VA Spousal Medical Benefits

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Medical benefits
Medical benefits (Image: "FDNY Ambulances" is Copyrighted by Flickr user: uberzombie (Will Tung) under the Creative Commons Attribution license.)

The U.S. Department of Veterans Affairs (VA) provides medical benefits for veterans and their beneficiaries, which generally includes spouses and children. Widows and widowers of veterans also might be eligible for health care benefits. VA benefits for spouses can contribute toward the cost of hospital stays, prescription drugs and nursing home stays.

Basics

Spouses must apply for benefits through the VA Health Administration Center (va.gov/hac/hacmain.asp). Medical benefits allow spouses to receive treatment at VA hospitals, at community outpatient clinics and through primary care physicians. Benefits cover necessary medical expenses and not cosmetic or optional services. Spouses might receive free health care based on their income. Otherwise, spouses will pay deductibles and copayments, which vary based on the treatment received.

CHAMPVA

The VA's Civilian Health and Medical Program (CHAMPVA) extends coverage to spouses who are not eligible for TRICARE (administered through the Department of Defense for active and retired military service people plus their beneficiaries). CHAMPVA recipients include spouses of veterans who are permanently disabled due to a service-related injury. CHAMPVA recipients also include surviving spouses of veterans who died due to a service-related disability or who were considered permanently disabled due to a service-related injury at the time of death. Most spouses of veterans who died in the line of duty receive TRICARE rather than CHAMPVA.

Significance

Prepare for the application process by gathering important documents. The VA often requests military discharge papers; proof of marriage, death or divorce; and financial evidence (e.g., bank statements, tax returns). Spouses should apply for medical benefits as soon as possible since the application process can span several months.

Denied benefits

Some spouses may be denied certain CHAMPVA benefits. Rejected applicants should review the code listed on the explanation of benefits. For example, code 27 refers to services or benefits that are not covered under the diagnosis, while code 270 refers to a missing, invalid or unreadable diagnosis. Specific questions regarding denials should be directed to the Inquiry Routing and Information System (IRIS).

Features

VA medical benefits are considered secondary to Medicare coverage. For example, if a spouse is at least 65 years old and receives Medicare, then VA benefits will contribute toward medical costs after Medicare benefits are exhausted. Spouses who are widowers lose CHAMPVA benefits if they remarry before turning 55 years old. Thus, widowers can remarry after age 55 and retain VA medical benefits.

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