Veteran's Voice: 'Understanding Health Care Options for Surviving Spouses'
Many of the calls we receive come from adult children helping a surviving parent sort through all of these benefits and programs. We love those calls. They mean someone is paying attention, stepping in early, and trying to prevent problems from turning into crises.
When a veteran passes, the surviving spouse is suddenly handed a stack of new questions — none arriving at a convenient time, and none of them simple. A recent question that came to us at Mountain Valor was: “How does health care work now?”
This month, I want to walk through the basics in relatively plain language.
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CHAMPVA: What It Is and When It Applies
CHAMPVA is a health care program administered by the U.S. Department of Veterans Affairs. It is available to spouses and dependents when the veteran is rated totally disabled due to a service-connected condition and is not eligible for TRICARE.
One important clarification: CHAMPVA is not only for after the veteran passes. Many spouses qualify while the veteran is still living, and that eligibility can continue after death, subject to remarriage and other VA rules.
CHAMPVA is never automatic. Enrollment requires submitting VA Form 10-10d along with supporting documentation, such as the veteran’s VA rating decision and a marriage certificate, or a death certificate if applying as a surviving spouse. Once approved, CHAMPVA generally acts as secondary insurance behind Medicare or private health insurance.
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TRICARE and TRICARE For Life
Some surviving spouses remain eligible for TRICARE instead of CHAMPVA. This most often applies when the veteran was a military retiree, medically retired, or when the spouse qualifies under the 20/20/20 rule—meaning there were 20 years of marriage, 20 years of creditable service, and 20 years of overlap between the two.
In our region, this rule often creates headaches. Many DEERS and ID card offices rarely encounter 20/20/20 cases, which can lead to delays or incorrect information. We recommend calling ahead, asking for a supervisor, and being prepared for the process to take time.
No matter how you are eligible, at age 65, TRICARE transitions to TRICARE For Life once the surviving spouse is enrolled in both Medicare Part A and Part B. Medicare becomes the primary payer, with TRICARE For Life covering remaining eligible costs.
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Medicare, Medicaid, and Long-Term Care
Medicare is federal health insurance available at age 65, but it does not cover long-term custodial care. Medicaid, which is state-administered, may help cover long-term care costs for those who meet financial eligibility requirements.
Understanding who pays first matters. With TRICARE For Life or CHAMPVA, Medicare pays first and the secondary program pays next. Medicaid is always the payer of last resort. When long-term care becomes necessary, Medicaid is typically the primary option, as neither Medicare, TRICARE, nor CHAMPVA provide comprehensive custodial care coverage.
Other Survivor Financial Support Benefits
Aid and Attendance is an additional monthly benefit available to eligible surviving spouses who need help with daily living activities. Eligibility is not based on the veteran’s disability rating. Instead, the veteran must have served during a qualifying wartime period, and the surviving spouse must meet medical need criteria—such as requiring assistance with bathing, dressing, medication management, mobility, supervision for safety, or living in assisted living or receiving in-home care. Aid and Attendance is paid in addition to other survivor benefits, such as the Survivors Pension, and eligibility is also subject to income and asset limits, with certain medical expenses allowed to offset income.
Dependency and Indemnity Compensation (DIC) is a tax-free monthly benefit paid to surviving spouses when the veteran died from a service-connected condition, or when specific VA disability rating timeframes were met prior to death.
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The Survivors Pension is a needs-based monthly benefit for spouses of wartime veterans. Eligibility depends on wartime service, income and asset limits, and marital status.
Many of the calls we receive come from adult children helping a surviving parent sort through all of these benefits and programs. We love those calls. They mean someone is paying attention, stepping in early, and trying to prevent problems from turning into crises. That involvement changes outcomes — especially in rural communities where support systems are thin.
If this feels overwhelming, you are not alone. The system is complicated, and rural families often face the greatest barriers. Mountain Valor and the Virginia Department of Veterans Services can help survivors navigate paperwork and next steps when questions arise.
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Author of the "Veteran's Voice" column, Kathryn Whittenberger is a retired Navy Senior Chief, the Executive Director of Mountain Valor Services, and a Floyd County resident.
Do you have a question or idea you’d like to see covered in a future column? Email us at support@mtnvalor.org — your input helps us share the information our community needs most.