Direct answer: CHAMPVA covers the spouse, child or surviving family of a Veteran rated permanently and totally disabled from a service-connected condition, or who died from one, if they can't get TRICARE. You pay a $50 yearly outpatient deductible ($100 per family), then 25% of VA's allowable amount, up to $3,000 a family per year.
By the numbers: After a family has paid $3,000 in out-of-pocket costs, to include both cost-share and deductible amounts, in a calendar year, CHAMPVA will pay the full allowable amounts for the remaining CHAMPVA-covered services and supplies. Source: 38 CFR 17.274(c)
“If you remarry on or after your 55th birthday, you can keep your CHAMPVA benefits after you remarry.” — VA: CHAMPVA benefits (updated Aug. 7, 2026)
Updated 2026-10-17
The spouse or dependent child of a Veteran rated permanently and totally disabled from a service-connected disability, or the surviving spouse or dependent child of a Veteran who died from a service-connected disability or was rated permanently and totally disabled at death. You can't be eligible for TRICARE. Some survivors of service members who died in the line of duty also qualify. Primary family caregivers in VA's caregiver program (PCAFC) with no other health insurance can qualify too (VA, updated Aug. 7, 2026).
A $50 calendar-year deductible per person ($100 most per family) for outpatient care and retail prescriptions, then 25% of CHAMPVA's allowable amount. No deductible for hospital stays. Family out-of-pocket costs stop at $3,000 a calendar year; after that CHAMPVA pays 100% of covered care (38 CFR 17.274).
Maintenance drugs through Meds by Mail (only if you have no other prescription coverage), care at VA facilities under CITI, listed preventive care (annual physicals, vaccines, cancer screenings, well-child care to age 6) and hospice: no deductible and no cost share (38 CFR 17.274; VA).
If you're eligible for Medicare, you must have Part A and Part B (a Medicare Advantage plan also counts) to get or keep CHAMPVA. Part D isn't required, but you can't use Meds by Mail with Part D. CHAMPVA pays after Medicare and covers some or all of the Part B deductible, not Part B premiums (VA, updated Aug. 12, 2026).
Not if you remarry on or after your 55th birthday. Remarrying before 55 ends CHAMPVA on the remarriage date; if that marriage later ends, you may qualify again from the first day of the next month (VA).
18, or 23 if enrolled in school (recertify at least once a year). Marriage ends it. A child permanently unable to self-support because of a disability that began before 18 can keep it past 18. A stepchild who leaves the Veteran's household after a divorce no longer qualifies (VA).
Online at VA.gov, or mail VA Form 10-10d with supporting documents to VHA Office of Community Care, CHAMPVA Eligibility, PO Box 137, Spring City, PA 19475. Include proof of other insurance or Medicare if you have it. The ID card can take up to 6 weeks. Questions: 800-733-8387 (CHAMPVA Guidebook).
As of Oct. 17, 2026 · VA CHAMPVA pages (Aug. 2026) · 38 CFR 17.274 · CHAMPVA Guidebook
If the Veteran is rated permanently and totally disabled from a service-connected condition (or died from one) and you can’t get TRICARE, apply for CHAMPVA. Costs: a $50 outpatient deductible per person ($100 a family), then 25% of the allowable amount, never more than $3,000 a family in a calendar year. Meds by Mail, VA-facility care under CITI, preventive care and hospice are $0.
The math:
Sources: VA CHAMPVA benefits · VA CHAMPVA care · 38 CFR 17.274
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Use CHAMPVA’s allowable amount from your explanation of benefits (EOB). VA says it’s usually the same as what Medicare or TRICARE pays.
