Page 22 - Medicare Benefit Policy Manual

50.4 - TRICARE and CHAMPVA (Civilian Health and Medical
Program of Veterans Administration)
(Rev. 1, 10-01-03)
A3-3153.3.D, HO-260.3.F

1. General

TRICARE and CHAMPVA are similar programs administered by the Department of
Defense, except that the Veterans Administration determines the eligibility of persons
seeking to establish entitlement to CHAMPVA coverage. TRICARE provides benefits
for health care services furnished by civilian providers, physicians, and suppliers to
retired members of the Uniformed Services and to spouses and children of active duty,
retired, and deceased members. The term “Uniformed Services” includes the Army,
Navy, Air Force, Marine Corps, Coast Guard, and the Commissioned Corps of the U.S.
Public Health Service and of the National Oceanic and Atmospheric Administration.
CHAMPVA provides similar benefits for spouses and children of veterans who are
entitled to VA permanent and total disability benefits and to widows and children of
veterans who died of service-connected disabilities.

The governmental entity exclusion does not preclude Medicare payment for items or
services furnished to a beneficiary who is also eligible for TRICARE/CHAMPVA benefit
payments for the same services. Medicare is the primary payer for such items and
services, and TRICARE/CHAMPVA is a supplementary payer. (See subsection 3,
below.)

2. Effect of Medicare Eligibility on TRICARE/CHAMPVA Entitlement

TRICARE/CHAMPVA beneficiaries, other than dependents of active duty members, lose
their entitlement to TRICARE/CHAMPVA if they qualify for Medicare Part A on any
basis and do not enroll in Medicare Part B (effective October 1, 2001).

NOTE: TRICARE beneficiaries that turned age 65 prior to April 1, 2001 are not
required to purchase Medicare Part B in order to retain their TRICARE Pharmacy
benefits. However, all TRICARE individuals entitled to Medicare Part A must be
enrolled in Medicare Part B to receive the rest of their TRICARE benefit.

Individuals who are eligible for Medicare Part B benefits only, do not lose their
entitlement to TRICARE/CHAMPVA benefits. If a Medicare beneficiary, who has lost
entitlement to CHAMPVA upon becoming entitled to Part A of Medicare, thereafter
exhausts any Part A benefits, the individual can again be entitled to CHAMPVA. Once
the individual re-attains CHAMPVA benefits, the individual will not lose them by virtue
of later again becoming eligible for Medicare Part A benefits. There is no similar
provision for TRICARE which enables an individual to re-attain TRICARE eligibility
after exhausting Medicare Part A benefits. A/B MACs (A) and (B) will direct questions
concerning this provision to the CHAMPVA Center.