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

[broncovet]

Mike, I suggest you get the medicare Part B and pay for it..its about 130 per month, taken out of your Social security.  I know this because, when I got disabled, I also got medicare and opted out of part B, with the thinking, "gee, if I need medical care, I simply go to VA, so I dont need part B. 

I was wrong, and am opting in to part B.  Here is why.  When I need health care, I have "0" options but go to VA.  However, with Part B, I can choose whether to go to VA or private care.  That choice is valuable, as sometimes VA care sucks.  

If you get medicare part b, for about 130 per month, you can also have a medicare advantage plan.  A medicare advantage plan is a private insurance company that essentially replaces medicare part b.  Some states or areas you can get a medicare advantage at 0 premium.  That is, your 130 bucks for medicare part b buys you the medicare advantage plan.  

If you "opt out" of the medicare part b to "save" the 130 per month, you will have a penalty (stiff) later on if you change your mind.  Basically I think its worth it to pay 130 per month to "not" HAVE to go to VA for health care.  I still may go to VA, but if the care is crappy, I change to private care.  

As far as VA "screwing you over", its what VA does.  They are experts at it.  This is one reason you need an alternative, that is, part B, so you have control over your health care choices, not some beaurecat at VA.  

If you opt in to part b, then you can choose whether to continue with part b, or to get a medicare advantage plan instead.  If you opt out of part B, you can not get a medicare advantage plan.   You can switch from medicare advantage, to medicare, or from one medicare advantage company to another on an annual bases. 

For me, I do not like "HMO" medicare advantage plans.  Reason: You have to go to your prime care doc to ask him if its okay for you to see another doc.  Without your prime care doc's referral, you can not see a specialist.  

I dont want  a gate keeper, whose job it is to keep me out of the specialists office.  If I think I need an orthopedic specialist, then I want to get one, not ask someone else if its okay.  

[HorizontalMike]

1 hour ago, broncovet said:

Mike, I suggest you get the medicare Part B and pay for it..its about 130 per month, taken out of your Social security.  I know this because, when I got disabled, I also got medicare and opted out of part B, with the thinking, "gee, if I need medical care, I simply go to VA, so I dont need part B. 

............[snip]......

I dont want  a gate keeper, whose job it is to keep me out of the specialists office.  If I think I need an orthopedic specialist, then I want to get one, not ask someone else if its okay.  

That sounds about right for me too.  Don't like gate keepers at all... medicare Part B sounds doable.  Is that "$130/month" your total medicare costs?  My SS is only $385/month (Teachers Retirement System took half my SS for "double dipping").

FWIW, I do like my PolyTrauma Doctor and my Psychiatrist, but have gone through 5 or 6 PCPs in the past 2yr.  PCPs don't know how to deal with TBIs and they just take everything personally just to get you out the door...

Back on subject, I don't like HMOs, particularly Humana and Blue Cross.  Both have screwed me over denying past accidents/coverage.

[Buck52]

The only thing unless you have a lot of $$  to see a specialist   then a PCP will need to refer you to him/her b/c specialist likes to be refereed    some require it.

I want it to where I can use the VA at my options  depends on what is wrong with me,  their med's are just as good as anyone else's   its the Appointment times I care about. getting seen in a timely manner and if I so choose  I can use the medicare Advantage plan and go see a Doc that way usually within 2 or 3 days week at the most.

Mike  the cost depends on who you choose to be your health provider ?  the medicare premium you choose depends on what plan you choose  some or cheaper than others but has less benefits, so what ever is your main medical condition at present  then look at that  to make your choice or what you think you may need later on down the road &  if your UN-sure  its best to get with a plan that covers all medical conditions , sure you will pay extra  but its worth peace of mind.

Mike go  to one of the free medicare dinners  seminars  and ask the Agent  questions...that's what I do , so for I been to two free dinners and the last one I have an appointment to go see the 14th April  to tell me more about the different medicare plans and my options who I chose for care providers and what they cover and the cost.

Unless you have kept your employer insurance when you was working  most of did'nt that are on TDIU...then its best to think about getting a medicare plan  other wise the medical care cost will eat you alive.

So Actually other than getting closer to the old dirt bed  turning 65 has its Advantages.

