Healthcare is a major concern for both veterans and their families, especially with respect to cost. The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health benefits program. CHAMPVA can assist the families of eligible disabled veterans with the cost of certain healthcare services and supplies. A Mobile, AL veterans disability benefits attorney can help your family learn how to use this important program.
Dependents of eligible veterans can purchase comprehensive, low-deductible health insurance through CHAMPVA. The program also complies with the requirements of the Affordable Care Act. In order to be eligible, the beneficiary cannot qualify for TRICARE. CHAMPVA provides coverage to the spouse, widow(er), or child of a veteran who:
- Is rated permanently and totally disabled because of a service-connected disability; or
- Was rated permanently and totally disabled because of a service-connected condition at the time of death; or
- Died of a service-connected disability; or
- Died on active duty, and the dependents are not otherwise eligible for TRICARE benefits
Those aged 65 or older may be able to qualify for CHAMPVA as well. There are special eligibility rules which take into account coverage for Medicare Parts A and B. The beneficiary is eligible for CHAMPVA without having to have Medicare Part B coverage if he or she was:
- 65 years or older before June 5, 2001;
- Otherwise eligible for CHAMPVA; and
- Entitled to Medicare Part A coverage
A beneficiary who turned 65 before June 5, 2001, and has Medicare Parts A and B, must keep them. A beneficiary who turned 65 on or after that date must be enrolled in A and B to be eligible. Your Mobile, AL veterans disability benefits attorney can answer questions about how Medicare may impact CHAMPVA coverage.
CHAMPVA’s allowable amount – what is paid for specific services and supplies – is in most cases equivalent to TRICARE. But the program is not the same as TRICARE. The two are administered separately, with differences in claim filing procedures and preauthorization requirements.
A provider who agrees to accept CHAMPVA agrees to accept the rates the program pays. In other words, the provider cannot charge the difference between what CHAMPVA pays and what it normally charges. If the beneficiary has other health insurance, it gets billed first.
CHAMPVA operates just like any other insurance program with respect to providing medical care. However, dental benefits are limited and vision benefits are only available to diabetes patients. CHAMPVA has an outpatient deductible ($50 per individual, $100 per family). For most care, patients must also pay 25% of the cost.
There are consequences if the beneficiary’s other health insurance denied payment on an out of network claim. In this case, CHAMPVA will also deny payment on the claim. You should review your network plan and discuss coverage questions with a Mobile, AL veterans disability benefits attorney.
The program is administered by the Veterans Health Administration Office of Community Care. A Mobile, AL veterans disability benefits attorney can help with the application process. Normally, applicants will receive written notification from the VHA within 45 days of submitting their application.
WE HELP VETERANS GET THE BENEFITS THEY NEED
Establishing eligibility for CHAMPVA starts with the veteran receiving a permanent disability rating. This requires meeting 100% of the disability schedule or being given a total disability individual unemployability (TDIU). Many veterans receive less than favorable ratings from the VA, and they don’t know where to turn. Our team helps veterans receive the appropriate rating and appeals decisions that they don’t agree with. Ascend Disability Lawyers, LLC works to take care of servicemembers and their families. Contact us today.
