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]

Roger that armorer!!

[Jimmer]

Horizontal Mike & Buck 52:  You might want to look at a Medicare Advantage Plan.  I feel it is superior to the traditional medicare plan, as it covers more, with less out of pocket costs.  The big insurance companies have it, Cigna, Blue Cross -Blue Shield, Aetna, Humana, United health Care.  I went to one of those seminars (free lunch yeah!) and I was really impressed with the Advantage plan (I went with Cigna).  I am sure your insurance will bring it up, but in case he doesn't ask him about the Medicare Advantage Plan.  I feel it is a really good deal

[Gastone]

Mike, do a read on VA requirements for Non-VMC Emergency Care. Pretty clear, the Vet has some hoops to jump through but nothing crazy.

Really just need you or someone to notify your VMC Emergency Dept Honcho by phone of your admission to the Non-VA ER (Get the Names of the Dr).Once you're stabilized, the VMC will arrange ambulance Transfer to the closest VMC or authorize your admission to the Non-VA Hospital for post-ER Care.

Big mistake many Sr vets make, giving the non-VA ER their Medicare card. Don't mention anything about your Medicare coverage, if you don't have the B Supplemental.

The Hospital will jump at the chance of billing Medicare, it pays faster than the VA. If the Vet doesn't have a part B supplement that covers the 20% copay, he could be looking at BIG $$$ for a Co-pay that the VA won't automatically cover.

I've had AARP's United Health Part B supplemental for about 4 years now. Full Boat coverage with no Deductibles or Copays cost about $160 per mos.  I still use my VMC for everything but if it comes to a Life or Death procedure, I think I'll stick with the Non-VA Specialists.

Semper Fi

[Buck52]

Jimmer

I been leaning toward the Medicare Advantage Plan(covers plan A & B & D  but my only concern is what about the fact that you can't use or be sold a Medigap policy.

However being a Veteran has its advantages too  we can get our scripts at VA, So this is why I am talking to the Medicare Agent  (from the free dinner)  I have a appointment with him April 14th and he will go over all the plans and how they work what they cover  and then its what I  think is best for my coverage & what I am willing or afford to pay, also my spouse is getting Medicare too  so were both going to this Appointment...its all just to confusing and makes one tend to be undecided as what plan to choose.

As I understand it  because you have the Medicare Advantage Plan, the Medigap policy would no longer provide benefits that supplement Medicare .....unless your able to afford a Medigap Policy too!

Sometimes if were not careful we end up paying for things we don't really need  like get to much coverage that you would never need to use  but this is our healthcare and we never know what the future brings.

I Wish President Trump  would just let all senior citizens 65 and older  go to any health care provider and get seen and taken care of no matter what medical condition  at no cost  and get any scrips for free....then all would be good for all us old farts. eh!

Edited March 18, 2017 by Buck52

[Jimmer]

Quote

 

Hi Buck 52, With the Advantage Plan, you don't need a medigap policy.  Instead of paying 20% like Medical has, you pay a fixed cost.  For example, I went to a board certified Pulmonologist for a DBQ, and my cost was $30.  In fact to see any and all board certified specialists is at  $30.  You know your costs upfront.  The cost for the Advantage Plan is what they deduct from Social Security for your Part B amount.  Instead of it going to medicare, it goes one of the companies that you select.  I am probably not doing a good job explaining to you, so your insurance guy can go into detail much better.  I feel you get better coverage, and play a lot loss out of pocket expense with an Advantage plan.   I totally agree with your last statement Buck 52, it would be great for us seniors (old farts)

[Buck52]

Yes I understand what you mean, I want to be able to use the VA and the Advantage Medicare Plan...so depending on what condition arises   then I have a Choice & no go broke paying for medical cost.

  Like Gastone mention  ''when it comes to a life & death procedure  its better to have a good Insurance plan that covers both cost hospital stays as well and prescription meds.

if worse comes to sheve we all still have VA!