If you count on CHAMPVA and Medicare is now on the horizon, you may be worried about losing coverage you have leaned on for years. Take a breath: the two programs are built to work together, and you do not have to choose between them. But there is one rule you cannot afford to miss. Once you are eligible for Medicare, you must keep both Part A and Part B, or you can lose CHAMPVA entirely. This guide walks you through how CHAMPVA and Medicare coordinate, who pays first, what you owe, and the exact proof the VA needs, so nothing catches you off guard.

First, what CHAMPVA is, and what it is not

CHAMPVA, the Civilian Health and Medical Program of the Department of Veterans Affairs, is a VA health benefits program for the spouses, dependents, and survivors of veterans who meet certain service-connected disability requirements. You may qualify if you are the spouse or dependent child of a veteran rated permanently and totally disabled from a service-connected disability, or the surviving spouse or dependent child of a veteran who died from a service-connected disability or who was rated permanently and totally disabled at the time of death. In certain cases, the surviving spouse or dependent child of a service member who died in the line of duty, not due to misconduct, may also qualify. A primary family caregiver for a veteran with disabilities can also qualify through VA's Program of Comprehensive Assistance for Family Caregivers, if the caregiver has no other health insurance.

Two distinctions matter, because they are easy to confuse and the rules are not the same for each. CHAMPVA is a VA program, but it covers the veteran's family, not the veteran: it is not the same as VA health care, and when both spouses are veterans, each may qualify for both programs. It is also separate from TRICARE, and you can't get CHAMPVA at all if you qualify for TRICARE. If your situation involves the veteran's own VA coverage, Medicare and VA benefits is the guide that speaks to that. This guide is about your CHAMPVA coverage and how it lines up with your Medicare.

Why you must keep both Part A and Part B

If you have depended on CHAMPVA to see a doctor or fill a prescription, the fear of a coverage gap is real, and it deserves a clear answer. Here is the rule to hold onto above all others: if you are eligible for Medicare, you must have both Medicare Part A and Part B to get or keep CHAMPVA. This applies whether you reach Medicare at 65 or earlier, through Social Security disability benefits, end-stage kidney disease, or ALS (see Medicare before 65). A Medicare Advantage plan (Part C) also meets the requirement, because it includes Parts A and B. There is one carve-out worth knowing before the premiums worry you: the CHAMPVA regulation provides that individuals age 65 or older who are not entitled to Medicare Part A retain CHAMPVA eligibility. If Part A is not available to you, you are not required to buy it, and the steps below cover how you document that.

The reason this matters so much is the consequence of getting it wrong. Because CHAMPVA requires Part B once you are Medicare-eligible, dropping Part B, or never enrolling in it, can cause you to lose CHAMPVA. People sometimes consider skipping Part B to avoid its monthly premium, not realizing that the choice can quietly cost them their CHAMPVA benefits too. If that has already happened to you, getting back onto both Part A and Part B is what CHAMPVA requires before your benefits can start again, so that is the first step, and Part B has fixed enrollment windows, so the timing matters. Medicare enrollment periods covers when you can sign up so you can close the gap and keep CHAMPVA.

There is also a narrow grandfather exception. Under the "CHAMPVA for Life" provisions, a beneficiary who had already reached age 65 as of June 5, 2001 but was not enrolled in Part B on that date can keep CHAMPVA without Part B. It has a trap of its own: someone in that same group who did buy Part B must keep carrying it to keep CHAMPVA, so cancelling it now to save the premium would cost them CHAMPVA. Anyone who turned 65 on or after June 5, 2001, which is essentially everyone approaching Medicare today, is bound by the standard rule and needs both parts.

Medicare pays first, CHAMPVA pays second

When you have both, the order of payment is set: Medicare is the primary payer, and CHAMPVA is the secondary payer. Medicare pays for your care first. Then, for services that CHAMPVA covers, CHAMPVA may cover costs you still owe. On your Medicare Part B deductible for outpatient care, the VA says CHAMPVA covers some or all of it: if what's left of the deductible is more than the CHAMPVA allowable amount for the claim, you pay your provider the difference. That allowable amount is, in most cases, the same amount Medicare pays for the service.

So CHAMPVA sits on top of Medicare, but it is not the same as full supplemental coverage, and a balance can still reach you. This secondary-payer arrangement is the same kind of coordination Medicare uses with other coverage you might have; if you want the broader picture of how Medicare decides who pays first, see coordination of benefits. The takeaway for you is simple: Medicare goes first, and CHAMPVA can help with some or all of what is left over on covered services.

