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    • Is There A Request For Reconsideration At the Local RO Level
      We had here not only a DAV VSO but also a lawyer who gave the wrong advice on this issue. The lawyer stated about a year ago here that there was no such thing as a Reconsideration Request at the VARO level.. He has since become enlightened.  and will remain nameless...because many of you recall that post. I wonder how many vet claim he handled that could have been resolved with a Recon request at the RO level, but they are probably still at the BVA by now. I won one too at the RO level a few years ago,. The DAV NSO however advised us that the DAV had a DAV template  for this type of request. for years ..they knew it could be done at the VARO level....however the DAV VSO (who also shall remain nameless but all above posts are still here) argued with me that a recon request at the RO level stops the NOD clock. Of course he was wrong and I had to post many many BVA denials whereby the veteran found out too late that they still had to file a NOD if the VA did not favorably act on their reconsideration request---within the one year NOD deadline.   The BVA denied them because their NOD was NOT filed in timely fashion. If any vet he told this NOD BS to, eventually succeeded in a re open or newer claim, perhaps they could recover the years of comp they lost, if they sued the DAV NSO,with proof of the wrong advise he gave them. The NSO left us and went to another vet's site. Actually most of his advise here was very good. No one knows it all....and after decades of VAOLA I am still learning too. But I have a gripe. When anyone here makes a statement that appears to be directly from a VA regulation, give us the Link please! And make sure it is current. I saw a post here on 2 outdated regulations. so rime ago. Maybe I corrected it or maybe I didn't.....anyone here who understands the AO regs knew it was wrong anyhow.  
    • C&P Exam Results, WTH is going on, Please Help!!!
      UPDATE 5/5!!! Well Yesterday the Claim Completed, but I see no Change in Disability Ratings, and my Benefits Letter still states 100% P&T with no Future Exams. SO I still dont know what the Heck is going on, Hopefully the BBE will be here soon So I can see what crap the VA is trying to pull. Thanks again guys  
    • Denied!! Hip Service connection. Guess what? Their is HOPE!
      Would you agree that this is new and material evidence? 
    • Denied!! Hip Service connection. Guess what? Their is HOPE!
      Berta, i found this old post from 29 jan 15 and it brought back to mind what happened at my C&P...  My other c&p was for joint pains and hip pain and to be honest i almost walked out on that one, because she was a practitioner and she made me feel like i was confused and maybe so, but she said what joints and when i told her she kept interrupting me and stating that i was already service connected for that so what joints are you claiming. So after i said neck and elbows she did the ROM on everything and poked me and said she was done. It lasted about a hour. Then i went for neck and elbow x-rays and was finally able to get out of that place. So who knows what the outcome will be. . I don't know how this hip issue went from a service connection issue to a secondary issue?  
    • Social Security disability
      UPDATE: Well I met with my lawyer and went over my application for ssdi they said i have a slam dunk case but with my pension I fall under the windfall elimination provision .that means my benefits will be reduced by 80% so much for paying into the system sorry for the rant do I still go for the 20% on my own or with the lawyer thanks all 
    • NOD / DRO or TARP?
      And please read over the 2010 PTSD regulations here. I didn't see PTSD claimed at all on the 2009 denial. If it had been, that would have put you into the pre 2010 PTSD regs...but Gastone is correct. I thought at first you had been grandfathered into the older regs but I was wrong when I read the download. I assume they sent you a 5103 waiver or something that indicated they needed info on your stressor. If you consider filing a new claim ,I would if I were you, state every possible theory of entitlement, such as depression and acquired psychiatric disorder, as well as PTSD because that way you are not locked into solely the PTSD criteria. I began helping vets with claim in around 1984...predominantly PTSD claims due to the Vietnam War. I found at that time the VA wanted to read about Blood and guts.and detailed horror stories of Vietnam stressors, many of which were stressors the veteran and/or JSRRC  could prove. The new regulations only account for "fear" and "Close proximity to hostile fire" as supporting a stressor description. Still they need to have details on your stressor, that would support those above 2 factors. "but I had documented stressors (Combat Action Badge and serious incident reports" Did they have the incident reports?      
    • E-Benefits Status
      Welcome aboard and it is very common for the Status to go back and forth. I had 1 claim sit at Prep for Notification for over 2 months, then go back to Gathering of Evidence. Ebenefits is a great tool to use, but not always 100% up to date. The main Days to look at the site is Mon and Fri, where the statuses usually change. Do you have access to MyHealthEVet, and if you do post the C&P exam results here, and we can give you a more accurate guess. I am SC for PTSD and TBI, and they were not Deferred. As long as the Medical Evidence, or Scans are there then the VA will grant SC. Good luck and keep us posted. God Bless
    • Lots of issues
      Welcome aboard and glad to see you are learning about the process. It is too hard to try to figure out when claims will complete. I had a C&P 2 months ago and the claim just completed yesterday. What is the Current status of your claim? Do you have access to Ebenefits? Do you have access to MyHealthEVet? Good luck and keep us posted, God Bless
    • Denied!! Hip Service connection. Guess what? Their is HOPE!
      That is even better than 2013 , if there is a 38 CFR 3.156 issue here.
    • CUE? Not using SMR?
      Asknod correctly advised on the third 'prong' of CUE, as the BVA calls it: "Having proved CUE, all he has to do is show that the error manifestly changed the outcome. " Therefore someone has to figure out what the combined 10% was for, it seems to be for SC. An additional problem is the word "combined" on the rating sheet. The foot disability rating, determined by the established evidence they had at time of this decision had to warrant a rating of at least 10%  , on it's own, and not "combined" and thus  'Manifest' the outcome of the decision, under CUE, as erroneous.  I think there were more pages to this rating sheet. And I agree this is for an attorney to deal with.I suggest you print off the thread here on this issue as the attorney might want to consider some of our comments.              

