Health Insurance Programs

VA medical and pharmacy copayments cancelled through Sept. 30, 2021

Read here about the American Rescue Plan's debt relief and cancellation and refund of copayments made to VHA for medical and pharmacy care from April 6, 2020 through September 30, 2021.
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Veterans Affairs Supported Housing (HUD-VASH)

Information on the Veterans Affairs Supported Housing program that helps homeless veterans find housing, pay rent, and get healthcare.

Medicare?

Question:

I'm 35 but I've got a 100% total and permanent disability rating. Can I get on Medicare?

 

Jim's Reply:

Yes, Medicare is available to you once you are approved for the SSDI benefit. Please click https://www.vawatchdog.org/social-security-and-medicare-benefits.html 
 

To be awarded the SSDI benefit isn't as simple as applying for it. The rules are different than those at your VA and even a veteran with a 100% VA rating may not qualify at the SSA. Good luck!

 

CHAMPVA?

Question:

Hello. I am on Medicare and have an AARP supplemental plan that gives me full coverage. I recently qualified for CHAMPVA and I’m wondering if I can drop my expensive AARP coverage and/or my prescription part D plan. Will CHAMPVA cover expenses the same as a Medigap plan? Thank you.

 

Jim's Reply:

CHAMPVA is outstanding health insurance but it takes a little effort and patience to get used to. My wife uses her Medicare and her CHAMPVA together and it provides her with high quality care and prescriptions both by mail and at a local pharmacy. We're sure that her health benefits are better than mine!
 

There are intricacies and mysteries when you start using CHAMPVA. Yes, it should cover everything but some things need preapproval and that can get confusing. I've never been a believer in any sort of supplemental Medicare insurance as most of those receive terrible ratings in consumer reviews. Rather than a "Medigap" policy, we save the money we'd be paying for that policy and pay out of pocket expenses with no pain.
 

And again, I've viewed Part D as a terrible deal and unless you need some exotic and hugely expensive meds it makes more sense to pay out of pocket. However, your CHAMPVA should pay for all your meds although there are small deductibles on occasion.
 

The best I can tell you is that health insurance is a personal decision that you have to make based on your tolerance for risk and the economics you face in day to day life. A lot of folks are over-insured and they're happy knowing that they'll get care and not take chances with billing and debt. Others, like me, are el-cheapo by design and we look for cost savings at every step.
 

Before you drop your current insurance, get comfortable with CHAMPVA. Talk with your doctor's billing office and listen to what they say. Visit your favorite pharmacist and learn what their experience with all the insurances are. These people are all happy to talk to you about how they get paid because it's in their best interests! 
 

Go for it. Good luck!

 

Medicare

Question:

Hello Jim, I'm a 100% disabled Veteran and on Medicare part A. I stopped part B around 6 years ago because I never used it for medical reasons. I'm turning 65 soon and am getting correspondence from Medicare to pick up part B again but pay late penalties. What's your take on getting Medicare parts A and B? I appreciate your guidance and help with this matter. They want me to sign the notice card to opt out of Medicare part B by July. If I don't sign the card and mail it in they'll make the penalty adjustments and place me on Medicare A and B again.

 

Jim's Reply:

Medicare A is required when you begin taking your SSA retirement or SSDI, opting out is very difficult. Medicare B is optional but as you've learned, if you don't take it when first offered the penalty for that can be brutal depending on how many years you delayed.
 

Health insurance is a very personal decision. If you live within easy reach of a VA medical center, that's likely all you need. If you aren't within an easy drive to your clinic, you may want Part B so you can visit civilian physicians at very low cost.
 

I have it all...VA care, Medicare A & B because I'm 3 hours away from my VA hospital and I'm 1 1/2 hours away from my VA primary care clinic. My small community has a very nice and highly rated hospital and a bunch of doctors offices that are less than 10 minutes from my house.
 

You see where I'm going with this. It's a lot more convenient for me to use my Medicare even if it costs me a little more. I do stay connected to VA health care because I like my VA primary care guy a lot and I have all prescriptions filled through VA.
 

You'll have to decide for yourself how much money you want to spend protecting your health and how comfortable you are relying on VA if you do without the extra insurance. Good luck sir.

 

Part B

Question:

I'm a Veteran, I have 50% service connected disability. It's my enrollment period. My rating will likely be increased as my condition worsens. I use VA 89% and the other % I have care approved through VA to use locally (Tricare) or I have employment insurance with a Union. I won't retire for 3 to 5 years depending on my health. Is there a penalty if I do not apply for part B at this time? I read that I'll have time without penalty once my employment benefits stop but I wanted to be sure. Thanks in advance for your input.

