100%TDIU and turning 65 Medicare and VA?

[HorizontalMike]

I have been on 100% TDIU for several years, and now I am coming up on age 65.  I have a basic employee provided health insurance plan through Aetna from my Teachers Retirement System of Texas.  This TRS-CARE1 program has informed me that after age 65, that they will become a "secondary payer".  If I understand this correctly, what was once an 80/20 plan (TRS-CARE1) now becomes a 20/80 plan.  I have a number of questions/concerns in how that works with VA 100% TDIU Disability.

1. The VA has been billing Aetna (TRS-CARE1) for services I receive from the VA (contracted rate, 80%, etc). How does this change when I turn 65?
2. I am receiving SS benefits at this time, so I assume that I will be auto-enrolled in Medicare A&B.  Correct?
   • Do/Will I need to up-grade my parts A&B?
   • What about part "D"? I currently get all my meds from VA, wonder if having an outside option would be worth the cost?
3. How much of a supplemental insurance plan do I NEED?
4. Can I depend on the VA to continue to cover me at 100%?  What if I have an auto accident and am taken to a non-VA hospital room?  Do I get stuck with the out-of-pocket expenses?
   • FWIW, hit deer on Harley a year ago, spent 32days in hospital and VA re-hab.  Got lucky since I never lost consciousness and was able to direct EMS to take me to the VA designated/contracted hospital... THIS TIME.  Bill was over $200k.  Everything got covered between VA and Aetna... THIS TIME.
   • Still ride Harley, so what will happen under "Medicare" in an out-of-network emergency in the future? (my biggest concern)

I have attempted to talk with Aetna, but all I seem to get are sales-people who refuse/can't give any advise as to options.  They only ask WHAT do I want... Not helpful to me at all.  And when I watch the news that TrumpCare wants to 5X elder health rates, I get very depressed.  BTW my major disability is TBI, so that may be factoring into my panic/depression about this as well.  Not having fun... 8-(

Edited March 14, 2017 by HorizontalMike

[Buck52]

Jimmer

So for the Advantage Medicare plan sounds like a good choice and I can select the private health care provider that is in the medicare  network.

 I'm just going to see what else is out there and what it all covers.  I want it all in writing...so  ease my mind.

 like the Select Plan?...but it has its boundaries!

[Jimmer]

Buck 52,  The nice thing about the Advantage Plan is that you know your costs ahead of time.  On my Cigna Card it says Specialist $30,  Urgent Care $25, Emergency $75.  To see a Primary Care doctor is $0.  So when I see a doctor they know and I know what the costs will be.  I use the Advantage Plan to see Specialists mostly, and it has been a real good savings compared to Medicare. They have been great in dealing with the V.A. getting letters, DBQ's etc. I have been with the Advantage Plan two years (I am 67,  a old fart!) They offer a HMO and a PCP plan.  The HMO you have to use the doctors in the network, but there are a boatload of doctors.  I actually have doctors tell me the prefer the Advantage Plan to Medicare, because they get paid quicker, then with Medicare (government red tape). 

[Buck52]

Roger That Jimmer,

I am leaning toward the Advantage Plan, but want to see what else is out there.

I turn 65 in July and want to have my plan all put in place, so for I been using the VA for all my health care  & I probably can keep using it but I do want private care to in case I need it  the way the VA is being so unpredictable  with Appointments.

Thanks for your input on this, its good to know all what you have mention.

[Jimmer]

Buck 52, Good that you are looking what all is out there.  Then you can compare.  I thinks that is a smart move on your part, having your plan in place when you turn 65.  I use the VA medical a lot, but having a private plan is important, as you mentioned especially  with the VA on appointments.  I had a situation about a year ago, that I went to see my private doctor (couldn't get a appt. with the VA in a reasonable amount of time), and he gave me a couple of tests.  He didn't like the results of the tests, and he had me at a specialist in less then two hours!

[armorer]

Being trained in medicine, I don't want the VA for anything. I understand it's a cost vs. resources issue, but still, I am trying to hold on to what I have, that has not had stripped from me.

And in most cases, ... :-(

I do like the blood and urine workups. They are handy for fasting and cleansing the body by finding out which vitamins are not being replenished enough. I need to find out what you are all talking about with SSDI and Medicare. I get Medicare in a couple of months. VA pts. are just meal tickets for VA providers in most cases: who just try to pawn off the cheapest and cheesiest medical applications and drugs, no mater how many times you say NO and how many HOURS you wait to tell them NO! Ymmv.

[Buck52]

The VA does use generics...but also uses name brands  They cut cost anyway they can,

The Medicare  Topic were have a conversation about  is What plan of Medicare is best?

for me I want to know what is cost effective and get a plan that best suites my medical health care.

if your turning 65 soon you need to sign up for medicare  3 months before you turn 65 or SSA will sign you up to just the basic medicare plan, you only have one time to choose a plan that you like and suites your health care, once you have a medicare plan you can change it or up-grade it during the Oct Nov Dec Months the following year.

I understand it takes 6 months for medicare to go in effect. once your signed up.

Medicare plans are to choose what you want and what is covered  including co-pay cost, hospital stays  and medications cost...this is a very important step in our life  were turning 65 and not spring chickens anymore..so unless your a Millionaire ...then its better to have a good health plan in case you need medical care and medicare give you that option.

Different medicare plans cost and you pay a monthly premium and what you able to afford & willing to pay  SSA will take the premiums  monthly cost out of your SSR  OR SSDI payments monthly.