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Pete53

Medicare Prescription Plan Is Confusing

7 posts in this topic

09:17 AM CDT on Monday, September 26, 2005

By BOB MOOS / The Dallas Morning News

The mailboxes of Medicare's 42 million beneficiaries will begin to bulge next week.

That's when seniors will start to receive sales brochures from insurers, pharmacies, pharmaceutical companies and others marketing prescription drug plans.

Medicare's new prescription drug benefit represents the most significant change in the federal program's 40-year history.

Yet, many older adults don't understand the new program, or they worry they won't come out ahead if they enroll in a drug plan.

"Whenever there's change, there's confusion and anxiety," says Khelan Bhatia, an advocate for AARP Texas. "But there's also opportunity."

Medicare administrator Mark McClellan expects the new drug benefit will cut many older Americans' prescription costs in half. And seniors with limited income and few resources will have almost no drug expenses.

The new benefit will come as welcome relief for many, he says. The average prices of dozens of prescription drugs used widely by seniors are rising more than twice as fast as general inflation, according to AARP.

"This coverage will help seniors afford the drugs they need to maintain or recover their good health," Dr. McClellan says.

JoAnn Walters, 78, of Dallas takes four prescriptions but doesn't know what she'll do.

"I have no idea whether the coverage would save me any money today, but you never know what your future will bring," she says.

Like other Medicare beneficiaries, Ms. Walters says she'll compare the drug plans to see if she can reduce her prescription costs.

"I've got some homework to do."

Here are some of the most frequently asked questions about the drug benefit, according to Medicare officials and others who work with seniors.

Must I enroll?

The benefit is voluntary. It's available to anyone on Medicare, regardless of health or income. But if you want the coverage, you'll have to enroll in one of the private insurance plans Medicare has approved.

Senior advocates add this cautionary note: If you wait and sign up for the drug benefit after the initial enrollment period ends May 15, you'll pay a penalty – an extra 1 percent in premiums for each month you delay.

"Even if you're healthy, you may want to get the coverage now," says Paul Zobisch, a Medicare volunteer. "You'd be insuring against what might happen later."

What if I already have prescription drug coverage?

Companies that provide retiree drug benefits will notify you whether their plans are at least as good as Medicare's.

If you have such coverage, you may want to keep it, says Robert Hayes, president of the Medicare Rights Center, a consumer group. As long as it's comparable to Medicare's benefits, you won't pay a penalty if you switch to Medicare later.

