Medical
Coverage for Spouses
This information is directed for Spouses of Veterans that are permanently and totally service connected disabled and DID NOT RETIRE from Military Service.
The below information is directed towards Spouses of Veterans that have yet become the age for Medicare..Part A & B
Information for Veterans who the VA has rated as permanently and totally disabled for a service-connected disability;
The following
information is not intended as a advertisement for CHAMPVA or any other particular
insurance carrier, but rather to make a certain
group of Veterans aware that there is insurance coverage for the spouse of
permanently and totally service connected disabled veteran that may be more
cost effective than their present coverage.
If the below eligibility criteria are met, there is no monthly or yearly cost for coverage. Medications are free through a mail in program. There is a $50 deductible and the Veteran or his spouse is only responsible for 25% of the cost of services. If the 25% paid by the Spouse amounts to $3000, the CHAMPVA would then defray 100% for medical coverage for the rest of that given year.
In addition to the CHAMPVA coverage, the CHAMPVA would be
the primary insurer of the spouse and as such, there are supplemental insurance
that the spouse can subscribe to that is available and sanctioned by CHAMPVA.
The supplemental insurance would have a very small yearly
fee for membership and also have a $150 deductible. The supplemental carrier
would
defray all of the 25% deductible that CHAMPVA requires after the $50 deductible
is met and the $150 deductible is met from the supplemental
carrier is also met. The monthly charge for the supplemental insurance is
minimal. As for age it is for example, a spouse that is 56 years is only
about $35 a month.
Once the Spouse of the Veteran reaches the age of Medicare,
then Medicare Part A & B would be required for the monthly cost which
at this
time is $66 a month(Rate starting JAN 1, 2004). Then CHAMPA primary coverage
would be converted to CHAMPVA for Life. CHAMPVA Life would be the supplemental
insurance carrier and defray the Medical expenses that Medicare does not pay.
There
are several supplemental Insurance carriers sanctioned by CHAMPVA, but most
limit the supplement to Tricare only.
CHAMPVA makes available, a list of Supplemental Carriers with their respective
toll free telephone numbers. When calling these Supplemental Carriers, make
sure that the carrier has the coverage for non-tricare elgible subscribers.
The information for Spouses that are of the age to have Medicare and still eligible for CHAMPVA is as follows:
Under CHAMPVA guidelines, an eligible CHAMPVA Spouse would
have to have Medicare and pay the $52 a month and then they could have
CHAMPVA as their supplement. There would not be a cost for the CHAMPVA. CHAMPVA
would defray all costs incurred not covered by Part B.
NOTE:: It should be noted also. This is an entitlement and therefore cannot be taken away by the VA.
For Supplemental
Insurance information assistance, you may call 1-800-613-6997. or visit the
website at www.federalpublishing.com. They will assist you in choosing the
right supplemental plan for your particular situation.
(Federal Publishing is a non-profit organization established
to assist the veteran and his spouse at no charge and no requirements
)
Medical
Care for Dependents and Survivors
CHAMPVA, the Civilian Health and Medical Program of the Department of Veterans
Affairs, provides reimbursement for most medical
expenses - inpatient, outpatient, mental health, prescription medication,
skilled nursing care and durable medical equipment. To be
eligible for CHAMPVA, an individual cannot be eligible for TRICARE (the medical
program for civilian dependents provided by the
Department of Defense) and must be one of the following:
1. the spouse or child of a veteran who VA has rated as 100 percent permanently
and totally disabled for a service-connected disability;
2. the surviving spouse or child of a veteran who died from a VA-rated service-connected
disability, or who, at the time of death,
was rated 100 percent permanently and totally disabled; or
3. the surviving spouse or child of a military member who died in the line
of duty, not due to misconduct. However, in most of these
cases, these family members are eligible for TRICARE, not CHAMPVA.
Individuals over the age of 65 must also meet additional CHAMPVA benefits
eligibility conditions. Individuals who reached age 65 before
June 5, 2001, and only have Medicare Part A, will be eligible for CHAMPVA
without having to have Medicare Part B coverage; those
who have Medicare Parts A and B, must keep both parts. Individuals who reached
age 65 on or after June 5, 2001, must be enrolled in
Medicare Parts A and B to be eligible.
For more information, or to apply for CHAMPVA benefits, visit the CHAMPVA
Web site (http://www.va.gov/hac/), call 1-800-733-8387 or
contact the VA Health Administration Center, P.O. Box 65023, Denver, CO 80206.
Many VA medical centers provide services to CHAMPVA beneficiaries under the
CHAMPVA In House Treatment Initiative (CITI)
program. CHAMPVA beneficiaries who use a CITI facility incur no cost for the
services they receive. However, services provided under
this program are on a space available basis, after the needs of veterans are
met. Because of this, not all services are available at all
times, nor are the same services available every day. CHAMPVA beneficiaries
should contact their nearest VA medical center to see if
it is a participating facility.
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