UNDERSTAND YOUR UNIQUE VETERANS’ MEDICAL BENEFITS
Military health care coverage may be available to eligible persons and family members. Coverage may include:
Veterans Affairs Benefits (VA)
CHAMPVA (Civilian Health and Medicare Program of the Department of Veterans Affairs)
For more information on any of these programs and other military benefits and eligibility, contact your local Veterans Service Officer. They help veterans and their families to obtain local, state, and federal benefits for which they may qualify. Locate your nearest CVSO/TVSO Wisconsin office here.
Veterans Affairs Benefits (VA)
A person may be eligible for VA health care benefits if that person served in the active military, naval, or air service and did not receive a dishonorable discharge. During the enrollment process, each Veteran is assigned to 1 of 8 priority groups. If a Veteran qualifies for more than one priority group, assignment will be to the highest one. This system helps to make sure that Veterans who need care right away can get signed up quickly. It also helps to make sure the VA can provide high quality care to all Veterans enrolled in the VA health care program.
Each Veteran’s medical benefits package is unique. It will include care and services to help treat illnesses and injuries, prevent future health problems, improve ability to function, and enhance quality of life. All Veterans receive coverage for most care and services, but only some will qualify for added benefits like dental care. The full scope of eligible covered benefits depends on a Veterans priority group, the advice of the Veterans VA primary care provider (main doctor, nurse practitioner, or physician’s assistant), and the medical standards for treating any health conditions the Veteran may have.
TRICARE is a health program for Uniformed Service members and their families, National Guard/Reserve members (Includes members of the Army National Guard, Army Reserve, Navy Reserve, Marine Corps Reserve, Air National Guard, Air Force Reserve, U.S. Coast Guard Reserve) and their families, survivors, former spouses, Medal of Honor recipients and their families, and others registered in the Defense Enrollment Eligibility Reporting System (DEERS).
TRICARE is regionally based and brings together military hospitals and clinics with a network of civilian providers to offer comprehensive, affordable health care, dental, and pharmacy coverage. TRICARE also provides programs for people with special needs. Benefits and plans will vary depending on a person’s beneficiary category.
TRICARE For Life is a Medicare-wraparound coverage for TRICARE-eligible beneficiaries who have Medicare Part A and B. Coverage is automatic when enrolled in Medicare A and B. The beneficiary must pay the Part B monthly premium. Visit the TRICARE For Life website (see link below) for information and publications regarding coverage and costs.
For more information on eligibility, program benefits, and how to apply for TRICARE, TRICARE FOR LIFE, and other TRICARE programs, visit the websites:
Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
CHAMPVA is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries.
A person may be eligible for health care through CHAMPVA if that person does not qualify for TRICARE and at least one of the following is true. A person is:
1. The spouse or child of a Veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office, or
2. The surviving spouse or child of a Veteran who died from a VA-rated service-connected disability, or
3. The surviving spouse or child of a Veteran who was at the time of death rated permanently and totally disabled from a service-connected disability, or
4. The surviving spouse or child of a service member who died in the line of duty, not due to misconduct (in most of these cases, family members qualify for TRICARE, not CHAMPVA).
There are other factors that may affect whether a person or other family members qualify for CHAMPVA.
If a person is eligible for CHAMPVA and also has Medicare Part A and Part B, CHAMPVA will cover many of the costs for health care services and supplies not covered by Medicare. CHAMPVA will pay after Medicare and any other insurance, such as Medicare HMOs and Medicare supplemental plans. CHAMPVA does not pay Medicare Part B premiums.