Health insurance and being a veteran and senior citizen is a difficult transaction at best because the larger companies like Cigna and United Health Care have some kind of difference of opinion with the VA. When I first went on Medicare I found that the book that was provided by Cigna does not recognize a VA doctor as a primary healthcare physician. Matter of fact, neither UHC nor Cigna recognize less expensive services to anyone such as Affordable Dentures nor Pearl Vision. Lest I should ramble on, allow me to do things in a more pointed manner........... 1. When we turn 65 all seniors must have medicare which costs (out of pocket) from $100 to $150 a month unless you qualify for medicaid. Medicare demands that a Primary Health Care physican be named and subsequent testing and care be given by that physician. VA physicians are NOT recognized by Medicare. 2. Unless a veteran is retired or 80%< disabled there are no special benefits regarding dental or optical care. Even those vets who fall into the catagories mentioned and need dental or optical work performed will go to a civilian contracted by the VA for those services. In other words, if you're insured, the health care provider pays minus the copay or if you're a qualified vet, the taxpayer pays a civilian contractor the full amount. 3. Even when a vet is insured, the larger insurance companies will not recognize less expensive services. When I needed dentures, Affordable Dentures (the company) was not recognized in the insurance plan but are half the price of any other recognized dental provider. My dentures cost nearly $1,500 with a co-pay of $380. With Affordable, they would have been $750.00 with a $150.00 co-pay and still have the same guarantees that the high cost health care facility offers. The same with ophthalmologists and opticians. My glasses alone cost nearly $700 but Pearl Vision would have done the same job with the same guarantees for less than half that price. In my way of thinking, if the VA were allowed to compete with other civilian physicians in all phases of a vets care on the insurance playing field then three things can happen: 1. While the VA depends on taxpayer funded care, it might be more profitable for the VA to accept all forms of insurance including medicare and medicaid. At least the taxpayer would be paying less to the insurance companies instead of saddling the full amount of care that is provided by the VA facilities. 2. By allowing the VA to compete with civilian doctors, more money could be funneled through the VA while lowering taxpayer burden and at the same time widening the range of services provided by the VA. 3. By also allowing lesser expensive services onto the playing field, (like generic pharm already does) then co-pays could drop along with a possible decrease in premiums while at the same time offering a competition of rates with the present higher costing healthcare providers.
I've been with VA Medical, off and on, since somewhere before 1988. I remember, because I had ankle surgery done at a VA Hospital. Anyway, somewhere around that time-frame is when companies started having employee's pay a contribution for health insurance and I just didn't make a good enough salary to do that. The last job I had, I had company health, because I was getting a good enough salary to contribute. After leaving that job, my wife had a temp job for awhile and I was on her health care. I've been back with VA Medical since 2010, but now also have Medicare, Florida Blue (Supplement) and Humana Walmart Drug Plan. When I became illegible for Medicare, I thought about going with just Medicare and the two supplements, but after doing some research, decided to keep my VA doctor as my PCP. All the research said that having both VA and Medicare was highly suggested. Now, my Florida Blue does pay the VA some for my VA stuff, but the VA doesn't do anything with Medicare. And, I only had one VA doctor that approved a couple of my prescriptions to be bought outside the VA System. The VA doctor I have now, will absolutely not do that. That is fine, because I have a somewhat high deductible with my Humana Walmart Drug Plan and have no deductible thru the VA. VA is/can be darn good, if a Veteran has a "Service Connected" injury, but others don't necessarily get the healthcare that those do. If a Vet lives close enough to a VA Hospital with emergency services, VA is good. If not, Medicare is definitely better. VA only pays for emergency medical outside a VA Hospital, when a form is sent to them requesting that and then it's entirely up to the VA if they will pay. I could go on and on about what the VA doesn't cover that Medicare and supplements will. Both wife and I are on Medicare and the two supplements and on her company Vision and Dental Care Plans. Monthly payments for all is around $700, but our current income can handle that. Later, once she leaves her current job, that could definitely change and I'd have to quit Medicare and the supplements.
@Bobby Cole , completely agree with your post. Seems our government goes out of it's way to confuse the question of VA and Medicare. As of right now, (till I turn 65 in a few months), I have both Humana (tricare prime) since I am retired military and for 3 conditions I am 'service connected' with the VA. As an example, if I have a problem with one of these 3 'connected' conditions, I need to be seen by a VA doctor at the VA clinic. All other medical problems, I see my regular doctor. The government is paying either way, just seems to make sense that I could just see my regular doctor for the 'connected' conditions and ease the burden on the VA system. When I turn 65 and start Medicare, this throws one more issue into the mix. I will have Medicare, Tricare for Life, AND the VA to deal with. My regular doctor has to accept both Medicare and Tricare for me to be seen. Lucky for me he takes both. I watched the confirmation hearings for our new VA director on CSPAN to see what changes he has in mind for the VA. I liked his answers, and I am glad he was confirmed. Hope to see some change soon
This confuses me. (I know, this is no surprise.) Michael received Medicare A and B just like most people when he turned 65. He was 69 years old before he ever got sick, not even a headache, so I couldn't talk him into further insurance. But when he developed a fistula between his bowel and urinary tract, I drug him to the VA. His condition was not service related, but the Houston VA took his Medicare, and he recieved excellent care. While he was there for his operation, I mentioned his hearing loss, which was service related, and he received two hearing aids that would have cost us $5,000 each if we had had to get them on our own. The VA assigned Michael a PCP, and he always received an appointment within a couple of days after calling the VA. I wish I could find such good health attention. I thought the VA care system was the same nationally.
