CHAMPVA and TRICARE for Survivors, Who Pays for What

Surviving spouses often try to enroll in both CHAMPVA and TRICARE, reasoning that two health plans beat one. The programs are built to be mutually exclusive: TRICARE eligibility generally blocks CHAMPVA, and the CHAMPVA application asks about TRICARE for exactly that reason. The question that actually matters is which program the survivor qualifies for, and the age 55 remarriage line runs through both.

What this article covers

CHAMPVA and TRICARE are two different government health-care programs for family members of military service members and veterans. Most surviving spouses do not have a clear picture of which program covers what, when, or which one pays first. This article walks through the eligibility rules for each, who is the primary payer, and how transitions between the two programs work.

This is educational. For specific claims questions, contact CHAMPVA at the Health Administration Center in Denver or TRICARE at the regional contractor that serves your state.

Key differences at a glance

• TRICARE is the DoD's health plan. Eligibility comes from the service member's status (active, reserve, retired, deceased) and from the family member's relationship to the service member.
• CHAMPVA is the VA's health plan. Eligibility comes from the veteran's VA status (permanently and totally service connected, died from a service connected condition, or died in the line of duty) and from the family member's relationship to the veteran.

A surviving spouse who is eligible for TRICARE is generally NOT eligible for CHAMPVA. A surviving spouse who is NOT eligible for TRICARE may be eligible for CHAMPVA, when the underlying conditions are met.

In short, the two programs are designed to be mutually exclusive on the survivor side, so the survivor has one health plan, not two. There are narrow transition windows where both can apply.

TRICARE eligibility for survivors

The surviving spouse of a service member receives TRICARE as follows:

• Active duty death: The surviving spouse and dependent children receive Transitional Survivor benefits at active duty TRICARE rates for 3 years after the death. After 3 years, the surviving spouse moves to retired survivor TRICARE coverage. Children remain on active duty TRICARE rates until age 21 (or 23 if a full-time student) or until they become independent.
• Death during retired-pay-eligible service: The surviving spouse is enrolled in the same TRICARE plan the retiree was on (Prime, Select, TFL after age 65) at retiree-survivor rates.
• TRICARE for Life (TFL): Once the surviving spouse is enrolled in Medicare Part B, TFL becomes the secondary payer to Medicare. This applies regardless of whether the spouse was previously on TRICARE Prime or Select.

Source rules:

• 10 USC 1086 (TRICARE eligibility)
• 32 CFR Part 199 (TRICARE regulations)

CHAMPVA eligibility for survivors

CHAMPVA is for the family members of a veteran who is, or was:

1. Permanently and totally (P&T) service connected disabled while living, OR
2. Rated P&T at the time of death, OR
3. Died from a service connected condition, OR
4. Was killed in the line of duty.

The "family member" definition for CHAMPVA includes:

• The surviving spouse (until remarriage; remarriage at or after age 55 does not terminate eligibility).
• Dependent children (until age 18, or age 23 if a full-time student, or any age if a "helpless child" under 38 CFR 3.356).
• Stepchildren who lived with the veteran in a parent-child relationship.

Source rules:

• 38 USC 1781 (CHAMPVA statute)
• 38 CFR 17.270 to 17.278 (CHAMPVA regulations)

When a survivor is eligible for both

A surviving spouse who was married to a military retiree, and whose retiree died from a service connected condition or was rated P&T at death, is eligible for both TRICARE (because the retiree was retired) and CHAMPVA (because the death was service connected). In that case, CHAMPVA is NOT available; TRICARE is the only plan the spouse uses.

Why: CHAMPVA does not pay when the survivor has TRICARE eligibility. The CHAMPVA application form (10-10d) asks about TRICARE eligibility. If TRICARE is available, CHAMPVA does not enroll the spouse.

This is by design. CHAMPVA was created in 1973 to cover family members of VA-recognized disabled veterans who do NOT have a TRICARE option. The two programs do not stack.

When a survivor is eligible for CHAMPVA but not TRICARE

Common scenarios:

• The veteran did not serve long enough to be retiree-eligible (no 20-year retirement) but was rated P&T service connected during life and died from a non service connected cause. Survivor is eligible for CHAMPVA only.
• The veteran was a National Guard member rated P&T service connected and died from a service connected condition without ever reaching active duty retirement. Survivor is eligible for CHAMPVA only.
• The veteran was killed in the line of duty during a non-active duty period (e.g., during reserve drill). Survivor is eligible for CHAMPVA only.

How CHAMPVA works at the provider

CHAMPVA is a fee-for-service plan, not an HMO. The survivor can see any provider who accepts CHAMPVA payment. The provider bills CHAMPVA after the visit. CHAMPVA pays the allowed amount, less the survivor's cost share (typically 25 percent of CHAMPVA's allowed charge, with an annual catastrophic cap).

For prescriptions, CHAMPVA uses the Meds-by-Mail program for many maintenance medications, plus retail pharmacy coverage.

For inpatient care, CHAMPVA pays the DRG-based allowed amount, less the cost share.

How TRICARE for Life works at the provider

A surviving spouse age 65 or older, enrolled in Medicare Part B, automatically becomes eligible for TFL. Medicare is the primary payer; TFL is the secondary payer. The survivor presents both cards at the provider. Medicare pays its share, TFL pays most or all of the remainder. The survivor's out-of-pocket cost is generally very low.

Remarriage rules for each program

• TRICARE: A surviving spouse who remarries generally loses TRICARE coverage. If the new marriage ends (divorce or death), TRICARE eligibility can be reinstated.
• CHAMPVA: A surviving spouse who remarries before age 55 loses CHAMPVA. Remarriage at or after age 55 does not terminate CHAMPVA. If the new marriage ends, CHAMPVA can be reinstated.

This is the same age-55 rule that applies to DIC. If the survivor is reasoning through remarriage, the age-55 line is the critical one.

How to apply

• TRICARE survivor enrollment: When the service member dies, the surviving spouse should contact the DEERS Support Office (1-800-538-9552) to update enrollment status. New TRICARE cards arrive within 30 days.
• CHAMPVA: VA Form 10-10d, Application for CHAMPVA Benefits. Send to the VA Health Administration Center, Denver, Colorado. Required documents include the death certificate, marriage certificate, and proof of the veteran's P&T or service connected death status (usually the most recent rating decision letter or the veteran's BIRLS extract).

Common misunderstandings

• A surviving spouse cannot be on both CHAMPVA and TRICARE at the same time.
• A surviving spouse who is eligible for TRICARE is not eligible for CHAMPVA, even if the death was service connected and otherwise CHAMPVA-eligible. The TRICARE-first rule applies.
• TFL is the secondary payer to Medicare after age 65 and Part B enrollment. The surviving spouse still needs Part B enrollment for TFL to function.
• CHAMPVA is fee-for-service. It is not part of the TRICARE network. Providers who accept CHAMPVA may or may not accept TRICARE; they are separate networks.

Sources

• 10 USC 1086 (TRICARE eligibility)
• 32 CFR Part 199 (TRICARE regulations)
• 38 USC 1781 (CHAMPVA statute)
• 38 CFR 17.270 to 17.278 (CHAMPVA regulations)
• VA CHAMPVA page (va.gov)
• TRICARE Survivor Eligibility page (tricare.mil)
• VA Form 10-10d (CHAMPVA application)
• DEERS Support Office (1-800-538-9552)

Related on this site

• Benefits for Children of Veterans with Birth Defects
• Survivor Benefit Dependencies, How DIC, Chapter 18, Helpless Child Status, and SBP Sit Alongside Each Other
• 38 USC 1318 DIC: When Cause of Death Needn't Be Service Connected