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

[HorizontalMike]

Well, after looking and reading about all the Medicare options, I ended up choosing to go with the standard Medicare A&B for  $134/month.  As I said earlier, I already have an employer-based health plan (with Express Scripts) that compliments my 100% TDIU care at the VA.  That 80/20 plan will convert to a 20/80 plan when I turn 65 in May.  The Medicare A&B will pick up as primary payer to my employer-based health plan (Aetna), thus giving me an alternative to the VA if I need it in an emergency (out-of-town & away from VA).

As far as the topic of VA healthcare, I have two opinions:

1. PCP care through VA sucks.  These generalist practitioners will make/take any excuse to delay/deny serving the patient.  For example, I have been a diabetic 8-10yr.  About 1-1/2yr ago I managed to lose 40lb and keep it off.  I immediately had to go through four (4) PCPs trying to get my Metformin medications adjusted/lowered.  The last PCP looked at me and told me to my face "You are not diabetic."  He refused to acknowledge that I was/am a "well controlled" diabetic through proper diet.  He unilaterally completely stopped/discontinued my Metformin prescription.  Long story made short, after a series of emails to the VA Secretary and the head of the VA hospital I use, I will now be seeing my FIFTH (5th) PCP for the first time this May.  We shall see where this goes from here. NONE of my PCPs have been trained in treating TBI patients and they tend to take everything personal regarding my "don't play well with others" episodes.
2. My healthcare through my Polytrauma Doctor and my Psychiatrist, has been and is great.  I get personal and timely replies when I secure message them via MyHealtheVet.  Between the two of them, I get all my hormone replacement therapy and depression medications taken care of.  I even got my diabetes testing supplies renewed through them.  This has changed my life and allows me to see that the sun actually does rise in the morning.  IMO, specialized TBI care works, and works well, WHEN your doctors actually have had the proper training.  I do have to say though, that all of this was a result of the anal retentive nature of my TBI.  I am intelligent (earned BS, MA, PhD) and persistent.  After several repeated letters/emails to my Congressmen (and other Congressmen as well), the Secretary of the VA, and other local and National VA personnel, I finally began receiving the healthcare I need.  FYI, still +4yr and counting, to get my retro-disability check.

And in support of this website and its recommendations, keep fighting, and... "Don't let the bastards win."

[Jimmer]

Buck5, My Medicare Advantage plan is called "Cigna-Health Spring Preferred (HMO)".  The amount I pay monthly is the amount that medicare deducts for part B, which is $134.00 month which goes to Cigna instead of medicare.  To see my main doctor (Primary Care Physician) is no cost.  Any "preventive" stuff done is no cost, such as yearly physical, flu shots, are no cost.  To see any specialist it is $30.  Urgent care cost is $25.  And emergency costs are $75.  You pay for MRI's, about $125.00 depending on what is involved.  The great thing is you know all your cost ahead of time.  For example I was involved in a Horrific car accident two years ago.  I was sitting a  red light (first car) and a truck slammed into me doing 45 m.p.h. (He fell asleep and hit the gas instead of the brake) totaled my car, and also most totaled me.  At the hospital they ran tests and found out my stomach had "flipped", and I would need surgery for it.  It was extensive surgery, and they had top notch surgeons doing it to unflip, and realign my stomach.  (No offense but I didn't trust the V.A. doctors to do this surgery).  I was in the hospital 20 days.  My bill was for the hospital stay, $1,050.00.  (I paid $175.00 for the first six days day 7-90 no charge.  After 90 days, I guess they don't think you gonna make it). And another $400.00 in co-pays for see the specialists.  My total was $1,450.00.  The hospital bill was $336,000.   So I feel I did all right.   You really know what your costs are, so you don't get blind sided.  Also, I you have an emergency, and had to see a doctor out of the "network", you will not be charge for it, other then your co-pay amount.

[john999]

My question would be that if you have cancer do you want to have to wait for your "gatekeeper" to refer you to a specialist who is part of your HMO plan?   If I were hard up against it I would take a Medicare Advantage plan with a PPO.  If the plan is a large one then most of the doctors will be in it.  I just want to be sure in the case of some more rare or quasi-experimental disease or treatment that I have the best shot possible to get the care I need.    The one thing I would not do is try to save a buck at the risk of my health.  Medicare is one of the few good things our government dreamed up for the masses.  Unless you are a lawyer you cannot understand the fine print in Medicare Advantage plans or any insurance plan for that matter.  Medicare is the most straight forward plan of all in my opinion.  It all does depend on what you can actually afford.  I probably spend too much on insurance.  I bought a disability insurance plan for individuals about 30 years ago.  It was cheap and it just paid a supplement to SSDI and my OPM disability, but I have been drawing it since 2002 every month.  The first year it paid for itself concerning all my premiums.