CHAMPVA has no monthly premium. You pay a $50 yearly outpatient deductible per person ($100 per family), then 25 percent of the CHAMPVA allowable amount for covered care, and your family's yearly out-of-pocket costs stop at $3,000. Here is every number, with real examples, straight from the VA's current figures.
Every CHAMPVA cost in one table
| Cost | 2026 amount | Notes |
|---|---|---|
| Monthly premium | $0 | No premium and no enrollment fee. CHAMPVA is a benefit, not a plan you buy. |
| Outpatient deductible | $50 per person, $100 per family | Per calendar year. Applies to outpatient care only. |
| Your cost share | 25 percent of the allowable amount | CHAMPVA pays the other 75 percent. The allowable is a controlled rate tied to Medicare, not the sticker price. |
| Catastrophic cap | $3,000 per family per calendar year | After your deductibles and cost shares reach $3,000, CHAMPVA pays 100 percent of the allowable for covered services for the rest of the year. |
| Meds by Mail prescriptions | $0 | Maintenance medications by mail for beneficiaries with no other drug coverage. No deductible, no cost share. |
| Care at a VA facility (CITI) | $0 | The VA covers the entire cost when a VA medical center treats you under the CHAMPVA In-house Treatment Initiative, where available. |
The deductible and the cap reset on January 1. The cap counts what you actually paid in deductibles and cost shares for covered services.
A real-world example
Say a primary care visit has an allowable amount of $120.
- Early in the year, before you meet the $50 deductible, you pay the first $50 plus 25 percent of the remaining $70. That is $67.50, and your deductible is done for the year.
- Every visit after that, CHAMPVA pays $90 and you pay $30.
- Your monthly cost for having CHAMPVA stays at $0.
Compare that with a marketplace plan that charges $400 or more a month and a $5,000 deductible, and you see why protecting your CHAMPVA eligibility matters so much.
The $3,000 catastrophic cap
Your cost shares and deductibles count toward a catastrophic cap of $3,000 per family per calendar year. Once your out-of-pocket spending on covered services hits $3,000, CHAMPVA pays 100 percent of the allowable amount for covered services for the rest of that year.
This is the single most underrated CHAMPVA benefit. Even in a terrible medical year with surgery and hospital stays, a family's exposure on covered care is capped at $3,000.
If you have Medicare or other insurance, you usually pay nothing
When you have other health insurance, including Medicare, that insurance pays first and CHAMPVA pays second. The VA's provider fact sheet puts it plainly: CHAMPVA pays the lesser of 100 percent of the allowable amount or the remainder of the charges, and the beneficiary will normally have no cost share. In practice, many families with Medicare plus CHAMPVA pay close to nothing for covered care. Details in our CHAMPVA and Medicare guide.
What about prescriptions?
Got a bill after CHAMPVA already paid? Our guide to reading your CHAMPVA EOB explains what you actually owe and what your provider has to write off. Prescriptions filled at a retail pharmacy follow the same deductible and 25 percent cost share. Many beneficiaries pay $0 instead through Meds by Mail, the free mail-order benefit for maintenance medications when you have no other drug coverage.
One 2026 rule to know: CHAMPVA covers GLP-1 drugs such as Ozempic, Mounjaro, Wegovy, and Zepbound only for their FDA-approved medical uses, and not for weight loss. The Meds by Mail guide has the full list.
What CHAMPVA does not pay for
Federal regulation excludes a specific list of services, so plan for these separately:
- Routine dental care. CHAMPVA covers dental only when it is medically necessary for a covered condition. Families can buy separate coverage through the VA Dental Insurance Program.
- Routine eye exams, eyeglasses, and contact lenses, except in narrow medical situations such as after cataract surgery or for certain eye conditions.
- Hearing aids.
- Chiropractic and naturopathic care, and acupuncture.
- Routine foot care such as trimming toenails, unless a condition like severe diabetes makes it medically necessary.
- Cosmetic surgery and custodial care.
Preventive care is covered: an annual physical, CDC-recommended immunizations, cancer screenings, and well-child care.
If you work in a billing office
You are probably here looking for the CHAMPVA fee schedule. There is not one to download: the VA says CHAMPVA pays equivalent to Medicare and TRICARE allowable charges, so your Medicare allowable for the code is the practical reference.
The rest of what you need, including payer ID 84146, the one-year filing deadline, which four categories need preauthorization, and the federal rule against balance billing, is in our guide to billing CHAMPVA.
Three ways to lower your 25 percent
- Confirm the provider accepts CHAMPVA. A provider who accepts CHAMPVA agrees to the allowable amount as payment in full, so your 25 percent is figured on a controlled rate and you cannot be balance-billed beyond it. Our phone script gets that confirmation in one call.
- Use Meds by Mail for every maintenance medication you can.
- Consider a supplement. Some families buy a CHAMPVA supplemental insurance plan that covers the cost share in exchange for a monthly premium. Whether it is worth it depends on your expected medical use, and we break down that math honestly in the guide.
Common questions
How much does CHAMPVA cost per month?
Nothing. CHAMPVA has no monthly premium and no enrollment fee. Your only costs are a $50 per person yearly outpatient deductible ($100 per family), 25 percent of the allowable amount for covered care, and never more than $3,000 per family in a calendar year.
What is the CHAMPVA deductible for 2026?
The outpatient deductible is $50 per beneficiary per calendar year, with a $100 maximum per family. The VA names only an outpatient deductible, and Meds by Mail prescriptions carry no deductible at all.
What is the CHAMPVA catastrophic cap?
$3,000 per family per calendar year. Once your deductibles and cost shares for covered services reach $3,000, CHAMPVA pays 100 percent of the allowable amount for the rest of that year. The cap resets on January 1.
Can a doctor bill me more than the 25 percent cost share?
Not if they accept CHAMPVA. Providers who accept CHAMPVA agree to the allowable amount as payment in full and cannot balance-bill beyond your cost share. Confirm acceptance with the billing office before treatment.
Does CHAMPVA cover dental, glasses, or hearing aids?
Routine dental care, routine eye exams, eyeglasses, contact lenses, and hearing aids are excluded by regulation, with narrow medical exceptions. Dental coverage can be bought separately through the VA Dental Insurance Program.
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Keep reading
- How to Find a CHAMPVA Provider Near You
- Can You Go to Any Doctor With CHAMPVA?
- The Pros and Cons of CHAMPVA, Honestly
- Who Qualifies for CHAMPVA?