Is Champva Enough Without Ohi?

[mymansavet]

What a great site! I'm the wife of a Vietnam vet (USN) and recently got my CHAMPVA card, so I'm overwhelmed with information. I really appreciate everything I'm learning here.

I plan to cancel my current health insurance, as it has unreasonably high and ever-increasing premiums despite my catastrophic-care deductible, and doesn't cover preventive care adequately. I never fulfill my deductible, so I pay for all my health care each year. Considering how much CHAMPVA covers, I just can't see any advantage in keeping this OHI.

Is there something I'm not understanding? Are there in fact disadvantages to only having CHAMPVA without OHI? And if so, what are they?

I'm thinking about getting CHAMPVA supplemental insurance, but I'm not sure what provider(s) would be appropriate to my situation. I was referred to federalpublishing.com, but the information there is pretty skimpy, and the VA can't give me any recommendations. Most of the coverage seems only to apply to families of retired career military. I think that I might be eligible for AMRA's supplement, but I'm not sure—one chart I looked at seemed as though I'd need to be retired myself to qualify. I'm going to give AMRA a call, but I'm wondering if anyone here has CHAMPVA supplemental coverage with them and can recommend it? Or can recommend/suggest another provider?

Thanks for all your help. I don't know who I'd ask if it weren't for you folks!

[carlie]

Welcome to Hadit.com .

[jbasser]

Welcome to Hadit.

Many folks would advice against dropping other health insurance but I for one encourage it.

the reasons are this. Champ VA is no cost to the beneficiary. It would be secondary to other insurance anyway.

For about 30 bucks per month you can get a Champ VA supplament that pays the remaining cost so you are saving in the long term. http://www.champvahealthinsurance.com/

Are you receiving medicare?

JBasser

[Chuck75]

Insurance, regardless of where from, seems to be less than desired. Do you need something besides CHAMPVA? My opinion would be yes. The whys are two numerous to get into.

That aside, cost of any insurance is a major factor, as is a problem when you drop conventional insurance. Often, those of us that have disabling conditions are not "eligible" for individual insurance, or the cost goes out of sight.

Group insurance can be lost completely if it is discontinued. (If I drop coverage via my wife's group insurance, it's gone forever.) Ultimately, a decsion must be based upon cost, availability of providers (can be a problem with CHAMPVA and even TRICARE)

and personal/family medical history.

What a great site! I'm the wife of a Vietnam vet (USN) and recently got my CHAMPVA card, so I'm overwhelmed with information. I really appreciate everything I'm learning here.

I plan to cancel my current health insurance, as it has unreasonably high and ever-increasing premiums despite my catastrophic-care deductible, and doesn't cover preventive care adequately. I never fulfill my deductible, so I pay for all my health care each year. Considering how much CHAMPVA covers, I just can't see any advantage in keeping this OHI.

Is there something I'm not understanding? Are there in fact disadvantages to only having CHAMPVA without OHI? And if so, what are they?

I'm thinking about getting CHAMPVA supplemental insurance, but I'm not sure what provider(s) would be appropriate to my situation. I was referred to federalpublishing.com, but the information there is pretty skimpy, and the VA can't give me any recommendations. Most of the coverage seems only to apply to families of retired career military. I think that I might be eligible for AMRA's supplement, but I'm not sure—one chart I looked at seemed as though I'd need to be retired myself to qualify. I'm going to give AMRA a call, but I'm wondering if anyone here has CHAMPVA supplemental coverage with them and can recommend it? Or can recommend/suggest another provider?

Thanks for all your help. I don't know who I'd ask if it weren't for you folks!

[titlewave]

We have CHAMPVA only. I am comfortable with having only that. The only other insurance we added was a long term care policy for my wife which we obtained thru USAA. Long term care insurance is not too expensive if you buy before you get too old. I am not willing to give up a chunk of my assets for nursing home care and I don't believe in transferring assets to your kids so the government has to pay for your care.

[broncovet]

Of course, you know much more about your situation than we do, so you will need to decide if additional insurance is necessary. Years ago, I was in the insurance business. We agents LOVED people who just "couldnt get enough insurance", and bought supplements on top of supplements.

I am pretty sure that Champva has a $50 annual deductable. If you bought other insurance, it would only pay copays and the deductable. Insurance is designed NOT to make money on it. In other words, if you had 2 health insurance policies, and had a 10,000 claim, insurance co A and B are not going to both pay it..it will be divided and you wont get more than your medical bills. (There used to be an exception with a company that did not pay your hospital bill, they just sent you something like $1000 per month when you are in the hospital..I am unsure if this coverage is still legal or being sold at present)

You really need to analyze your health conditions, your finances, and your insurance, along with a proposed supplement to come up with an answer. However, for me, I am quite unwilling to spend $30 per month to pay my $50 annual deductable..this makes absolutely no sense to pay $360 per year to prevent a $50 deductable.

People often do this with car insurance. They pay $1000 per year for Comp an Collision with a deductable (sometimes known by non insurance people as "full coverage" insurance, which is a misnomer..."full coverage" means no deductable) on a car worth $500. Its a waste of money.

ON the other hand, if your supplement insurance covers something you desire that Champva does not (oh, I dont know..maybe dental, or other things Champva does not cover) then the supplemental insurance may be worth it. Read your champ va book. Many times your agent will go over it with you..have your champva handbook ready when he comes.

