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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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HorizontalMike

100%TDIU and turning 65 Medicare and VA?

Question

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 by HorizontalMike

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Mike I am in the same Boat with ya, I don't have any employers insurance  all I have is the VA,

I turn 65 in July

I'm sure you been getting all the notifications about medicare in the mail  and the free dinner for you and your spouse, we went to one in particular medicare dinner and I am setting up a visit with one of these guys  he is not in it for the $$  he just happens to be an insurance guy that is turning 65 too.

So As I understand it  3 months before we turn 65 we need to have a plan worked out  or medicare will automatically sign you up, I think I am going with plan 9 that covers everything   hospital stays, scrips, the whole 9 yards. I do not want to count on the VA Other than getting my Scrips and use them for treating my S.C. PTSD and I'll still see my PCP twice a year  to be able to stay in the VA  System.

I have an appointment set up with this guy and were going to talk it over and he is to explain what all I'll be cover for with Medicaid and how the VA is involved. and what I need to do.

Hey those free dinners are nice...:wink::wink:

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Mike as I understand it  if you have an accident and taken to a private hospital, as long as you or someone notify s the VA this is an emergency then VA will pay...But someone needs to notify the VA ASAP that you have been taken to the private hospital  a Nurse or Dr From the private hospital can call the VA 1-800 # Your spouse  or who ever is with you at  that time  if who ever your with at the time can't  call  the Dr's/Nurse or Receptionist must call the VA . As long as that call is made to the VA you be ok.

Keep you a emergency card on you at all times stating you are a Veteran and for someone to call the VA at  he time of your Admittance  to let the VA Know you have a life threatening emergency.

the VA 1 -800 #

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I understand what you are saying, but still worried about that out-of-network emergency being denied.  Much of my fear is generated by this article that explains how the VA misuses the law to deny and deny, until they are forced to change on appeal:

https://militaryadvantage.military.com/2016/04/appeals-court-finds-the-va-wronged-vets-by-ignoring-2010-law/

Notice that Staab, the subject of the article, was denied by the VA FOR 7 YEARS!  Staab, now 83yr old (4yr older than USA life expectancy for men), is lucky to finally see the $$$.

I understand that the law has AGAIN been clarified to keep the VA from denying, but who knows what tactic the VA will use next.  THAT SAID, I want to know what I need to do about additional supplemental coverage to avoid this kind of fiasco in the first place.

FWIW, I have always carried an emergency info card with my better half's number and contact info.  Also have my VA Serviced connected card on top, in my wallet. 

OH, and by the way, I am at ~4-1/2yr and counting, waiting for my retro-disability  check for roughly $70k... Tick, tock, tick, tock... "another day older and closer to dead..."

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 Mike,

I would suggest to go to one of these medicare seminars with one of the medicare Reps (The free Dinner) and check with the Rep,  they are trained in medicare and know what is best for your situation and what you can afford to pay.

 We have to pay for medicare,  it just has different programs to choose from, I think there are 10 different plans/ programs in Medicare.

You need to look at all the different plans and choose which plan works best for you  including copays or non co pays  and that is what these seminars are for  you can ask as many questions and what if's that you want to.

I have not chose my Medicare Plan yet...but I am going to check with this Medicare Rep And he also happens to be an insurance Agent  in his occupation field....But he also is turning 65 too! he is not there to sell you insurance but is there to help you chooses a Medicare plan that best fits your Budget.

 H e has seen all types of insurance plans for medicare, so with his experience I will see what plan best fits me and my situation & what I can afford to pay monthly. ( the 300 bucksTo be taken out of my SS Check Monthly) for my Medicare Premium.

I want a plan that covers everything and no out of pocket cost...hey being 65  I'll have 1 more year on my car payments and that's it for me no more new cars /payment,'s.. and I'll only have my mortgagee payments to make/Utility's ect,,ect,,, plus the medicare Insurance cost ,  &  I count on that being fairly high around 300 $$ a month,  but as  expensive as health care is today and the future   that 300 should be my safe way out as for as paying for health care coverage.

Edited by Buck52

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As for as VA Paying for private care in that article of Stab vs VA  he eventually won  but  yeah it took 7 years  ..so most of us that encounters a non VA Emergency Visit  & the cost of who will pay maybe tied up in legation for years..I mean they may keep coming for us old farts  but I say hell let therm come they can't eat us.

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  • Our picks

    • Hello Defenders of freedom!

      I have a question pertaining to this denial for headaches. The decision letter is quoted below. 

       

      3. Service connection for headaches.

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      Your STRs are negative for any treatment of or diagnosis of headaches. On your post-deployment exam in 2005 you denied any headaches. On separation, you denied any headaches. VA treatment records are negative for any treatment of or diagnosis of headaches. On VA exam, the examiner stated there was no evidence of any residuals of a traumatic brain injury.

      We have denied service connection for headaches because the evidence of record fails to show this disability was incurred in or caused by military service."

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      Click here to purchase your digital journal. HadIt.com receives a commission on each purchase.
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      June 23, 1999 June 30, 2019

      VA Benefit InformationSummary of benefit informationYou have one or more service-connected disabilities:Yes         Your combined service-connected evaluation is:100%               You are considered to be totally and permanently disabled due solely to your service-connected disabilities:Yes           The effective date of when you became totally and permanently disabled due to your service-connected disabilities:July 01, 2019

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      SMC-K1

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