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Coordination of Medicare And Other Health Benefits

Medicare And Champus

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CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) covers retired military personnel and the families of active, retired or deceased members of the military. Most CHAMPUS beneficiaries who become eligible for premium-free Medicare Part A: Hospital Benefits lose their eligibility for CHAMPUS.

Note For People With End Stage Renal Disease

People who lose CHAMPUS eligibility due to Medicare eligibility based on End Stage Renal Disease may reinstate the CHAMPUS coverage if they later lose Medicare due to an improvement in their condition. There are certain groups of people who are permitted to have both CHAMPUS and Medicare.

They are:

  • People who are eligible for Medicare Part B only.
  • People who must pay monthly premiums for Medicare Part A.
  • People who are eligible for Medicare due to disability other than End Stage Renal Disease. (NOTE: To keep CHAMPUS, you must enroll in Part B Medicare.)
  • Dependents of active duty service members.

For people who have both Medicare and CHAMPUS, Medicare is the Primary payer of medical claims unless the services are furnished by a federal provider such as a military hospital. CHAMPUS may supplement what Medicare does not pay in full such as the deductible and coinsurance, but CHAMPUS would never pay more than if CHAMPUS had been the only carrier.

NOTE: If you have Medigap insurance, the Medigap company may be required to pay for CHAMPUS services as if they were Medicare-covered services.

                                    Reviewed by Jacques M. Chambers, CLU 
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