmacy can then bill CHAMPVA as your secondary coverage. If both plans cover your prescription, you won’t pay a cost share.
Note: You can’t use Meds by Mail if you have other prescription coverage.
Learn how to use Meds by Mail
Care and services we cover through CHAMPVA
When you enroll in CHAMPVA, we share the cost of certain healthcare services and supplies with you. If you have other health insurance in addition to CHAMPVA, you may not need to pay a cost share.
CHAMPVA covers most healthcare services and supplies. Here are some of the types of care CHAMPVA covers:
- Family planning and maternity care
- Hospice care
- Inpatient care (when you stay in a hospital)
- Mental healthcare
- Outpatient care and procedures (like office visits)
- Skilled nursing care (medical care by licensed providers to help with medications, wound care, and other recovery and medical needs)
Here are some other treatments and services CHAMPVA covers:
- Ambulance services
- Medical equipment that your provider prescribes to support your everyday activities
- Organ transplants
- Prescription medications
The CHAMPVA Guidebook has more information on covered services, getting care, and using CHAMPVA.
Questions about CHAMPVA coverage
Does CHAMPVA cover dental and vision?
If you’re enrolled in CHAMPVA, you can purchase dental insurance through the VA Dental Insurance Program (VADIP). VADIP offers dental insurance at a reduced cost.
Learn more about the VA Dental Insurance Program
CHAMPVA offers limited vision coverage. CHAMPVA doesn’t cover eyeglasses or contact lenses except in certain cases.
Do I need prior authorization to use CHAMPVA?
In most cases, you don’t need to get authorization (approval) before you get care through CHAMPVA. But you do need approval for certain types of care.
You need approval for these types of care:
- Inpatient mental health care (when you stay at the facility)
- Care for alcohol or substance use disorders
- Dental care (in limited cases when we cover dental care)
- Organ transplants
Note: If you get medical equipment or mental health care through VA CHAMPVA In-House Treatment Initiative (CITI), you don’t need approval first.
To get approval for mental health care, alcohol use, or substance use:
Ask your provider to call us at
How much does CHAMPVA pay and how much will I pay myself for care?
In most cases, we pay the same amount as Medicare or TRICARE for specific services and supplies. We call this the “allowable amount.”
Here’s what you need to know about how you share in the cost of care:
- You have a $50 deductible each calendar year (or $100 maximum for your family): You must pay this amount first for any urgent prescriptions through OptumRx or outpatient care (like office visits) before we start to pay part of these costs. There’s no deductible for inpatient care (when you stay in a hospital).
- You’ll also pay a cost share of 25% of our allowable amount each calendar year. That means that for each service or supply we cover, you’ll need to pay 25% of the cost. If you have other health insurance, you may not need to pay a cost share.
- The maximum out-of-pocket cost for your entire household under this plan is $3,000 each calendar year. After you pay $3,000, we’ll pay 100% for covered services.
Can I get care at a VA health facility through CHAMPVA CITI?
If you have CHAMPVA, you may be able to get care at your local VA health facility through the CHAMPVA In-House Treatment Initiative (CITI).
Here’s what to know about CITI:
- We cover the entire cost of care and services you get through CITI.
- The types of care you can get through CITI depend on your local facility.
- If your facility can’t provide the care you need, they may refer you to a local provider in our community care network. You’ll need to pay part of the cost for this care.
- If you’re eligible for Medicare, you can’t get care through CITI. Other health insurance may also affect your eligibility.
Contact your local VA health facility to find out if they participate in CITI and check your eligibility.
Find your local VA health facility
If you have questions about CITI, contact your local VA health facility. Or call us at
How can I get a new or replacement CHAMPVA ID card?
After you apply for CHAMPVA, we’ll send you an ID card by mail. It may take up to 6 weeks to get your card after you apply.
If you need a replacement card, call us at
How can I get my IRS 1095-B tax form as a family member?
If you’re a family member and you need your 1095-B tax form to show proof that you had VA health coverage when filing your state taxes, you’ll need to request a paper copy of your form.
For the CHAMPVA program, contact us at
For the Spina Bifida or Children of Women Vietnam Veterans health care programs, contact us at
Note: Starting in 2026, we’ll no longer automatically mail the 1095-B form.
CHAMPVA, Medicare, and other insurances
Yes. If you don’t have other health insurance, CHAMPVA will be your primary insurance.
If you have another health insurance policy, CHAMPVA will be your secondary insurance. In special cases, you may see CHAMPVA pay as primary to your other health insurance policy.
CHAMPVA is always the secondary payer except to these programs:
- Medicaid
- State Victims of Crime Compensation Programs
- Indian Health Services
- Supplemental CHAMPVA policies
If you have other health insurance, your health care provider should bill the other insurance first. The provider should then submit the Explanation of Benefits (EOB) from the other insurance along with the claim for reimbursement to CHAMPVA.
Note: CHAMPVA counts as minimum essential coverage under the Affordable Care Act. Each year, CHAMPVA will automatically provide IRS Form 1095-B when requested. There’s nothing else you will need to do to prove minimum essential coverage.
