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

[john999]

Buck

          What happened to you and your wife with the heart operation sounds like malpractice to me.  They treated you as a charity case.  The local vet treats dogs and cats better than that.   I had a staff infection in my foot that required being dressed and undressed every day for 8 weeks.  My wife could not have done it.  I could not have done it.  It hurt like hell.  Your wife could have gotten a staff infection just like I did and she might  have died.  Keep that Medicare A&B when you get it and make sure she gets it when she turns 65.  I cannot believe the VA would have sent her home after 3 days with no follow-up and no wound care!  Since she has champVA it should coordinate with Medicare in a good way.  Wound care is so important I would never take myself or my wife to the VA if I had other means.   They are bastards.  If you have no other means you have no choice.  I worked at the VA back in the early 80's.  I remember going to one of the hospital floors and hearing somebody screaming.  I looked into the door where the screams were coming from and there was an old vet and a frustrated looking nurse tying to insert some kind of drain into the old guys chest.  He as screaming his head off, but it was just another day at the funny farm for us medical supply clerks.  It was the only job I could get.

 

 

 

[Buck52]

John999  this was done at the VA Through the CTI program from ChampVA...The run all the test and did the heart surgery, and that was the end of it because about that time  they closed all the speciality clinics in the VA to ChampVa Patients ...no CTI Program at my VAMC...

So they turned her away...I called an attorney that handles mal-practice  cases /Checked with Ms berta  he said it was not enough to file....so we left it alone.

 she has not been able to use the VA Specialty Clinics  since  her heart surgery but can use a PCP but when the PCP Orders anything from the specialty clinics  they turn her away.

she can get her meds by mail via VA

[broncovet]

You can, generally, choose whether your medicare advantage plan is "HMO" or "PPO".  I simply avoid the HMO type as they have the "gatekeeper" (your PCP) whose job it is to keep you out of the specialists office.  
I recommend avoiding HMO's (including medicare advantage plans which are HMO) for that reason, but, of course, that is personal preference.  THis explains it better:

https://www.medmutual.com/For-Individuals-and-Families/Health-Insurance-Education/Compare-Health-Insurance-Plans/HMO-vs-PPO-Insurance.aspx

It also explains you have to go to your PCP to ask for a referral.  In my state, the PPO's cost about the same as the HMO's, and both are offered with medicare advantage plans.   

 

[john999]

Buck

 

                  I am lucky since when my wife had to have abdominal surgery I got her to a local private hospital just in time and we had good insurance via OPM.  What happened was she had a  spot in her gut that was getting ready to start leaking material into her body cavity thus causing a massive infection.  She was not in the hospital that long but it was scary and every time I went to see her which was multiple times a day she would be thrashing around in pain.  I would start hollering and get her a shot of morphine.  I got her to the local hospital and they had her on the operating table within an hour.

                 When I got the staff infection in my foot it was due to a podiatrist's malpractice.  I hired a lawyer, but they dropped the case because no doctor would come out and say that the podiatrist was

responsible for the staff infection.  He was responsible, of course, but the doctors won't say it because that would put all those jerks on the hook.  I found out that this same podiatrist had been reported and

punished by the medical board in Florida.  Yet the guy was still able to practice in Florida.  He would not even admit that his procedure caused the infection or that I had an infection.  In another week I would

lost my foot or my life if the infection had of gotten into my blood stream.  People think it is easy to sue doctors but it is not easy.   They are well protected by the AMA and their friends in state legislatures. 

Money talks and doctors have money to donate to greedy politicians.  There is the usual quid pro quo that goes unstated.  You help me and I will help you.   

 

               My wife only goes to the doctor when she has an emergency.  I have told her time and again we will both be sorry that she does not take better care of herself but she is afraid of doctors 

except when she is in severe pain and I have to haul her ass to the ER.  She has high blood and it is untreated because she won't go to a doctor and do what the doctor says.  I have to keep the

insurance on her because when she has a stroke it will break us without maximum insurance coverage.            

                

 

                

            

[broncovet]

Champva is the BEST insurance I never had!!!!  (My wife gets Champva, but I do not.)  

[john999]

Bronco

            I would trade my VA care for ChampVA in about sixty seconds.   I have used the Choice Program and they send me to these half ass doctors and clinics that are in the program.

My dentist has tried to sign up with the VA and they just won't process the paperwork so he gave up and I won't use a VA dentist.  They pulled the wrong tooth and would not pay for

an implant to replace it.  Some people love the VA.  These are mostly vets who are broke or don't have any other insurance.  If you are destitute VA care seems pretty good.  My VAMC

is really an old folks home in disguise.  Most patients I see are old and in wheelchairs or about half dead.  I see few young guys. Most of the Vietnam Era vets with the standard VA cane

or knee braces etc.  I mean these guys are not healthy.  I am a 67 year old with 87 year old body and I look good compared to most I see.  Good info about the PPO's for Medicare Advantage. Why

are we treated like trash by the VA?  This is a rhetorical question since we all know the answer which is that we are lower than whale shit to our beloved government.   These people have improved

my ability to hate.