Dealing with an addiction issue is a struggle that can feel overwhelming without the right support. However, with treatment and supportive people around you, you can overcome the difficulties surrounding this problem.
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is designed to provide healthcare assistance to certain populations of people in the veteran community.1 This CHAMPVA guide will help you understand whether you are an eligible beneficiary of CHAMPVA coverage and how you can get started with your journey to sobriety.
What is CHAMPVA?
CHAMPVA is a healthcare assistance program that provides medical services for certain Veteran dependent population groups. Those groups include spouses, widows, and children of disabled or deceased Veterans, who don’t receive TRICARE benefits.1
With CHAMPVA insurance, eligible beneficiaries can access the health benefits program managed by the Department of Veterans Affairs (VA).1
CHAMPVA Eligibility Requirements
Certain eligibility requirements must be met for a spouse, widow, or child of a Veteran to qualify for CHAMPVA benefits. To qualify for CHAMPVA benefits, one of the following situations must apply:1
- The Veteran was rated permanently and totally disabled because of a service-connected disability.
- The Veteran was rated permanently and totally disabled because of a service-connected condition at the time of death.
- The Veteran died due to a service-connected disability.
- The Veteran died on active duty and the dependents are not eligible for Department of Defense TRICARE benefits.
With CHAMPVA health benefits, you have access to medically necessary and appropriate care for many different conditions. Often, prior approval from CHAMPVA is not required.2
However, certain treatments do require prior authorization. These forms of treatment include:2
- Mental health services.
- Substance abuse services.
- Dental care.
- Organ transplants.
Does CHAMPVA Cover Substance Abuse Treatment & Rehab?
Yes, you can access your CHAMPVA insurance policy to receive addiction treatment. If you meet the criteria of a beneficiary, you can use up to 3 substance-use disorder treatment benefit periods in a lifetime. A benefit period lasts for 1 year, beginning on the first day of covered treatment. It doesn’t matter how many times you receive services during that time period (i.e., consecutive days spent in rehab or visits to an outpatient center).2
Some of the types of substance use treatment covered by CHAMPVA insurance include the following:2
- Inpatient rehab treatment
- Outpatient treatment
- Partial hospitalization program (PHP)
- Intensive outpatient program (IOP)
The facility where you receive your substance abuse treatment must be TRICARE-approved or Medicare-certified.2 Be sure to contact the facility beforehand, and they will verify your CHAMPVA insurance for you.
Does CHAMPVA Cover Medications?
Yes, CHAMPVA health covers certain medications that are approved by the Department of Health and Human Services Federal Drug Administration (FDA). However, CHAMPVA does not cover medications for opioid use disorder (e.g., methadone or suboxone).2
What Does CHAMPVA Not Cover?
Even though you have medical, dental, mental health, and substance abuse coverage for various services, there are some things that are not covered by a CHAMPVA plan. As it concerns behavioral health issues, the following services are not covered:2
- Learning disorder treatment
- Gender-affirming operations
- Stress management
- Marriage counseling
- Medication for opioid use disorder (MOUD)
Does CHAMPVA Cost Money?
There are no monthly premiums with CHAMPVA, but you may have to pay an annual deductible before treatment begins, and copayments for certain services. However, an out-of-pocket limit or catastrophic cap is set at $3,000 per year. This means that once you’ve paid this amount, CHAMPVA covers 100% of the remaining costs of covered services that year.1
Do Providers Outside of the VA Take CHAMPVA?
CHAMPVA does not have a network of providers. Instead, when hospitals, treatment centers, doctors, and doctors participate in the CHAMPVA program, it is referred to as “accepting assignment.”4 If possible, confirm that the facility accepts assignment before obtaining healthcare services.
The allowable amount for inpatient hospital services established by the Veteran’s Health Administration Office of Community Care (VHA OCC) must be accepted by all hospitals that participate in Medicare. This also applies to all hospital-based healthcare professionals employed by these hospitals.4
CHAMPVA benefits may also be used to pay for services from providers that do not accept assignment. However, you will likely have to pay the full amount for services up-front and request reimbursement from the VA at a later date. In addition, the amount you owe may exceed the allowable amount the VA covers. If this is the case, you would only be partially reimbursed.4
Does CHAMPVA Include Medicaid and Medicare?
If you have both CHAMPVA and Medicare, Medicare is the first payer. This means Medicare would be billed before CHAMPVA and, if there is a balance remaining, CHAMPVA may cover it.5 If you have Medicaid, the opposite is true, and CHAMPVA is the first payer, with the potential remaining balance for treatment going to Medicaid.1
CHAMPVA & Other Benefits
You can have CHAMPVA and other benefits. In most cases, the other insurer will be the first payer. If you have CHAMPVA and another form of insurance, CHAMPVA will pay the lesser of either:1
- 75% of the amount after the CHAMPVA deductible is met.
- The remainder of the costs of a service that were not covered by the other insurer.
Exceptions, in which CHAMPVA is the first payer, include:1
- State Victims of Crime Compensation Programs.
- Indian Health Services.
- Supplemental CHAMPVA policies.
CHAMPVA vs TRICARE: What’s the Difference?
Unlike CHAMPVA, which is a VA program for the spouses, widows, and children of disabled or deceased Veterans, TRICARE is a DoD regionally managed healthcare program for active duty and retired members of the uniformed services, their families, and survivors.6
If you are eligible for TRICARE, you are not eligible for CHAMPVA.1
It’s best to confirm your CHAMPVA benefits with the rehab facility to ensure that you will have coverage. To inquire about CHAMPVA coverage at an American Addiction Centers (AAC) facility call .