CHAMPVA Savings Estimate Worksheet

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This worksheet will help you estimate the savings you could realize by dropping your Medigap or OHI (Other Health Insurance) policy.

This worksheet applies to individuals who have coverage by Medicare Parts A and B, CHAMPVA and also have a Medigap policy or other major medical insurance.

Premiums

Let’s start with your annual premiums and compare that total to the most you would spend under CHAMPVA (called the catastrophic cap).

Result Number 1:

How much is your annual insurance (Medigap/major medical) premium?

 

(monthly premium___$______________ x 12): __$__________________

Prescription Medication

Seven of the ten Medigap policies do not provide any prescription medication coverage. The remaining three have annual limits and co-pays.

How much did you spend last year on prescription medication?

Fill in the amounts

Now multiply that amount by 75% (this is the amount CHAMPVA would have paid toward your prescriptions):

(A)

                   $_____________________

If your insurance had a pharmacy deductible, let’s add it:

(B)

                   $_____________________

 

Result Number 2 — this is approximately how much you would have saved on prescription medication:

(A) + (B)

                   $_____________________

You could save even more if you used CHAMPVA’s Meds by Mail program — there are NO co-pays or deductibles with Meds by Mail; your medication is free!

Hospitalization

Medigap/OHI policies generally pay your cost of a hospital stay. CHAMPVA does the same thing. You would not save or lose any money if you did not have your Medigap policy.

Doctor Office Visits (Including Specialists)

Medicare Part B covers most doctor office visits, and your Medigap policy might cover any co-pay or cost share.

CHAMPVA would normally pay all of your cost share or co-pay. So, you would save the entire amount you paid last year for doctor office visits.

Result Number 3 (enter the amount you spent on co-pays or cost shares last year for doctor office visits:_____$__________________

 

Now let’s total up your savings

 

Premiums (Result Number 1):

$___________________________

 
 
 

Prescription Medication (Result Number 2):

$___________________________

 
 
 
 

Doctor Office Visits (Result Number 3):

$___________________________

 
 
 
 

Now add all three for your total savings:

$___________________________

 
 
 

Now subtract CHAMPVA’s annual catastrophic cap: (this is the most you would have to pay in a year for CHAMPVA services)

-3000

 

Here’s the minimum savings you would enjoy:

$___________________________

 

And remember, if you use CHAMPVA’s Meds by Mail program, you can save even more because your prescription medication would be free!

This is a PDF Version of this worksheet