If you have other health insurance (OHI) and you don’t tell us until after we’ve processed a claim for payment, we’ll automatically reprocess the claim with the OHI information. You or your provider will need to pay us back the overpayment amount.
CHAMPVA reviews every health care claim you submit to verify OHI information.
We’ll stop payments and deny your claims in both of these situations:
- You or your provider stop sending OHI information
- You tell us you’ve signed up for a new OHI plan
In your Explanation of Benefits (EOB), we’ll tell you that we need information about your new health insurance plan before we can restart claim payments.
To avoid delays in processing your claims, it’s important for you to notify CHAMPVA right away if there are changes to your OHI.
If you’re eligible for Medicare, you must have Medicare Part A and Part B in order to get or keep CHAMPVA benefits. A Medicare Advantage plan (also called Part C) also meets this requirement.
Most people become eligible for Medicare at age 65. You may become eligible for Medicare before age 65 if you meet 1 of these requirements:
- You get Social Security Disability Insurance (SSDI) benefits, or
- You have end-stage kidney disease or ALS (amyotrophic lateral sclerosis)
When you turn 65, you must provide proof of your Medicare coverage to keep your CHAMPVA benefits. If you’re not eligible for Medicare when you turn 65, you must provide a document called a “notice of disallowance” from the Social Security Administration.
Note: You don’t need Medicare Part D to get CHAMPVA.
Yes. CHAMPVA is the secondary payer to Medicare. This means that Medicare pays for your care first. Then, CHAMPVA may cover costs that you still owe after Medicare pays.
Yes. Medicare Advantage plans (also called Medicare Part C) include original Medicare (also called Medicare Parts A and B). If you’re eligible for Medicare, you must have Medicare Parts A and B to get CHAMPVA. A Medicare Advantage plan meets this requirement.
CHAMPVA is the secondary payer to Medicare. This means that your Medicare Advantage plan will pay for your care first. Then, CHAMPVA may cover costs that you still owe after Medicare pays.
CHAMPVA will cover some or all of your Medicare Part B deductible for outpatient care. A deductible is an amount you need to pay yourself before your insurance starts to pay.
If the remaining part of your Medicare Part B deductible is more than the CHAMPVA allowable amount for your claim, you’ll need to pay your provider the difference between your remaining deductible and the allowable amount.
Note: CHAMPVA doesn’t cover Medicare Part B premiums (monthly payments for insurance coverage). You’ll need to pay these premiums yourself.
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a VA program. CHAMPVA is for the spouses, dependents, and survivors of Veterans and service members who meet certain service-connected disability requirements.
TRICARE is a Defense Department (DOD) program. TRICARE (formerly called CHAMPUS) is for active-duty and retired service members, their families, and their survivors.
If you’re eligible for TRICARE, you can’t get care through CHAMPVA.
CHAMPVA and school enrollment for dependent children ages 18 to 23
If you’re covered under CHAMPVA as a dependent child and you turn 18 years old, you’ll need to send us proof that you’re enrolled in high school, college, or another educational institution to keep getting benefits.
To avoid a gap in benefits between your high school graduation and your first college term, you can send us your college acceptance letter.
You must send us a school certification letter within 1 month after your first school term begins. You’ll need to recertify at least once a year.
Ask your school to write us a letter on school letterhead that includes all of these pieces of information:
- Your full name and the last 4 digits of your Social Security number
- Your estimated graduation date
- Start and end dates for the semester or term
- Signature and title of a school official
You or your school can mail the letter to this address:
VHA Office of Integrated Veteran Care
CHAMPVA Eligibility
PO Box 137
Spring City, PA 19475
Or you or your school can fax the letter to 1-
Request your IRS 1095-B tax form
Your Form 1095-B IRS document shows proof that you had CHAMPVA health coverage during the most recent tax year. Due to changes in the Affordable Care Act (ACA), you no longer need to file this form with your federal taxes.
However, you may still need it for:
- State tax filing
- Your personal records
Note: We no longer mail 1095-B forms automatically. You can request your Form 1095-B by calling us at
How to update your other health insurance information
If you’ve already received the CHAMPVA benefits enrollment packet, you can update your other health insurance information.
You’ll need to submit these 2 supporting documents:
- A completed CHAMPVA-Other Health Insurance Certification (VA Form 10-7959c)
- A copy of the front and back of your health insurance card or Medicare card
Note: If you have Medicare Part D for prescription coverage, you’ll also need to submit a copy of the front and back of your Medicare Part D card.
You can submit your documents in the following ways:
- Online: You can fill out VA Form 10-7959c and upload copies of your cards online.
- By mail: You can download a PDF of VA Form 10-7959c. Then send your completed, signed form and copies of your cards to the address listed on the PDF.
Get VA Form 10-7959c to download
How to update your address
Call us at
If you’re changing your address, have your last address available. We’ll need to verify this before updating your file.
How to contact us if you have more questions
Call us at
You can send any written communication to this address:
CHAMPVA
PO Box 500
Spring City, PA 19475
You can also contact us online through Ask VA.