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HadIt.com Anniversary 24 years on Jan 20, 2021
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Need Help With ChampVA for my wife.


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My wife is 42.  My wife had solely CHAMPVA.  She got sick with ESRD.  She was on dialysis for several years and the state paid her Medicare Part B.  She miraculously got better and she is no longer on dialysis.  The state ceased paying her Part B.  ChampVA subsequently dropped her ChampVA because you are required to carry Part B if you have Part A.  Otherwise you lose you ChampVA.  Now my wife did not realize she needed to maintain her Part B.  At the time she did not have money to allocate for Part B.  She did not realize she would lose ChampVA.  Anyway, Social Security will not allow her to acquire Part B.  So she cannot get ChampVA back.  This all doesn't make sense to me.   My wife is 42.  She isn't 65.  She had ChampVA in the beginning.  Why would she now not be entitled to ChampVA.  Can she tell Social Security to drop her from Part A and that will make her eligible again for ChampVA?  Something is not right here.  Either they should let her acquire Part B or ChampVA should return her to her original status.  She is in limbo.  She has no insurance but has 20% Kidney function.  What should we do?

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I don't understand why they dropped her. Can you scan and attach here the letter from CHAMPVA saying why she is no longer eligible? I have had CHAMPVA for many years until I became eligible

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Paul my wife is in ESRF, we were able to keep CHAMPVA until she became eligible for medicare. The problem occured when Medicare dated her eligibility for January 01. We didn't get the cards until June then notified CHAMPVA. Now are having to go back to providers and straighten all the billing out between them. You say she is no longer on dialysis with Medicare you are eligible if you have ESRF so maybe a doctor or providing facility notified them that she is no longer considered end stage so they dropped her. They should have put in writing the reason for dropping her in the notification letter. Like Broncovet says stay far away from Medicare's prescription plan it will cost you a lot of money.

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Can you scan and attach the letter that denied her CHAMPVA?

Cover C file #, name, prior to scanning it.

I was granted CHAMPVA due to my husband's 100% P & T SC PTSD.

Medicare Part A and B is required when a CHAMPVA person reaches age 65.

I assume you are both young enough that your wife's CHAMPVA was based on you 100% P & T SC rating....?

I don't get this. If we see the denial maybe we can help more.

 

 

 

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I did some research but unfortunately this issue was a BVA denial and then a CAVC denial- based on the same premise:

https://cite.case.law/vet-app/28/112/

"Pursuant to this provision, an individual who satisfies the other requirements for the program and is entitled to hospital insurance benefits under Medicare Part A “is eligible for medical care under [ ] section [1781(d)(1)(A) ] only if the individual is also enrolled in the supplementary medical insurance program under Part B of the medicare program.”38 U.S.C. § 1781(d)(1)(A) (emphasis added). Here, the plain meaning of the word “only” as “solely” or “exclusively” creates a mandatory prerequisite to CHAMPVA eligibility: Even if a claimant satisfies the other eligibility criteria, he or she is eligible for CHAMPVA benefits “only if’ the claimant is also “enrolled” in Medicare Part B."

 

This case is also cited by NVLSP in the VBM.

 

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