| Care | Deductible? | You pay |
|---|---|---|
| Doctor visits, lab and X-ray, home health, outpatient mental health, ambulance | Yes | 25% of the allowable amount after the deductible |
| Retail pharmacy (OptumRx network) | Yes | 25% of the allowable amount after the deductible (full price until the deductible is met) |
| Durable medical equipment | Yes | 25% of the allowable amount |
| Outpatient (ambulatory) surgery | No | 25% of the allowable amount |
| Hospital stay paid by DRG | No | The lesser of: the per diem rate x days, 25% of the hospital's billed amount, or the base CHAMPVA DRG rate |
| Hospital stay not paid by DRG; skilled nursing facility; high-volume or residential mental health | No | 25% of the allowable amount |
| Low-volume inpatient mental health (under 25 mental health discharges a year) | No | The lesser of: the per diem rate x days, or 25% of billed charges |
| Emergency room | Depends | Billed as inpatient if you're admitted; otherwise outpatient rules |
| Meds by Mail; care at a VA facility under CITI | No | Nothing |
| Preventive care (annual physical, vaccines, cancer screenings, well-child care to age 6); hospice | No | Nothing |
Sources: VA CHAMPVA benefits · VA CHAMPVA care · CHAMPVA Guidebook.
| CHAMPVA | TRICARE (2026) | |
|---|---|---|
| Who it's for | Families and survivors of Veterans rated P&T service-connected (or who died of a service-connected condition); not TRICARE-eligible | Active duty and retired service members, their families and survivors |
| Run by | VA | Defense Department |
| Enrollment fee | None listed in VA's cost rules (only the deductible, 25% cost share and $3,000 cap) | Retirees: $186.96 to $1,191 a year in 2026 by plan, group and individual or family; active duty families $0 |
| Deductible | $50 a person, $100 a family (outpatient) | $0 in Prime; Select up to $397 a family in network |
| Your share of care | 25% of the allowable amount | Fixed copays in network for most care (e.g. retiree Prime $26 primary care) |
| Yearly cap | $3,000 a family | $1,000 to $4,635 a family |
| With Medicare | Part A + B required; CHAMPVA pays second | TRICARE For Life with Part A + B |
You can’t have both: TRICARE eligibility rules you out of CHAMPVA. Sources: VA CHAMPVA benefits · 38 CFR 17.274 · TRICARE costs 2026.
Facts and arithmetic only. VaultRubric isn’t VA, and this isn’t advice. VA decides who qualifies and what each claim pays; your explanation of benefits (EOB) is the final number.
The spouse or dependent child of a Veteran rated permanently and totally disabled from a service-connected disability, or the surviving spouse or dependent child of a Veteran who died from a service-connected disability or was rated permanently and totally disabled at death. You can't be eligible for TRICARE. Some survivors of service members who died in the line of duty also qualify. Primary family caregivers in VA's caregiver program (PCAFC) with no other health insurance can qualify too (VA, updated Aug. 7, 2026).
A $50 calendar-year deductible per person ($100 most per family) for outpatient care and retail prescriptions, then 25% of CHAMPVA's allowable amount. No deductible for hospital stays. Family out-of-pocket costs stop at $3,000 a calendar year; after that CHAMPVA pays 100% of covered care (38 CFR 17.274).
Maintenance drugs through Meds by Mail (only if you have no other prescription coverage), care at VA facilities under CITI, listed preventive care (annual physicals, vaccines, cancer screenings, well-child care to age 6) and hospice: no deductible and no cost share (38 CFR 17.274; VA).
If you're eligible for Medicare, you must have Part A and Part B (a Medicare Advantage plan also counts) to get or keep CHAMPVA. Part D isn't required, but you can't use Meds by Mail with Part D. CHAMPVA pays after Medicare and covers some or all of the Part B deductible, not Part B premiums (VA, updated Aug. 12, 2026).
Not if you remarry on or after your 55th birthday. Remarrying before 55 ends CHAMPVA on the remarriage date; if that marriage later ends, you may qualify again from the first day of the next month (VA).
18, or 23 if enrolled in school (recertify at least once a year). Marriage ends it. A child permanently unable to self-support because of a disability that began before 18 can keep it past 18. A stepchild who leaves the Veteran's household after a divorce no longer qualifies (VA).
Online at VA.gov, or mail VA Form 10-10d with supporting documents to VHA Office of Community Care, CHAMPVA Eligibility, PO Box 137, Spring City, PA 19475. Include proof of other insurance or Medicare if you have it. The ID card can take up to 6 weeks. Questions: 800-733-8387 (CHAMPVA Guidebook).
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