Question How it works with CHAMPVA and Medicare
Do I need Part A and Part B? Yes. Once you are Medicare-eligible, at 65 or earlier, you must have both Part A and Part B to keep CHAMPVA. Exception: at 65 or older and not entitled to Part A, you keep CHAMPVA without it.
Who pays first? Medicare pays first. CHAMPVA is the secondary payer.
What does CHAMPVA cover after Medicare? For CHAMPVA-covered services, some or all of the costs you still owe, up to its allowable amount.
Who pays the Part B premium? You do. CHAMPVA does not pay your Medicare Part B premium ($202.90/month in 2026).
Do I need Part D? No. Part D is the one part of Medicare that is optional here, and taking it costs you access to Meds by Mail.
What proof do I need at 65? Proof of your Medicare coverage. If you are 65 or older and not entitled to Medicare Part A, you keep CHAMPVA and send a notice of disallowance from the Social Security Administration instead.

CHAMPVA does not pay your Part B premium

It is worth being plain about this, because the cost can catch families off guard at an already stressful time. CHAMPVA does not pay your Medicare Part B premium. You are responsible for paying that monthly premium yourself, just as any other person on Medicare would. In 2026, the standard Part B premium is $202.90 a month, up from $185.00 in 2025, and higher earners pay more through an income-related surcharge.

That is the trade at the heart of keeping both coverages: Part B is required to keep CHAMPVA, and you carry the Part B premium yourself. It is a real monthly cost, and if it strains your budget, a Medicare Savings Program may help pay the premium for those who qualify. CHAMPVA's own help comes on the back end, after Medicare has paid, in the form of covering some or all of the costs you would otherwise owe on covered services.

Do you need Medicare Part D with CHAMPVA?

This is the question many CHAMPVA beneficiaries lose sleep over, and the answer is reassuring: you do not need Medicare Part D to get CHAMPVA. Part D is the only part of Medicare that is optional here, though. Part A and Part B are required once you are Medicare-eligible, as the section above lays out.

Taking Part D actually has a concrete cost. CHAMPVA fills prescriptions at pharmacies in the OptumRx network, and non-urgent prescriptions you take regularly can instead go through Meds by Mail, which delivers to your home at no cost to you. But the VA says you can use Meds by Mail only if you have no other prescription coverage, and Medicare Part D counts. With Part D, the Part D plan pays first and CHAMPVA pays second, and if both cover a prescription you won't pay a cost share; you just lose Meds by Mail. With CHAMPVA as your only drug coverage, you pay the full cost until you meet a $50 annual deductible ($100 per family), then 25% of the CHAMPVA allowable amount, and Meds by Mail is open to you.

If Medicare Part D is your only other prescription coverage and you would rather use Meds by Mail, you can cancel Part D to become eligible. Call CHAMPVA at 800-733-8387 (TTY: 711) and ask for a letter of creditable coverage, which the VA says "confirms that CHAMPVA provides prescription coverage that's at least as good as Medicare Part D," then send that letter to Medicare and ask them to cancel your Part D coverage. Check your drugs first: Meds by Mail does not cover certain controlled substances, including many opioid pain medications, so call to find out whether a medication is available. If you carry another prescription plan besides Part D, that plan would still keep you out of Meds by Mail.

How to keep CHAMPVA when you turn 65

Turning 65 should not mean losing coverage you rely on, and it will not, as long as you show the VA the right document. The VA simply needs to confirm your Medicare status. Here is how to keep your CHAMPVA benefits in place.

1
Step 1

Confirm your Medicare status a few months before your 65th birthday

Ask the Social Security Administration whether you are entitled to Medicare Part A. Most people are: roughly 99% of Medicare beneficiaries get Part A premium-free, based on at least 40 quarters (about 10 years) of Medicare-covered work, and someone who falls short can generally buy it instead, for $311 a month in 2026 with at least 30 quarters, while the full $565 applies to certain people with fewer than 30. That matters here more than it might elsewhere, because the reduced $311 rate also goes to someone who was married to a person with at least 30 quarters of coverage. A CHAMPVA spouse or survivor with a thin work record of their own should have Social Security check the veteran's record before accepting the higher figure. Buying it is a choice, not a CHAMPVA requirement: if you are 65 or older and are not entitled to Part A, you retain CHAMPVA eligibility without it. If you do hold Part A, premium-free or purchased, then you must also carry Part B to keep CHAMPVA.

2
Step 2

Gather your proof

If you have Medicare, your proof is official documentation of your Medicare coverage; ask CHAMPVA which document it will accept. If you are not entitled to Medicare Part A, you request a notice of disallowance from the Social Security Administration instead, the document certifying that you are not eligible for Medicare Part A.

3
Step 3

Send your proof to CHAMPVA

Submit the document to CHAMPVA so your benefits continue without interruption. If you are unsure where to send it or what counts, call CHAMPVA before your birthday rather than after, so there is no gap.

Where to get help

You do not have to sort this out alone. These are the offices that handle CHAMPVA and Medicare questions directly.