Medigap supplemental insurance policies are another story. Most that do cover prescriptions aren't as good as Medicare's coverage, so you'll pay a penalty if you enroll in a Medicare drug plan later, Mr. Hayes says.

"It's important to remember that Medicare's drug discount cards are ending, so you won't be able to rely on those any more," Mr. Bhatia says.

What will the drug benefit cost, and what will I get in return?

Your costs will depend on the plan you choose. Competition is driving premiums down – to less than $20 a month for some plans, from the $37 once projected.

After you pay the first $250 of your annual drug expenses, you'll be responsible for 25 percent of the next $2,000 in bills, all of the next $2,850, and 5 percent beyond that.

Some plans will offer more coverage for higher premiums, says Rod Clark, Medicare's outreach coordinator in Dallas.

Each plan will have its own list of covered drugs, both brand name and generic. Dr. McClellan assures seniors that every medically necessary drug must be covered.

Is extra help available for people with low incomes?

Yes. If your annual income is less than $14,355 and your assets are below $11,500, Medicare will pay almost all of your drug bills. (For couples, income can't be more than $19,245 and assets can't exceed $23,000.) If your income is slightly higher, you'll get a smaller break on your premiums, deductibles and co-payments.

If you now get Medicaid, a Medicare Savings Program subsidy or Supplemental Security Income, you automatically qualify for the additional help. Others on limited incomes will have to apply for it through Social Security.

"This is a no-brainer for anyone who thinks he qualifies," Mr. Hayes said says. "Run, don't walk, to apply."

But keep in mind that requesting the extra help won't enroll you in a plan, he says. You'll still need to select one.

Once I decide on the drug coverage, how do I find the best plan for me?

Texans will select from among 20 plans.

"Having so many choices is a good thing, but it can also be overwhelming," Mr. Zobisch says. "So take it a step at a time."

First, find a plan that covers all or most of your prescriptions.

If the plan you're considering doesn't cover one of your drugs, talk to your doctor to see if your medicine can be switched to one in the plan, AARP suggests.

If not, talk to the plan's sponsor to see if your circumstances make you eligible for an exception that pays for a drug not on the list.

Next, identify a plan that works with a pharmacy near your home. You may also be able to order drugs through the mail.

Finally, make sure you can afford the out-of-pocket expenses.

"Consider your choices carefully, because you generally won't be allowed to change plans for a year," Mr. Bhatia says.

How can I compare plans and enroll in one?

Medicare's Web site will let you compare drug plans' costs and benefits, beginning in mid-October. Visit www.medicare.gov and select the "search tools" option.

You may also call Medicare at 1-800-633-4227. When you do, have at hand your Medicare card, a list of the drugs you take and the name of your pharmacy.

The Medicare & You 2006 handbook will be mailed to every Medicare household in October and will also have a detailed listing of the plans in your area, Mr. Clark says.

Once you decide, you may sign up at Medicare's Web site or through its toll-free number. Or you may directly contact the plan you've chosen.

"Don't rush to judgment," Mr. Bhatia said says. "Even when enrollment begins Nov. 15, you'll still have six months to reach a decision. Consult a family member or trusted friend to help you consider your options."

E-mail bmoos@dallasnews.com

Benefit won't be delayed

A one-year delay in the Medicare prescription drug benefit has been proposed as a way of offsetting some of the rebuilding costs from Hurricane Katrina, but the White House and Republican congressional leaders are ruling that out.

The drug benefit is set to begin Jan. 1.

Fiscal conservatives from the Republican Study Committee proposed the postponement last week, saying it would save $30.8 billion of the estimated $200 billion in Katrina-related costs.

"Congress must ensure that a catastrophe of nature doesn't become a catastrophe of debt for our children and grandchildren," said Rep. Mike Pence, R-Ind., chairman of the GOP study group.

But the Bush administration and House Republican leaders quickly dismissed the idea.

"This is an important benefit for our seniors that will save them significant money on their prescription drugs," White House spokesman Scott McClellan said.

House Majority Leader Tom DeLay, R-Sugar Land, called the proposed delay "a nonstarter."

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I think you can delay taking this plan if you have ChampVA or other drug coverage. I wonder if VA would act in the same way since we have coverage under VA for drugs. In other words you could just hold off on signing up for the plan without penalty.

