Overview of VA, TRICARE, CHAMPVA Health Benefits
Navigating the complexities of military and veteran health benefits can be challenging, especially when distinguishing between programs like VA Health Care, TRICARE, and CHAMPVA. Each program offers unique coverage options tailored to different groups within the military community. Understanding these distinctions is crucial for veterans, active-duty service members, retirees, and their families to make informed decisions about their health care. This chapter provides a comprehensive overview of these programs, outlining eligibility criteria, coverage specifics, and how they interrelate, to assist you in effectively managing your health care needs.
VA Health Care
Most veterans who enlisted after Sept. 7, 1980, or who entered active duty after Oct. 16, 1981, must have served 24 continuous months or the full period for which called to active duty. This includes current and former members of the Reserve or National Guard called to active duty by a federal order. Find out if you are eligible for VA healthcare as a veteran.
https://www.choose.va.gov/health
Providing care at 1,380 health care facilities, including 170 medical centers and 1,193 outpatient sites of care of varying complexity (VHA outpatient clinics) and one (1) EHR
TRICARE
TRICARE Prime –
Similar to a Civilian HMO
TRICARE Select –
Similar to a Civilian PPO
TRICARE for Life (TFL)-
Medicare A/B plus TFL
Insights & Tips #SitRep episode
CHAMPVA
You may only be eligible for health care through CHAMPVA if you don’t qualify for TRICARE and at least one of these descriptions is true for you (see link).
- CHAMPVA is administered by the VHA Office of Community Care
CHAMPVA Family and Caregiver benefits
Leaving Active Duty
When leaving active duty, service members may be entitled to or eligible for benefits offered by TRICARE and Department of Veterans Affairs (VA), depending on whether the service member retires or separates. If retiring, the service member is eligible for TRICARE as a military retiree and may also be eligible for certain VA benefits. Service members who separate due to a service-connected disease or disability may be eligible for VA benefits and certain TRICARE benefits.
Eligibility
Retired Service members may be eligible for both TRICARE and VA benefits. This means that health care may be covered by TRICARE and/or VA benefits. For most health care needs, TRICARE may be the main source of coverage.
- Does VA participate in the TRICARE Network?
- Yes, since 1995, VA health care facilities have participated as TRICARE Network Providers.
- VA can provide care for Active Duty Service Members, military retirees, & family members under their TRICARE benefit - on a space available basis.
- Each VA health care facility can serve as primary care manager for TRICARE beneficiaries, but more often TRICARE referrals are used for specialty care.
TRICARE and VA Types of Services
| Outpatient Services | Prescriptions |
| Inpatient Services | Supplies |
| Preventive Services | Dental Care |
- TRICARE Benefits: May vary depending on your health plan selection, rules and costs
- VA Benefits: Your eligibility and copayment depend upon discharge, service-connection or income