VI. Key Issues: Financing and Delivery >> D. Health Insurance Coverage >> Public Health Insurance >> Military Health Care (last updated 5.15.14)
What is Military Health Care?
As defined by the Bureau of Census, which annually surveys households to determine the extent of health insurance coverage, military health care includes:
- TRICARE. The TRICARE health program serves active duty service members, National Guard and Reserve members, retirees, their families, survivors and certain former spouses worldwide. It was formerly known as CHAMPUS (Comprehensive Health and Medical Plan for Uniformed Services) (Fronstein: Figure 1).
- CHAMPVA. The Civilian Health and Medical Program of the Department of Veterans Affairs is a health benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries. CHAMPVA is managed by the VA’s Health Administration Center (HAC) in Denver, Colorado which processes CHAMPVA applications, determines eligibility, authorizes benefits, and processes medical claims.
- VA Health Care. Care provided by the Health and Medical Program of the Department of Veterans Affairs and direct care provided by the Department of Veterans Affairs (DeNavas-Walt: Table C-3).
Who is Eligible for Military Health?
TRICARE. Eligibles include all active duty members of the seven uniformed services, members of the National Guard and Reserve, retirees, their families, survivors and certain former spouses.
CHAMPVA. An individual cannot be eligible for TRICARE/CHAMPUS and must be a spouse or child of a veteran in one of these categories who:
- Has been rated permanently and totally disabled for a service-connected disability by a VA regional office
- Died from a VA-rated service connected disability
- Was at the time death rated permanently and totally disabled from a service connected disability
- Was a military member who died in the line of duty, not due to misconduct (in most of these cases, these family members are eligible for TRICARE, not CHAMPVA).
An eligible CHAMPVA sponsor may be entitled to receive medical care through the VA health care system based on his or her own veteran status. Additionally, if the eligible CHAMPVA sponsor is the spouse of another eligible CHAMPVA sponsor, both may now be eligible for CHAMPVA benefits. In each instance where the eligible spouse requires medical attention, he or she may choose the VA health care system or coverage under CHAMPVA for his/her health care needs.
Effective October 1, 2001, CHAMPVA benefits were extended to beneficiaries age 65 and older, but eligibility depends on when the beneficiary turned age 65 and their Medicare enrollment status.
What Benefits Are Available Through Military Health?
CHAMPVA. In most cases, CHAMPVA pays equivalent to Medicare/TRICARE rates. CHAMPVA has an outpatient deductible ($50 per person up to $100 per family per calendar year) and a cost share of 25% up to the catastrophic cap (up to $3,000 per calendar year). By law, CHAMPVA is always secondary payer except to Medicaid, State Victims of Crime Compensation Programs and supplemental CHAMPVA policies. Therefore, the 25% allowable cost share is not collected from patients who have other health insurance. In such cases, then CHAMPVA pays the lesser of either 75% of the allowable amount after $50 calendar year deductible is satisfied, or the remainder of the charges after the other plan has paid its share; typically, therefore, the beneficiary will have no cost share.
If the beneficiary is eligible for CHAMPVA and also has Medicare Part A entitlement (premium-free hospitalization coverage) and Medicare Part B (outpatient coverage), CHAMPVA covers many of the costs not covered by Medicare. CHAMPVA will pay after Medicare and any other insurance, such as Medicare HMOs and Medicare supplemental plans, for health care services and supplies; but it does not pay Medicare Part B premiums.
How Many Are Covered by Military Health?
11.560 million individuals were covered by military health care in March 2009 (DeNavas-Walt: Table C-1).
- DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith. U.S. Census Bureau, Current Population Reports, P60-236, Income, Poverty, and Health Insurance Coverage in the United States: 2008, U.S. Government Printing Office, Washington, DC, 2009. [Full Text (pdf)]