CHAMPVA deductible, cost share, and catastrophic cap (2026)
Educational information only, not medical, legal, or insurance advice. Confirm with CHAMPVA and your provider. Last verified against VA.gov: October 14, 2026 (VA CHAMPVA care page updated Aug 12, 2026). Changelog
The short version: when CHAMPVA is your only coverage, you pay a small yearly deductible for outpatient care, then 25% of CHAMPVA’s allowable amount, and your whole family never pays more than $3,000 in a calendar year.
| Item | 2026 amount |
|---|---|
| Outpatient deductible | $50 per person, $100 per family, per calendar year |
| Inpatient deductible | None |
| Your cost share | Usually 25% of the allowable amount |
| What CHAMPVA pays | Usually 75% of the allowable amount |
| Catastrophic cap | $3,000 per family per calendar year |
Figures verified October 14, 2026 against VA's CHAMPVA care page, the CHAMPVA Guidebook, and 38 CFR 17.274. VA can change them, so check VA.gov.
What is the CHAMPVA deductible in 2026?
You pay the first $50 per person (or $100 for the whole family) of outpatient care and urgent prescriptions each calendar year before CHAMPVA starts paying. VA says there’s no deductible for inpatient care (a hospital stay). Under 38 CFR 17.274, the deductible is also waived for Meds by Mail, care through a VA facility’s CITI program, hospice, and listed preventive services such as cancer screenings, annual physicals, and vaccinations.
The allowable amount
The allowable amount is what CHAMPVA approves for a service or supply. VA says that in most cases it’s the same amount Medicare or TRICARE pays. Your cost share is figured on this amount, not on the provider’s bill.
If your provider accepts assignment, they agree to charge only the allowable amount. If they don’t, you pay them and file a claim, and CHAMPVA pays only its share of the allowable amount. You owe anything above it, and that extra doesn’t count toward your cap.
What is the CHAMPVA cost share?
After the deductible, when CHAMPVA pays first, you usually pay 25% of the allowable amount and CHAMPVA pays 75%. VA’s rule (38 CFR 17.274) puts it this way: CHAMPVA pays the allowable amount minus any deductible and minus your cost share.
There’s no cost share for Meds by Mail, care through CITI, hospice, or the preventive services listed above. Some inpatient stays are figured differently: the Guidebook uses a per-day amount or a DRG-based rate for certain hospital and mental health facility stays. VA’s pages don’t publish those 2026 dollar amounts, so we don’t list them here. Call CHAMPVA for your stay.
If you have other insurance
When CHAMPVA pays second, the Guidebook says you pay nothing in most cases, and CHAMPVA pays up to 100% of the allowable amount. VA says you may not need to pay a cost share if you have other health insurance. See CHAMPVA and Medicare: who pays first.
What is the CHAMPVA catastrophic cap?
Your family’s out-of-pocket costs for covered care are capped at $3,000 per calendar year. After that, CHAMPVA pays 100% of the allowable amount for covered services for the rest of the year.
Only your deductibles and cost shares count toward the cap. Amounts above the allowable amount and costs for things CHAMPVA doesn’t cover don’t count (38 CFR 17.274). See what CHAMPVA doesn’t cover.
Prescriptions
At an OptumRx network pharmacy, you pay full price until you meet the deductible, then 25% of the allowable amount. Outside the network, you pay up front and VA pays back 75% of the allowable amount. Meds by Mail has no cost to you. More on the pharmacy page.
Questions about a bill
Call CHAMPVA at 800-733-8387 (TTY 711), Monday–Friday, 8:00 a.m.–7:30 p.m. ET. If a claim was denied, see Denied claim?