CHAMPVA and TRICARE For Life: What They Cover for Long-Term Care

For a veteran's spouse or a military retiree, the question "Who pays if Mom needs a nursing home?" usually runs through two federal programs: CHAMPVA and TRICARE For Life. Both are strong health coverage, especially when paired with Medicare. But both have the same gap that Medicare has: they generally do not pay for long-term custodial care. Knowing that early gives your family time to plan.

Which program applies to your family?

A person can't have both. If you're eligible for TRICARE, you aren't eligible for CHAMPVA.

CHAMPVA basics

CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) is a cost-sharing health program. VA shares the cost of covered services from civilian providers. It is not VA health care at a VA medical center, though some VA facilities participate.

You may qualify if you are the spouse or dependent child of a veteran rated P&T disabled from a service-connected condition, or the surviving spouse or child of a veteran who died from a service-connected condition or was rated P&T at death. A surviving spouse who remarries before 55 loses CHAMPVA; one who remarries at 55 or older keeps it. Primary Family Caregivers in the VA caregiver program who have no other insurance are enrolled automatically.

When CHAMPVA is the main payer, the 2026 CHAMPVA Guidebook lists an annual deductible of $50 per person or $100 per family, a usual 25% cost share, and a $3,000 yearly catastrophic cap on cost sharing. Apply with VA Form 10-10d online or by mail, and report any other insurance with VA Form 10-7959c.

CHAMPVA and Medicare: keep Part B

This is the rule families most often get wrong. If you're entitled to Medicare Part A, whether at 65 or earlier because of disability, you must enroll in and stay enrolled in Medicare Part B to keep CHAMPVA. A Medicare Advantage plan also meets the requirement. If Part B is canceled, CHAMPVA ends the same day. The only exception in VA's guidebook is for people who were 65 or older before June 5, 2001 and had only Part A at that time.

Once you have Medicare, Medicare pays first. Claims usually pass from Medicare to CHAMPVA automatically, and CHAMPVA pays its share of what remains. For services both cover, out-of-pocket costs are often small or zero. If you have a Medigap policy, CHAMPVA processes the balance after the supplemental plan pays.

What CHAMPVA covers, and doesn't, for long-term care

• Skilled nursing facility care: Covered for patients who need skilled care under a nurse or physician, after a three-day inpatient hospital stay. With Medicare as primary, the guidebook shows $0 cost in most cases for days 1 to 100 and a 25% cost share after day 100.
• Home health care: Limited to intermittent skilled care for a homebound patient, ordered by a physician and provided by a licensed nurse.
• Hospice: Covered for terminally ill patients with a life expectancy of six months or less. Inpatient respite within hospice is limited to five days.
• Prescriptions: Meds by Mail can send maintenance medications at no cost for beneficiaries without other drug coverage, including Medicare Part D.

Not covered: custodial care; housekeeping, homemaker, and attendant services; and care given by a member of your immediate family or someone in your household. In plain terms, help with bathing, dressing, and supervision at home, in assisted living, or in a long-term nursing home stay is not a CHAMPVA benefit.

TRICARE For Life basics

TRICARE For Life is Medicare-wraparound coverage for TRICARE-eligible people who have Medicare Part A and Part B. There is no separate enrollment and no enrollment fee. Coverage starts automatically the day both Medicare parts are in effect, and your Medicare card and uniformed services ID card serve as proof. Each eligible person is covered individually.

Medicare pays first; TRICARE pays second for services both cover, so most of those services cost nothing out of pocket. For services only TRICARE covers, you pay TRICARE's deductible and cost shares. Overseas, where Medicare doesn't pay, TRICARE becomes the primary payer, and you still need Part B to stay eligible.

Skilled nursing under TFL

Medicare covers up to 100 days of skilled nursing facility care per benefit period after a qualifying hospital stay. TRICARE covers skilled nursing with no day limit as long as the care is medically necessary skilled care, so TFL can keep paying after Medicare stops. TFL beneficiaries need pre-authorization starting on day 101.

The custodial care exclusion

TRICARE states plainly that custodial care is generally excluded. The narrow exception is for seriously ill or injured service members, not retirees. Once a skilled nursing stay shifts to help with daily living and supervision, TFL stops paying, just as Medicare does.

Planning for the gap

Because neither program pays for long-term custodial care, families usually piece it together from other sources:

• VA pension with Aid and Attendance, if the veteran or surviving spouse meets wartime service and financial rules
• VA long-term care services for the veteran, including home care, adult day health, and nursing homes
• Medicaid, for those who meet its financial limits
• Long-term care insurance, if purchased in advance
• Personal savings and family support

For the full picture on Medicare's side, read what Medicare covers for long-term care.

Next steps

1. Confirm the right program. Is your loved one TRICARE-eligible, CHAMPVA-eligible, or neither?
2. Check Medicare Part B. Make sure it is active and will stay active.
3. Keep cards together. Medicare card, CHAMPVA card or military ID, and any supplemental plan in one place.
4. Ask about skilled nursing early. After a hospital stay, confirm whether the next step is skilled care (often covered) or custodial care (not covered).
5. Call with questions. CHAMPVA: 800-733-8387. For TFL, use the contacts on tricare.mil.

Last reviewed October 19, 2026. General information only, not medical, legal, or financial advice. Benefit rules and amounts change, so confirm with the agency before you decide. See our disclaimer.