 

Jim's Reply:

Part B can be extraordinarily complex and the CMS does a good job of answering your questions here https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-late-enrollment-penalty 

 

Billing Insurance

Question:

Hi Jim. I have been 100% P&T for 14 years. I am 66 years old and I have Medicare and a supplement plan. Recently, I received a statement from my Medicare supplement plan showing that the VA billed my supplement plan for my treatment. The statement also shows that Medicare was billed and both Medicare and the supplement provider paid for this service. Up until this year, all of my VA care was covered by my 100% P&T disability. I don't understand why this VA is billing Medicare and my supplement provider. Thanks for any insights you can give me.

 

Jim's Reply:

This is nothing more or less than the usual sloppy bookkeeping done by VA. If you're 100% nobody should be billed. However, no matter what you do, VA is going to bill anyone on your list of insurers and hope they get a bite. 


Billing Medicare doesn't reap a payment, it just offsets the VA budget in a creative way. If your supplement carrier doesn't raise a fuss, VA will just take the money and never look back.


This usually happens when the provider you're seeing doesn't tick the correct boxes in the screen they're looking at so billing occurs because you have an insurer listed there.


There's little you can do. You can spend your time trying to find the responsible people inside your VAMC...lots of luck with that. You could tell your insurer but the last I heard of anyone doing that, nothing at all happened. Most insurers see it as the cost of doing business with VA and if it doesn't run into hundreds of thousands of dollars, nobody pays it any attention. Trying to correct mistakes at VA is like arguing with a stop sign...it usually goes nowhere.


My thought is, why do you pay for a Medicare supplement? I've never used one and can't see where there are any benefits to that...other than throwing money at another insurer. Those plans are expensive as heck and after the deductible and copay, I can't see a benefit? I have A & B as well as VA care and it's never been a problem.


Good luck sir.

 

 

Medicare B

Question:

Am I required by law to obtain Medicare Part B if I am 100% disabled Vietnam veteran? Agent Orange got me. Lung cancer, neuropathy, PTSD, etc. I was 16 and a VOLUNTEER! GOD BLESS you and your efforts.

 

Jim's Reply:

No, you are not required to take Medicare Part B. Many do take it and find it to be a convenient and not to costly addition to their health care but it is not required.

 

Health Care?

Question:

I'm a Gulf war disabled combat vet. I'm 70/30 permanent total and unemployable. I have chronic PTSD, Bipolar, and ADHD. I'm supposed to be in the #1 priority group for healthcare. Can the VA deny me care for disability for any reason at all or are they obligated?

 

Jim's Reply:

You can't be 'fired' as a patient of the VA. The healthcare priority groups have never had much meaning. The highest rated #1 group is supposed to receive some sort of special treatment when making appointments and such but I've never seen that work well. 
 

VA can flag a patient who is disruptive and require that the veteran have a police escort to appointments or any time he is on campus and a disruptive patient may find he sees different providers but otherwise, VA is obligated to provide your care as long as you are properly registered.

 

CHAMPVA

Question:

I was recently enrolled in ChampVA through my husband. I also have OHI through my employer. Can I drop that insurance and just have ChampVA?

 

Jim's Reply:

Yes, you can drop private pay insurance and save that money. And many do just that...my wife and I did.
 

Whether or not you'll be happy will depend on your tolerance for jumping through hoops. CHAMPVA isn't as easy to work with as your typical BC/BS employer plan. There are preapprovals required, lost paperwork, unanswered phones and don't even think of emailing anyone there. Always remember, it's the VA. We have our best luck hanging on the phone and calling again and again until we get someone who knows what's up. I hear that they have an old school fax machine and that's the only way they communicate with regional offices.
 

If you have an established relationship with a doctor you like, ask her office manager to take a few minutes and talk insurance with you before you drop the private pay. If you don't have an established relationship with a provider, now may be a good time to do that and talk with them about insurance.
 

While you're at it, ask a couple of practice managers or insurance billing clerks to chat with you about how they get paid. They're always happy to do this...it makes their job a lot easier.
 

Having said that, once you are into the plan and your doctors are used to it and you have your mail order pharmacy set up, CHAMPVA works really well and covers most expenses. There are plenty of preventive services just so long as you get that preapproval.
 

Our doctors are perfectly happy with it although my wife has to watch the billing process carefully and she's always prepared to jump on the phone to straighten out a problem. We've started her transition to Medicare so there are more hoops to jump through but overall, it's worth it to have great health care at a very reasonable cost. My stepson has CHAMPVA for his family and the wife and two kids are very well cared for by CHAMPVA while VHA takes good care of him.


It's good, cost effective health insurance. Go for it.