38 CFR 17.271 - Eligibility.

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§ 17.271 Eligibility.
(a) General entitlement. The following persons are eligible for CHAMPVA benefits provided that they are not eligible under Title 10 for the TRICARE Program or Part A of Title XVIII of the Social Security Act (Medicare) except as provided in paragraph (b) of this section.
(1) The spouse or child of a veteran who has been adjudicated by VA as having a permanent and total service-connected disability;
(2) The surviving spouse or child of a veteran who died as a result of an adjudicated service-connected condition(s); or who at the time of death was adjudicated permanently and totally disabled from a service-connected condition(s);
(3) The surviving spouse or child of a person who died on active military service and in the line of duty and not due to such person's own misconduct; and
(4) An eligible child who is pursuing a full-time course of instruction approved under 38 U.S.C. Chapter 36, and who incurs a disabling illness or injury while pursuing such course (between terms, semesters or quarters; or during a vacation or holiday period) that is not the result of his or her own willful misconduct and that results in the inability to continue or resume the chosen program of education must remain eligible for medical care until:
(i) The end of the six-month period beginning on the date the disability is removed; or
(ii) The end of the two-year period beginning on the date of the onset of the disability; or
(iii) The twenty-third birthday of the child, whichever occurs first.
(Authority: 38 U.S.C. 501, 1781)
(b) CHAMPVA and Medicare entitlement.
(1) Individuals under age 65 who are entitled to Medicare Part A and enrolled in Medicare Part B, retain CHAMPVA eligibility as secondary payer to Medicare Parts A and B, Medicare supplemental insurance plans, and Medicare HMO plans.
(2) Individuals age 65 or older, and not entitled to Medicare Part A, retain CHAMPVA eligibility.
Note to paragraph (b)(2):
If the person is not eligible for Part A of Medicare, a Social Security Administration “Notice of Disallowance” certifying that fact must be submitted. Additionally, if the individual is entitled to only Part B of Medicare, but not Part A, or Part A through the Premium HI provisions, a copy of the individual's Medicare card or other official documentation noting this must be provided.
(3) Individuals age 65 on or after June 5, 2001, who are entitled to Medicare Part A and enrolled in Medicare Part B, are eligible for CHAMPVA as secondary payer to Medicare Parts A and B, Medicare supplemental insurance plans, and Medicare HMO plans for services received on or after October 1, 2001.
(4) Individuals age 65 or older prior to June 5, 2001, who are entitled to Medicare Part A and who have not purchased Medicare Part B, are eligible for CHAMPVA as secondary payer to Medicare Part A and any other health insurance for services received on or after October 1, 2001.
(5) Individuals age 65 or older prior to June 5, 2001, who are entitled to Medicare Part A and who have purchased Medicare Part B must continue to carry Part B to retain CHAMPVA eligibility as secondary payer for services received on or after October 1, 2001.
(Authority: 38 U.S.C. 501, 1781)
Note to § 17.271:
Eligibility criteria specific to Dependency and Indemnity Compensation (DIC) benefits are not applicable to CHAMPVA eligibility determinations.
[63 FR 48102, Sept. 9, 1998, as amended at 67 FR 4359, Jan. 30, 2002; 73 FR 65553, Nov. 4, 2008]

Title 38 published on 2013-07-01

The following are only the Rules published in the Federal Register after the published date of Title 38.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2014-03-25; vol. 79 # 57 - Tuesday, March 25, 2014
    1. 79 FR 16200 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date
      GPO FDSys XML | Text
      DEPARTMENT OF VETERANS AFFAIRS
      Final rule; delay of effective date.
      Effective Date: The effective date for the final rule published May 6, 2013, at 78 FR 26250, is delayed from April 1, 2014 to June 1, 2014.
      38 CFR Part 17

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United States Code
U.S. Code: Title 38 - VETERANS’ BENEFITS

Title 38 published on 2013-07-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 38 CFR 17 after this date.

  • 2014-03-25; vol. 79 # 57 - Tuesday, March 25, 2014
    1. 79 FR 16200 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date
      GPO FDSys XML | Text
      DEPARTMENT OF VETERANS AFFAIRS
      Final rule; delay of effective date.
      Effective Date: The effective date for the final rule published May 6, 2013, at 78 FR 26250, is delayed from April 1, 2014 to June 1, 2014.
      38 CFR Part 17