CHAMPVA Enrollment, covered services, the Part A and Part B requirement, and requesting a letter of creditable coverage. 1-800-733-8387 (TTY: 711)https://www.va.gov/resources/champva-care/ va.gov CHAMPVA
Social Security Administration Medicare Part A and Part B enrollment, premium-free Part A eligibility, and issuing a notice of disallowance if you are not eligible for Medicare Part A. 1-800-772-1213https://www.medicare.gov/basics/get-started-with-medicare/sign-up/how-do-i-sign-up-for-medicare ssa.gov
Medicare Questions about what Medicare covers, Part B premiums, and how Medicare coordinates as the primary payer. 1-800-633-4227 (TTY 1-877-486-2048)https://www.medicare.gov/talk-to-someone medicare.gov

Frequently Asked Questions

Do I need Medicare Part B to keep CHAMPVA?

Yes. Once you are eligible for Medicare, whether at 65 or earlier, you must have both Medicare Part A and Part B to get or keep CHAMPVA. Dropping Part B, or never enrolling in it, can cause you to lose your CHAMPVA benefits, so keeping Part B is not optional once you are Medicare-eligible. A Medicare Advantage plan (Part C) also satisfies the requirement, since it includes Parts A and B. There is one carve-out in the CHAMPVA regulation: individuals age 65 or older who are not entitled to Medicare Part A retain CHAMPVA eligibility, so if Part A is not available to you, you are not required to buy it.

Who pays first, Medicare or CHAMPVA?

Medicare pays first. CHAMPVA is the secondary payer, so after Medicare pays, CHAMPVA may cover costs you still owe for CHAMPVA-covered services. It is not the same as full supplemental coverage: on the Part B deductible, for example, CHAMPVA covers some or all of it, and you pay the provider any part that is more than CHAMPVA's allowable amount.

Does CHAMPVA pay my Medicare Part B premium?

No. CHAMPVA does not pay your Medicare Part B premium. In 2026 the standard Part B premium is $202.90 a month, and you pay it yourself. CHAMPVA's role is to help with some or all of what you still owe after Medicare pays, on services CHAMPVA covers.

Do I need Medicare Part D if I have CHAMPVA?

No. Part D is the one part of Medicare that is optional for a CHAMPVA beneficiary, and taking it has a real cost: the VA counts Part D as other prescription coverage, which shuts you out of Meds by Mail, the home-delivery pharmacy that costs you nothing. If Part D is your only other prescription coverage and you want Meds by Mail, call CHAMPVA for a letter of creditable coverage and send it to Medicare with a request to cancel Part D.

What proof do I need to give the VA at 65?

When you turn 65, you must give the VA proof of your Medicare coverage to keep CHAMPVA. If you are 65 or older and are not entitled to Medicare Part A, you keep CHAMPVA and send a notice of disallowance instead, the document from the Social Security Administration certifying that you are not eligible for Part A. You can reach Social Security at 1-800-772-1213. You are not required to buy premium Part A to keep your CHAMPVA benefits. If you do hold Part A, whether premium-free or purchased, you must then also carry Part B.

What happens if I already lost CHAMPVA by missing Part B?

If your CHAMPVA ended because you were not enrolled in Part B, having both Part A and Part B again is what CHAMPVA requires to get or keep benefits, so re-enrolling is the first step. Part B has set enrollment windows, so contact the Social Security Administration to find your next enrollment period, and contact CHAMPVA once your Medicare is active to ask what they need to restart your benefits.

Learn More

MedicareWhat is Medicare? Parts A, B, C, and D explainedWhat is Medicare? A plain guide to Parts A, B, C, and D, who qualifies, 2026 costs, when to enroll, and what it doesn't cover, with help-paying options. MedicareMedicare enrollment periods and when to sign upWhen to sign up for Medicare without a lifelong penalty: the 7-month Initial Enrollment Period, working past 65, the GEP, and what each late penalty costs. MedicareMedicare and VA benefits for veteransHow VA benefits and Medicare work together: why veterans should take Part B at 65 to avoid a lifelong penalty, and delay Part D with VA drug coverage. MedicareHow Medicare coordination of benefits worksMedicare coordination of benefits: who pays first with employer coverage, retiree plans, or COBRA, plus the COBRA trap behind a lasting Part B penalty. MedicareMedicare late-enrollment penalties, and how to avoid themWorried you missed a Medicare deadline? Here is how the Part A, B, and D late enrollment penalties are calculated, how long each lasts, and how to avoid them. MedicareTRICARE For Life and MedicareTRICARE For Life coordinates with Medicare for military retirees, survivors and certain former spouses. Learn why Part B is required and who pays first.

If you are a CHAMPVA beneficiary approaching Medicare and want help keeping your coverage in place, find personalized guidance at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

Still have questions?

Brevy answers from this guide and every other guide here, and can check what you qualify for.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.