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Using the VA is penalty enough. My HMO is making us use the plan. It sort of stinks but who knows?

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I don't plan on getting it. I get my Meds from VA and Tricare. Of course I wonder if they will close that loophole and make us take it someday.

Sort of like being forced to take Medicare over Tricare. Paying 3 times as much for the same thing I don't use.

Joy.....

:unsure:

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I don't plan on getting it. I get my Meds from VA and Tricare. Of course I wonder if they will close that loophole and make us take it someday.

Sort of like being forced to take Medicare over Tricare. Paying 3 times as much for the same thing I don't use.

Joy.....

:unsure:

If you have TRICARE or CHAMPVA stay with that. If you join Medicare you will have to pay the premium each month if you use it or not! I was told the premium is $45.00 per month. When you are on Medicare you can join any Medical Insurance Company of your choose. Some Medicare Insurance Companies Premium's are FREE. I have Health America Advantra with is free, I pay for part-B, I get my FREE meds by mail from ChampVA. You know the Medicare prescripton program is just another way for the goverment to help the rich and Drug Companies get richer. Don't you remember how much the Drug Co. spent the first six months, last year to pay the Lobbiest? I read that in ARAP, I think it was around $1,000,000.00. Any senior on medicare and has a limited income could apply for Healthy Herizon, this is a federal program, it passed Congress and became Law around the 1900's. This program provides payment of Medicare Part B premium for persons with limited resources whose incoome is more that 100% but less than 120% of the Federal Poverty Income Guidelines. There are other programs where the income is much higher! In the State of Pennsylvsnia the County Assistance Office is where you apply or you can go to the Area Agency on Aging.

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09:17 AM CDT on Monday, September 26, 2005

By BOB MOOS / The Dallas Morning News

The mailboxes of Medicare's 42 million beneficiaries will begin to bulge next week.

That's when seniors will start to receive sales brochures from insurers, pharmacies, pharmaceutical companies and others marketing prescription drug plans.

Medicare's new prescription drug benefit represents the most significant change in the federal program's 40-year history.

Yet, many older adults don't understand the new program, or they worry they won't come out ahead if they enroll in a drug plan.

"Whenever there's change, there's confusion and anxiety," says Khelan Bhatia, an advocate for AARP Texas. "But there's also opportunity."

Medicare administrator Mark McClellan expects the new drug benefit will cut many older Americans' prescription costs in half. And seniors with limited income and few resources will have almost no drug expenses.

The new benefit will come as welcome relief for many, he says. The average prices of dozens of prescription drugs used widely by seniors are rising more than twice as fast as general inflation, according to AARP.

"This coverage will help seniors afford the drugs they need to maintain or recover their good health," Dr. McClellan says.

JoAnn Walters, 78, of Dallas takes four prescriptions but doesn't know what she'll do.

"I have no idea whether the coverage would save me any money today, but you never know what your future will bring," she says.

Like other Medicare beneficiaries, Ms. Walters says she'll compare the drug plans to see if she can reduce her prescription costs.

"I've got some homework to do."

Here are some of the most frequently asked questions about the drug benefit, according to Medicare officials and others who work with seniors.

Must I enroll?

The benefit is voluntary. It's available to anyone on Medicare, regardless of health or income. But if you want the coverage, you'll have to enroll in one of the private insurance plans Medicare has approved.

Senior advocates add this cautionary note: If you wait and sign up for the drug benefit after the initial enrollment period ends May 15, you'll pay a penalty – an extra 1 percent in premiums for each month you delay.

"Even if you're healthy, you may want to get the coverage now," says Paul Zobisch, a Medicare volunteer. "You'd be insuring against what might happen later."

What if I already have prescription drug coverage?

Companies that provide retiree drug benefits will notify you whether their plans are at least as good as Medicare's.

If you have such coverage, you may want to keep it, says Robert Hayes, president of the Medicare Rights Center, a consumer group. As long as it's comparable to Medicare's benefits, you won't pay a penalty if you switch to Medicare later.

Medigap supplemental insurance policies are another story. Most that do cover prescriptions aren't as good as Medicare's coverage, so you'll pay a penalty if you enroll in a Medicare drug plan later, Mr. Hayes says.

