To be eligible for CHAMPVA, you cannot be eligible for TRICARE/CHAMPUS and you must be in one of these categories:
- the spouse or child of a veteran who has been rated 100% permanently and totally disabled for a service connected disability by a VA regional office, or
- the surviving spouse or child of a veteran who died from a VA-rated service connected disability, or who was at the time death rated 100% permanently and totally disabled, or
- the surviving spouse or child of a military member who died in the line of duty, not due to misconduct.(in most of these cases, these family members are eligible for TRICARE, not CHAMPVA)
You must also meet the following conditions for benefits to be extended past age 65:
- if you turned 65 before June 5, 2001, and only have MEDICARE Part A, you will be eligible for CHAMPVA without having to have MEDICARE Part B coverage.
- if you turned 65 before June 5, 2001, and have MEDICARE Parts A and B, you must keep both Parts to be eligible.
- if you turned 65 on or after June 5, 2001, you must be enrolled in MEDICARE Parts A and B to be eligible.
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Notice to new & expectant parents: In order to establish CHAMPVA eligibility for a newborn child, the following must be accomplished prior to the submission of an application.
- Obtain a Social Security Number for the newborn by applying to the nearest Social Security Administration office.
- Establish dependency of the newborn to the veteran sponsor by contacting the local VA regional office.
Since the payment of claims is contingent upon the claimant's eligibility status, new parents are encouraged to take the above action as early as possible.
Medicare Impact: Individuals, 65 or older, who lose CHAMPVA eligibility by becoming potentially eligible for Medicare Part A or who qualify for Medicare Part A benefits on the basis of disability, may re-establish CHAMPVA eligibility by submitting documentation from the Social Security Administration (SSA) certifying their non-entitlement to or exhaustion of Medicare Part A benefits.
Otherwise eligible individuals under age 65 who are enrolled in both Medicare Parts A&B are potentially eligible for CHAMPVA as secondary payer to Medicare. To determine CHAMPVA eligibility, SSA documentation of enrollment in both Parts A&B is required.
CHAMPVA For Life and Remarried Widows/Widowers
If you remarried after your first veteran-sponsor died, and the remarriage ended, you may be eligible for CHAMPVA for Life or CHAMPVA. To be eligible, your first marriage must have been to a veteran who was 100% permanently and totally disabled or who died from a service connected condition. It does not matter if the veteran was retired from the military.
Eligibility Definitions
Service-connected condition/disability: refers to a VA determination that a veteran's illness or injury was incurred or aggravated while on active duty in military service and resulted in some degree of disability.
Sponsor: refers to the veteran upon whom CHAMPVA eligibility for the applicant is based.
Spouse: refers to a wife/husband or widow(er) of an eligible CHAMPVA sponsor. In some instances, may include a remarried surviving spouse whose remarriage is either terminated by annulment or legally determined void when supported by appropriate documentation.
Child: includes legitimate, adopted, illegitimate, and stepchildren. To be eligible, the child must be unmarried and:
- under the age of 18; or
- who, before reaching age 18, became permanently incapable of self-support as rated by a VA regional office; or
- who, after reaching age 18 and continuing up to age 23, is enrolled in a full-time course of instruction at an approved educational institution.
NOTE: The eligibility of children is not affected by divorce or remarriage of the spouse or surviving spouse.