CHAMPVA & Medicare
If you get your medications in the mail at no cost, read the box below before you do anything else. A Medicare drug plan ends that benefit, and VA states in its own guidance that you do not need one.
No plan described here is a veterans plan, a VA plan, a military plan or a federal employee plan. Medicare Advantage and Part D plans are private insurance. None is issued by, sponsored by, endorsed by or affiliated with the Department of Veterans Affairs, the Department of Defense, any branch of the armed services, or the Office of Personnel Management. Your VA, TRICARE, CHAMPVA, FEHB or PSHB coverage is administered by those agencies and nothing on this page changes it.
Meds by Mail and a Medicare drug plan cannot coexist
CHAMPVA delivers regularly taken medications to your home at no cost through Meds by Mail. VA states that you can use Meds by Mail only if you have no other prescription coverage. A Medicare Part D plan is other prescription coverage — and so is a Medicare Advantage plan that includes Part D. Joining one does not add a drug benefit on top of Meds by Mail. It ends a free benefit and replaces it with one that has copays. If you get your medications in the mail, that is the whole decision, and the number to confirm it on is 1-800-733-8387.
CHAMPVA & Medicare, step by step
Check whose service this coverage comes from
The CHAMPVA beneficiary is usually not the veteran. CHAMPVA covers spouses, surviving spouses and children of veterans who are permanently and totally disabled from a service-connected condition, or who died from one or in the line of duty, and who are not TRICARE-eligible. It is worth being sure which programme you actually hold before reading anything else here.
Confirm with: CHAMPVA — 1-800-733-8387
You must have Part A and Part B to get or keep CHAMPVA
VA states that a person eligible for Medicare must have both Part A and Part B to get or keep CHAMPVA. A Medicare Advantage plan also satisfies that requirement, so enrolling in one does not endanger your CHAMPVA eligibility. Dropping Part B, on the other hand, can end it.
Confirm with: CHAMPVA — 1-800-733-8387
VA says it plainly: you do not need Part D to get CHAMPVA
That is VA's own published wording, and it is the clearest statement anywhere in this section. CHAMPVA pharmacy benefits are creditable drug coverage, so there is no Part D late-enrolment penalty building while you hold them. If a Medicare Advantage plan makes sense for you for other reasons, the structure that protects what you have is one with no Part D coverage in it.
Confirm with: CHAMPVA — 1-800-733-8387
CHAMPVA pays second, and keeps doing so
CHAMPVA is the secondary payer to Medicare. If you have a Medicare Advantage plan, that plan pays first and CHAMPVA may cover costs still owed. The layered structure survives — but claim handling varies, so confirm how it will work for the specific plan before you enrol.
Confirm with: CHAMPVA — 1-800-733-8387
What CHAMPVA does and does not pay toward Medicare
CHAMPVA covers some or all of the Medicare Part B deductible for outpatient care. It does not cover your Part B premium — you still pay that. Where CHAMPVA is your only coverage there is a $50 per person annual deductible ($100 per family), a 25% cost share of the CHAMPVA allowable amount, and a $3,000 household catastrophic cap; where you also have other coverage you frequently pay no cost share at all.
Confirm with: CHAMPVA — 1-800-733-8387
Two smaller things worth knowing
A Medicare-eligible beneficiary cannot get care through the CHAMPVA In-House Treatment Initiative, so do not count on treatment at a VA facility. And CHAMPVA itself offers only limited vision coverage and generally does not cover eyeglasses or contact lenses — though CHAMPVA beneficiaries can buy dental cover at reduced cost through the VA Dental Insurance Program, which is worth looking at before you buy dental anywhere else.
Confirm with: CHAMPVA — 1-800-733-8387
Where the drug coverage question lands
Every kind of coverage on this page already includes prescription drug coverage that Medicare counts as creditable — meaning it is at least as good as a Part D plan, so you are not building a late-enrollment penalty while you hold it. That one fact decides the shape of any Medicare Advantage plan that would make sense next to it.
A Medicare Advantage plan that carries no Part D drug coverage is usually written as “MA-Only” or a medical-only plan. It covers what Part A and Part B cover, plus whatever extras the plan includes, and it leaves your existing drug coverage alone. For two of the programmes below, that is not a preference — adding Part D takes a benefit away.
Check this yourself
Nothing here is a decision about your benefit. These are the people who administer it and can tell you how it applies to you.
- CHAMPVA — 1-800-733-8387 · www.va.gov
- Medicare — 1-800-MEDICARE · www.medicare.gov
Talk it through with somebody who knows how these fit together
No medical questions, no pressure, and no application on the first call. If the honest answer is that your existing coverage already does the job, that is the answer you will get.
The ones that come up every week
Does enrolling in a Medicare Advantage plan affect my VA health care?
No. Your VA enrolment, your Priority Group and your disability compensation are administered by VA and are not changed by a private insurance enrolment. What a Medicare Advantage plan does is give you a way to get care outside the VA system. It pays nothing toward care you receive at a VA facility.
I use the VA for all my prescriptions. Do I need a Medicare drug plan?
Generally no. VA pharmacy benefits are creditable prescription drug coverage, which means you are not building a Part D late-enrolment penalty while you use them. The same is true of TRICARE, CHAMPVA and federal plan drug benefits. Confirm your own situation with the programme that administers your coverage.
Can I keep my FEHB plan and take a Medicare Advantage plan at the same time?
OPM states that an individual may enrol in a Medicare Advantage plan and also remain enrolled in an FEHB plan. If you do, OPM requires you to tell your FEHB plan, because it needs to know whether you have Original Medicare or a Medicare Advantage plan in order to coordinate benefits correctly. Confirm the specifics with your own carrier and with OPM at 1-888-767-6738.
What is the difference between suspending and cancelling FEHB or PSHB?
Suspension is reversible — an annuitant can return during a later Open Season, or immediately if a Medicare Advantage plan is involuntarily lost. Cancellation is generally permanent, and takes the government's share of the premium with it. They are different administrative actions. Before filing either, call OPM Retirement Services at 1-888-767-6738 and get the answer for your own enrolment.
I get my CHAMPVA medications in the mail. Should I take a Medicare drug plan?
VA states that Meds by Mail is available only to CHAMPVA beneficiaries with no other prescription coverage, and that you do not need Part D to get CHAMPVA. A Medicare drug plan would end Meds by Mail rather than add to it. Confirm with CHAMPVA at 1-800-733-8387 before changing anything.
Will a Medicare Advantage plan lower my Part B premium?
Some plans include a Part B premium reduction, often called a giveback. It is a feature of particular plans in particular counties rather than something Medicare Advantage does generally, and the amount varies. It is worth asking about for your own county, and worth checking on Medicare.gov rather than taking anyone's word for it — including ours.
Does TRICARE For Life end if I join a Medicare Advantage plan?
No. You still have Medicare, the Medicare Advantage plan becomes the primary payer, and TRICARE For Life remains the second payer for TRICARE-covered services. Note that TRICARE's guidance says Medicare Advantage claims do not cross over automatically, so a claim may occasionally need following up. Dropping Part B, on the other hand, does end TRICARE For Life.