"It's important to remember that Medicare's drug discount cards are ending, so you won't be able to rely on those any more," Mr. Bhatia says.

What will the drug benefit cost, and what will I get in return?

Your costs will depend on the plan you choose. Competition is driving premiums down – to less than $20 a month for some plans, from the $37 once projected.

After you pay the first $250 of your annual drug expenses, you'll be responsible for 25 percent of the next $2,000 in bills, all of the next $2,850, and 5 percent beyond that.

Some plans will offer more coverage for higher premiums, says Rod Clark, Medicare's outreach coordinator in Dallas.

Each plan will have its own list of covered drugs, both brand name and generic. Dr. McClellan assures seniors that every medically necessary drug must be covered.

Is extra help available for people with low incomes?

Yes. If your annual income is less than $14,355 and your assets are below $11,500, Medicare will pay almost all of your drug bills. (For couples, income can't be more than $19,245 and assets can't exceed $23,000.) If your income is slightly higher, you'll get a smaller break on your premiums, deductibles and co-payments.

If you now get Medicaid, a Medicare Savings Program subsidy or Supplemental Security Income, you automatically qualify for the additional help. Others on limited incomes will have to apply for it through Social Security.

"This is a no-brainer for anyone who thinks he qualifies," Mr. Hayes said says. "Run, don't walk, to apply."

But keep in mind that requesting the extra help won't enroll you in a plan, he says. You'll still need to select one.

Once I decide on the drug coverage, how do I find the best plan for me?

Texans will select from among 20 plans.

"Having so many choices is a good thing, but it can also be overwhelming," Mr. Zobisch says. "So take it a step at a time."

First, find a plan that covers all or most of your prescriptions.

If the plan you're considering doesn't cover one of your drugs, talk to your doctor to see if your medicine can be switched to one in the plan, AARP suggests.

If not, talk to the plan's sponsor to see if your circumstances make you eligible for an exception that pays for a drug not on the list.

Next, identify a plan that works with a pharmacy near your home. You may also be able to order drugs through the mail.

Finally, make sure you can afford the out-of-pocket expenses.

"Consider your choices carefully, because you generally won't be allowed to change plans for a year," Mr. Bhatia says.

How can I compare plans and enroll in one?

Medicare's Web site will let you compare drug plans' costs and benefits, beginning in mid-October. Visit www.medicare.gov and select the "search tools" option.

You may also call Medicare at 1-800-633-4227. When you do, have at hand your Medicare card, a list of the drugs you take and the name of your pharmacy.

The Medicare & You 2006 handbook will be mailed to every Medicare household in October and will also have a detailed listing of the plans in your area, Mr. Clark says.

Once you decide, you may sign up at Medicare's Web site or through its toll-free number. Or you may directly contact the plan you've chosen.

"Don't rush to judgment," Mr. Bhatia said says. "Even when enrollment begins Nov. 15, you'll still have six months to reach a decision. Consult a family member or trusted friend to help you consider your options."

E-mail bmoos@dallasnews.com

Benefit won't be delayed

A one-year delay in the Medicare prescription drug benefit has been proposed as a way of offsetting some of the rebuilding costs from Hurricane Katrina, but the White House and Republican congressional leaders are ruling that out.

The drug benefit is set to begin Jan. 1.

Fiscal conservatives from the Republican Study Committee proposed the postponement last week, saying it would save $30.8 billion of the estimated $200 billion in Katrina-related costs.

"Congress must ensure that a catastrophe of nature doesn't become a catastrophe of debt for our children and grandchildren," said Rep. Mike Pence, R-Ind., chairman of the GOP study group.

But the Bush administration and House Republican leaders quickly dismissed the idea.

"This is an important benefit for our seniors that will save them significant money on their prescription drugs," White House spokesman Scott McClellan said.

House Majority Leader Tom DeLay, R-Sugar Land, called the proposed delay "a nonstarter."

The medical industry will make alot of money on a questionable benefit.

B)

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How about a plan that actually guarantees affordable drugs and health care for our senior citizens and not another bureaucracy that just buries our elderly in paper work, quite literally, to death.

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