@Ina I. Wonder Welcome to the confusion club. You are correct, the VA system works the same nation-wide, only difference is how long of a wait time and locations. You can have both Medicare and VA coverage. Problems arise on what's covered and who pays, Medicare or VA. I agree about the hearing aids. Got a set of the lastest, high-end ones with great support and unlimited batteries and repairs. Every Vet should apply with the VA. Could be a lifesaver someday.
This is just some research that I found online talking about VA Medical compared to Medicare. VA health coverage isn’t set in stone and isn’t the same for everyone. The VA assigns enrollees to different priority levels according to various factors, such as income and whether they have any medical condition that derives from their military service. If federal funding drops, or doesn’t keep pace with costs, some vets in the lower priority levels could lose VA coverage entirely. If the VA determines that you qualify for healthcare coverage, you will be assigned a priority level based on a scale of 1 to 8-1 being the highest priority and 8 being the lowest. For example, if you are considered a priority level 8, you will get far less coverage and slower access to care than if you were a priority level 1 or 2. In general, the more you need healthcare coverage due to a combination of service-related disability and low income, the more coverage you will get from the VA. Can VA health coverage work with Medicare? The two plans are separate and seldom coordinate payments to give you extra cost savings. In other words, if you get care at a non-VA facility, Medicare generally pays the bills, unless you have received prior authorization from the VA. There are exceptions, of course. For example, an emergency may require you to go to the nearest medical provider which is a non-VA facility. In this case, the VA may pick up some of the cost until you can be moved to a VA facility for further care. However, Medicare can still provide you with more options for care than VA health benefits Also, it can provide a secondary source of coverage if VA funding or facilities get scaled back. Can the VA charge Medicare for my medical care or prescription drugs and vice versa? No. The VA and Medicare do not coordinate benefits. This means that if you have a Medicare-approved outpatient procedure completed at a non-VA facility, only Medicare will cover that procedure. In addition, Medicare may not cover the full cost of the procedure, so you may have out-of-pocket costs.
Just wanted to clear something up. When you are first accessed by the VA, you are assigned a 'Priority Group'. The money Congress gives the VA each year is limited, so this is why a 'Priority' system is in place. Its a numbers thing. If funds given is low, they ask that the lower 'Priority' groups pay more based on their income. Once you are in the system, your wait time is the same as any other vet. My local regional VA hospital has an average wait time of 22 days. I am 'Priority 2', I call and get an appointment and wait time is the same as someone who is 'Priority 6'. The 'Priority' marker is not about your 'Priority' on being seen, it is purely about funding. Only the government could come up with this type of wording and system...
When I went to the VA orientation a number of years ago they explained that we would have to fill out a "means" form once a year. It was simply a statement of how much money we made that year in order to determine what tier of payment each of us fits into. NOTE: The VA no longer asks for the means statement but they do consult with the IRS. Because I retired at 62 at the behest of VA affairs, I make less than $1000.00 a month so I qualify for free VA services sans dental and optical. At the orientation, they told us that if we made over a thousand dollars a month and if we spent any amount of time in a VA hospital we would be charged as much as $1000.00 a day (depending on the type of service) and we would be responsible for paying the total back within 90 days after leaving the VA facility, unless of course, we made other arrangements with the VA. They warned us that non-payment WOULD result in a garnishment of wages and or social security benefits. Now, here's the real screwy part of all of that. If the VA goes after a vet for non-payment and garnishes his Social Security, the VA will be paid by the same department that runs Medicare, which is of course, the department of social security. Yet, the VA and Medicare will not come to grips between themselves and see the benefit of joining themselves at the hip in order to accomplish their joint cause which is the care of veterans. Now, here's the caveat. If Medicare and the VA did come together, there would be a chance of a greater depletion of social security benefits. Which, brings me back to finding a better type of insurance that would satisfy all of a vets needs without potentially hammering away at his/her back pocket or limit his ability to work in the labor force for fear of going over a set wage limit.
When I got back with the VA in later 2010, I was asked to fill out a "means" form, but didn't do it. I knew that we'd end up paying a co-pay for any service and for prescriptions, because my wife's income was so high. I remember, years ago, I didn't pay for some prescriptions I got from the VA and they got me for it. When we all got that President Bush Stimulus Check in 2008, the money I owed the VA was taken out of it and it was noted on it.