The hospital's meter hit $1.3 million. Ours stopped at $3,000. Find out if your family qualifies — and run your own worst year.
CHAMPVA is the VA's health coverage for the families of veterans rated Permanently & Totally disabled (and for survivors of veterans who died of service-connected causes): no premiums, a $50 annual outpatient deductible, a 25% cost share of the VA allowable amount, and a hard $3,000-per-family annual cap on out-of-pocket costs for covered care. It is a dependents-only program: CHAMPVA is never awarded to the veteran themselves — the veteran's own coverage is VA health care — it exists so the spouse and children get protection too. It may be the most slept-on benefit in the system — and the most misunderstood, because TRICARE eligibility bars it (military retirees' families use TRICARE even at 100% P&T), the Reserve gray-area rules are answered wrong all over the internet, and almost nobody knows TDIU rated P&T counts. This free tool routes your exact situation — separated, retired, Guard/Reserve, survivor, dual-100% — to a per-person eligibility verdict, compares CHAMPVA against your real plan in a typical year and a catastrophic one, and lets you watch a month-by-month hospital bill run against both coverages until one payment meter stops at $3,000. Built by the family whose $1.6 million in bills cost $3,000 out of pocket.
Eligibility routing encodes 38 USC 1781 and 38 CFR 17.270–17.278: the Permanent & Total gate (TDIU rated P&T counts), the TRICARE-eligibility bar that routes military retirees' families to TRICARE, the Reserve/Guard cases — including the gray-area rule that a 20-good-years retiree under 60 who does not purchase TRICARE Retired Reserve keeps CHAMPVA for a P&T family until age 60 — survivor rules with the remarriage-before-55 cutoff, child age-outs at 18/23, the Medicare Part B requirement at 65, and the dual-P&T household case. CHAMPVA cost mechanics are the program's published numbers: no premiums, $50-per-person deductible (family-capped at $100), 25% cost share of the VA allowable amount, and the $3,000 annual family catastrophic cap.
The comparisons use sourced benchmarks that your real numbers always override: KFF's 2025 Employer Health Benefits Survey (average family premium $26,993; average worker share $6,850), the HHS 2026 marketplace out-of-pocket ceilings ($10,600 individual / $21,200 family), TRICARE's published 2026 rate tables (Select retiree Group A $375/family enrollment with a $4,381 catastrophic cap; TRICARE Retired Reserve at $1,548.30/month family), and CMS's 2026 Part B premium. The friction section cites KFF's analysis of HealthCare.gov insurer transparency data (19% of in-network claims denied in 2023; insurer range 1%–54%) rather than inventing hassle statistics. Simulator cost shares are computed on an allowed-equals-billed simplification — in catastrophic years the caps dominate, which is the point being illustrated. TRICARE math is directional (real TRICARE uses copay schedules). Every benchmark card shows its source and pull date.
This is an educational estimator, not insurance advice or an eligibility determination — the VA makes those. Numbers current as of the stamp shown in the footer; rates change annually. A free accredited VSO can help with every form this tool mentions.
CHAMPVA covers the spouse and children of a veteran rated Permanently and Totally disabled (100% P&T) from a service-connected condition — and the survivors of a veteran who died from a service-connected condition or was P&T at death — provided they are NOT eligible for TRICARE. TDIU counts when it is rated Permanent and Total. Children are covered to 18, or 23 if enrolled full-time in school; a surviving spouse who remarries before 55 loses eligibility, while remarriage at 55 or later keeps it. There are no premiums: beneficiaries pay a $50 annual outpatient deductible (capped at $100 per family), a 25% cost share of the VA allowable amount, and never more than $3,000 per family per year in deductibles and cost shares on covered care. The cap applies to CHAMPVA-covered services at VA-allowable rates — care CHAMPVA doesn't cover isn't capped, which is true of every insurance cap in this comparison.
No. CHAMPVA is a dependents-only program — it is never awarded to the veteran, even at 100% Permanent and Total. The veteran's own coverage is VA health care: a 100% P&T rating places the veteran in Priority Group 1 with $0 copays for VA care. CHAMPVA exists to give the spouse and children comparable protection, which is why the two benefits are often confused. For survivors, CHAMPVA covers the spouse and children after a veteran's service-connected death.
No. TRICARE eligibility bars CHAMPVA under 38 USC 1781, and military retirees (20-year or Chapter 61 medical retirees) and their dependents are TRICARE-eligible — so a retiree's family uses TRICARE Prime or Select even when the retiree is rated 100% P&T. CHAMPVA is effectively the TRICARE-equivalent for P&T veterans who separated rather than retired. Retiree TRICARE remains strong coverage: for 2026, Select retiree Group A enrollment is $375/family with a $4,381 catastrophic cap.
Yes — if the veteran is rated P&T and the family does NOT purchase TRICARE Retired Reserve. A gray-area retiree (20 good years, under age 60) is not yet TRICARE-eligible in the way that bars CHAMPVA; buying the premium-based TRR plan (about $1,548/month for a family in 2026 — over $18,500/year) makes the family TRICARE-covered and forfeits CHAMPVA. Skip TRR and the P&T veteran's family keeps CHAMPVA at $0 premiums until the retiree turns 60, when regular TRICARE eligibility begins and CHAMPVA ends. The safe order of operations: apply and get CHAMPVA eligibility confirmed in writing BEFORE dropping TRR — never leave the family uncovered while the paperwork settles. If DEERS incorrectly blocks a gray-area application, DMDC (1-800-538-9552) can correct the record.
Yes, when the TDIU rating is Permanent and Total. A veteran paid at the 100% rate through TDIU whose rating is P&T qualifies their spouse and children for CHAMPVA exactly as a schedular 100% P&T rating would — one of the least-known facts in the system, and a major reason TDIU is worth pursuing for veterans stuck between 60% and 90% who cannot maintain substantially gainful employment.
CHAMPVA has no premiums. Beneficiaries pay a $50-per-person annual deductible (capped at $100 per family), then 25% of the VA allowable amount, and out-of-pocket costs stop at a $3,000 annual family catastrophic cap. For comparison, the average employer family plan in 2025 cost $26,993 in total premiums with workers paying $6,850 of it (KFF), and 2026 marketplace plans can expose a family to a $21,200 out-of-pocket maximum on top of premiums. A catastrophic year that costs a CHAMPVA family $3,000 can cost an insured civilian family $18,000–$28,000 between premiums and the out-of-pocket max. With no other prescription coverage, CHAMPVA's Meds by Mail ships maintenance medications at $0.
File VA Form 10-10d (Application for CHAMPVA Benefits) online at VA.gov or by mail, with the veteran's P&T award letter (or proof of service-connected death), marriage and birth certificates, school certification for children 18–23, and Medicare cards where applicable (Medicare Parts A and B are required to keep CHAMPVA — at 65, and at any age once entitled to premium-free Part A). Processing historically ran about six weeks to a few months; the VA announced in November 2025 that the application backlog was eliminated and new applications now process in days. Once approved, covered care back to your eligibility date can be reimbursed — file those retroactive claims within 180 days of the approval notice, so keep receipts while the application processes. When asking whether a practice accepts CHAMPVA, call the billing department rather than the front desk.