 

Edited March 21, 2017 by Buck52

[john999]

I think all Medicare Advantage policies are HMO type policies.  To me Medicare advantage is for people who can't afford Medicare and some sort of medigap and drug policy. If you are P&T and your spouse has ChampVA she/he must have Medicare A&B after when they turn 65.  I kept my employee insurance from the Feds since I worked for the USPS when I retired.  Even though my wife has ChampVA I keep her on my family policy from the Post Office.  I do this because I just don't trust the VA or our government to not cut insurance benefits in the future.   I probably overpay for medical insurance because just in the last 5 years I had a surgery that cost $100,000 Plus and my wife went to the ER and ran up a $30,000 bill in just three hours.  Our insurance to include Medicare A&B and ChampVA  and NALC Insurance paid our bills entirely.   Can anyone here afford to fork out $130,000 for medical care? 

I went to my dermatologist and had a few spots frozen on my arm and leg.  The doctor wrote this up as surgery.  They do this to get paid.  My brother's employee insurance denied him coverage for his dermatologist doing the same thing.  He has an HMO but not Medicare.  He still works and his employee insurance sucks IMO.  I have advised him to check out his future costs for this insurance when he retires to see how it coordinates with Medicare.   ChampVa coordinates perfectly with Medicare.  The VA does not coordinate with Medicare and they attempt to steal from my private insurance by billing them for service connected treatments. 

I guess what I am saying is get all the medical insurance you can afford.  If you have to cut back on anything don't let it be your medical insurance.  I and my wife have long term care insurance. It costs me plenty, but if I or my wife end up in assisted living or a nursing home I want to choose my own or have my wife choose.  The VA is responsible for my long term care, but they have the option of sending me to their version of a "euthanasia home" or a decent nursing home.  I don't want those MF'ers to let me rot in some understaffed and cheaper home.  This they will do since they only thing they care about is money. 

When I was an employee I had a private disability policy and I had the group plan as well.  I am getting payments from the private disability policy16 years after I applied for total disability from SSDI,  OPM and the VA.   The group plan stopped paying as soon as I got OPM and SSDI.  It was a ripoff.   So I guess what I am saying is that if you do not completely CYA you may regret it in the worst way.  Your dependents may suffer because I foresee that future health care systems are going to face cuts from our masters in congress no matter who is in charge.  Our masters give the orders and we take them.

 

[john999]

Buck

 

                      Yes, getting to 65 has the advantage that you get Medicare before they throw dirt on you.  For those between ages 50-64 who find themselves disabled or unemployable they suck on a very tuff old hooter and it is the hind one as well.  Imagine be 50 years old and not having any medical insurance!  Most of us could not afford to get ill in that case.     I get most of my meds from the VA.  If I have serious medical problems I go to private doctors.  I am SC for CAD due to Agent Orange.  The VA has never sent me to a cardiologist.  My VA PCP is my cardiologist. She is not qualified.    Therefore I have a private cardiologist.  I have private pulmonologist because the VA never would have DX'ed me with OSA even though I complained about poor sleep for years.   The VA never follows up on any of my chronic conditions unless I demand it.  Then they attempt to bill my insurance as they did when they encouraged me to get the aortal aneurism exam. I realize now that this was just a way for the VA to capture some insurance money since I had no indications of having an aneurism.  I thought it would be a good idea to get the exam but did not know they would bill my insurance for it.  I wonder if they would have tried to bill me if I did not have the insurance.  They did try and bill me for treatment of drug abuse even though I was not getting treatment for drug abuse.  So I trust the VA not at all.  Get all the insurance you can afford but see if it coordinates with Medicare.  I wonder if the 7% increase in VA budget will show up in the form of better medical care for us or will disappear down the rat hole into bonuses for VA incompetent employees?

 

[Buck52]

yes John I Totally Agree..my spouse as the ChamP VA  & About 12 years ago she had to have a tripple heart by pass at age 50 and after the heart surgery after 3 days they sent her home...I thought wtf?

they never looked at her or gave rehab or anything  I even had to clean and dress her deep wound , she got an infections about a week after the surgery and took he back to the VA Hospital  the Dr look at me and said you better pay attention   becuse your going to have to do this (clean the wound and dress it)

I told the VA if I had to clean the wound and dress it the VA can give us the necessary bandages and cleaner soulation fluids and everything we need...so they sent all that to us..I said I should send VA a Bill for doing your Dr's work...eh!

We went back home and I clean and dress her wound for 3 or 4 months until the wound closed up  she has private medical insurance now as well as dental from delta insurance she still uses champVA  that is good insuance  it helps with the supplmentals...and she is getting ready to sign up for medicare too...when I sign up.

Edited March 21, 2017 by Buck52