[mymansavet]

Thanks for your welcome!

Unfortunately, I don’t qualify for group insurance as I’m self-employed. Expensive individual coverage is all I can get. And I’m several years away from Medicare, so that’s not an option.

The availability of CHAMPVA providers is certainly a concern. But I can still be treated by a doctor who doesn’t accept CHAMPVA assignment—I just have to pay them the difference between their charges and CHAMPVA’s allowable amount, plus my 25% cost share. And if I get supplemental insurance such as AMRA’s, I won’t have to pay the cost share, so my out-of-pocket medical expenses will be even less.

If I retain my current OHI, I’d have to spend almost $10,000 next year in deductible and premiums ($360 a month for the latter) before the insurance company would start paying. Even if I needed a lot of medical care and had to use a non-assignment provider, I’d be saving money by dropping my OHI and just using CHAMPVA and a supplemental. Or am I missing something here that I need to know?

Chuck75, you mention that there are numerous other reasons besides cost to retain OHI. Can you give me a few examples? I really want to make a smart decision that I won’t kick myself for later.

Titlewave, could you give me the website address of the provider of your wife's long-term care policy? I'm not familiar with USAA.

Are any other members using CHAMPVA supplemental insurance to pay for their cost-share 25%? If so, can you recommend a provider?

Thanks again!

[Pete53]

In my opinion you can do just fine with a supplement like USAA and ChampVA is primary. When you are eligible for Medicare remember to drop the supplement and take Part B of Medicare.

The Pharmacy Benefit is quite good and lets you choose between generic or brand.

[mymansavet]

Thanks for your behind-the-scenes perspective, broncovet. I'd just posted my previous reply when I saw yours, and as a new hadit.com member, my posts have to be individually moderator-approved for a while, so their appearances are delayed.

Yes, CHAMPVA’s deductible is $50 a year. Their coverage is more complicated than this, but basically they pay 75% of medical expenses, including prescriptions. I’m not sure if a CHAMPVA supplement such as AMRA’s (with its own deductible of $150) pays that deductible, but this is small change compared to what I’m paying now for my OHI (Other Health Insurance).

AMRA’s supplement pays the 25% of the allowable amount that CHAMPVA doesn’t (my co-pay), for doctors’ visits, prescriptions, and hospitals. Their $540/year premiums plus their $150 deductible plus CHAMPVA’s $50 deductible would still have saved me a lot of money this year. I don’t want to make any money through my insurance, I just don’t want to spend any needlessly.

My OHI private health insurance (different than CHAMPVA supplemental insurance) doesn’t really cover much more than CHAMPVA does—no dental, or routine eye exams, for instance. So I’m still leaning very heavily toward giving it the boot. But I’ll gladly hear other opinions pro and con. I keep thinking this is a no-brainer, but I don’t want to look back in a few months and realize that the no-brainer was me!

[broncovet]

mymansavet

It sounds like you are doing a good job considering your options, and Im guessing that by you doing this thorogh of a job planning, you will make the right choice for you. My brother used to call it the 5 P's....Proper Planning Prevents Poor Performance.

Most agents and those knowledgeable about insurance recommend that insurance be saved for the "catastrophe" and not used for the "fender bender". Remember that insurance companies purpose is to make money...so if you expect them to pay every 5$ copay, be prepared to pay for that service. I dont think its worth it, reminding you that it is not free for the insurance company to process a claim and send you a check for $5, so you are likely to pay $10 in premiums so that you wont have to pay that last five bucks.

However, you do want to analyze if their are any "huge holes" in your coverage. An example might be something like coverage for a heart transplant. If your insurance excudes this along the lines of this being experimental surgery, then you may well want to think about a supplement that would include it.

Bottom Line: REad and analyze both policies and then decide.

Most, if not all states, have a 30 day money back guarntee required from every insurance policy. That is, it is the customers right to read over the policy and not just listen to the salesman touting the benefits of his company, because the policy defines the limitations of the policy. This means you can buy the policy look it over for thirty days and get your premiums back. I recommend reading the policy. In Champva's case, read over the booklet they send you thoroughly.

[titlewave]

The long term care policy was purchased thru USAA.com. Good company. The policy was underwritten thru John Hancock. I shopped long term care with John Hancock with a local agent and USAA was quite a bit cheaper. If use you a local agent you end paying his commission also.

[john999]

I kept the FEHB I got from being a retired federal employee. It is BC/BS. I have medicare which is primary for me. My wife has ChampVA which is secondary. We don't pay anything for medical care if we stay in the BC/BS network which is vast. The thing you want to be sure you are covered for is a chronic illness that requires constant treatment. You also need the coverage for a really major illness That runs in the the tens of thousands of dollars. I tell you that when my wife was in the hospital for her diverticulitus she got the best of care. She went to the hospital with pain in her stomache region. She got all the tests right away and she was in surgery within hours. This is because the hospital knew they would be paid. When I got my foot operated on I was admitted in the morning and operated on within hours by a plastic surgeron. If the hosptial believes there is any chance they won't get paid they will shrug you off and this can be fatal. Look at the VA sending people home with severe infections because they are pinching pennies. When my wife gets medicare I will drop the BC/BS family plan which is expensive.