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]

John999  this attorney I contacted  that's all they do is malpractice suites,(Federal level )

you give the paralegal the run down and why you think they are wrong and what all they did to you, if my spouse was ever in danger after the surgery  on deaths bed...for something they needed to do but never did, I guess if I had not cleaned her wound and she got a bad infection and was on deaths bed   then we could have filed the suit..its kinda like CUE and they need to catch the Dr's and Nurses PA'S all in a lie and have documentation to back it all up.

you can bet your sweet A** this Dr that told me to pay attention your gonna have to do this..it was not in any of the records  we search and search and found nothing to anything negative he said or the Nurse, they cover them selfs after the fact.

Edited March 21, 2017 by Buck52

[broncovet]

John...

   I agree.  I never understood why my wife gets better care than I do..she can go to VA OR she can use Champva.  I have to use VA care or lump it, no matter how long the VA care takes to get an appointment, no matter how bad the care is.  

Sure, they say, "use Veterans choice"...that is nothing near as good as Champva.  Not even close.  First, to get Veterans choice, you have to make an appointment with your PCP, which is no easy task..and usually takes at least a month.  Then, your PCP refers you to choice, that is, the "choice program" where they are supposed to call you to set up an appointment.  

Then you have to worry about VA actually paying the VEts choice doc bill..you know, they like to loose your information there, too.  Loosing your information is "not just" for your Regional office anymore..your VAMC gets in on the act, too, with Veterans choice.    The "choice" is "will they loose my information" or will I give up waiting and accept the VA's long waiting list.  Its not

good choices.  Yea, sometimes it works ok, but not so well in others.  

[Buck52]

broncovet

Guys like Mike and myself don't know what HMO or PPO's OR Any type O programs

This is one of my Questions to ask the Agent....what is the difference between the two  unless its just the healthcare plans and what and how much they pay?...because I am trying to get a plan that any  healthcare provider will take and do quality health care. and without bringing my pocket book.

 

The VA Sleep Clinic could not get me in for a sleep study  within 90 days and they called and said they were getting me to go to a private Sleep Study using the Choice Program, gave my spouse a # To call and set me up the appointment time..and for her to call them back and let them know when the appointment was...so she did  I went to the sleep study and my spouse called the VA Sleep Clinic and let them know it all has been done, the VA  sleep clinic called the private sleep clinic and got the results ..I never seen a Bill or anything  so I take it the VA Paid the 3.800.00 sleep study private Bill?

Edited March 22, 2017 by Buck52

[armorer]

2 hours ago, broncovet said:

John...

   I agree.  I never understood why my wife gets better care than I do..she can go to VA OR she can use Champva.  I have to use VA care or lump it, no matter how long the VA care takes to get an appointment, no matter how bad the care is.  

Sure, they say, "use Veterans choice"...that is nothing near as good as Champva.  Not even close.  First, to get Veterans choice, you have to make an appointment with your PCP, which is no easy task..and usually takes at least a month.  Then, your PCP refers you to choice, that is, the "choice program" where they are supposed to call you to set up an appointment.  

Then you have to worry about VA actually paying the VEts choice doc bill..you know, they like to loose your information there, too.  Loosing your information is "not just" for your Regional office anymore..your VAMC gets in on the act, too, with Veterans choice.    The "choice" is "will they loose my information" or will I give up waiting and accept the VA's long waiting list.  Its not

good choices.  Yea, sometimes it works ok, but not so well in others.  

And Veteran's choice has it's limits. Do you want an acupuncturist stabbing needles all along your lower spine for $15 per visit? Me neither. Medicare is not a pot of gold by no means, but in comparison, it's 'most' of a workable total 'Western Medicine' care option at a reasonable price.

As well, the time factor could mean life, death, or significant infection time. 'ASAP' Catscan's at my VA hospital is secondary to maxed out flow of hospital patient's with one xray machine. But they won't let you go outside, because there is a 0.00001% chance they can squeeze you in. Seriously, the pt. process flow is a joke with no one who is competent over the pt. flow (usually a maintenance man or an islander technician who does not know English.) But yeah, after about 40 hours of waiting, you may get seen, although your life could be depended on it. 'Procedures' are somehow 'magically' interpreted as 'Policies' due to a lack of English language literacy, making you see a Department head to get reasonable service, if you can find one.

ymmv.

[Jimmer]

Buck 52 The medicare advantage plan has two plans,  a HMO &  PPO.  A HMO (Health Maintenance Organization) requires you to see your primary care physician  (PCP) if you wish to see a specialist.  The Primary care writes a referral to a specialist.  I have a HMO advantage plan.  I can call my Primary care doctor, and get a referral in 24-48 hours., it is automatically sent to the specialist.  I then call the specialist and make an appointment.  IF I see the primary doctor, he will send the referral right from the office, or have his staff contact them right then and there.  A PPO plan is when you see a specialist whomever you want, and make the appointment.  Some people don't like the HMO because of the "gatekeeper" approach, and the specialist have to be doctors in the network, meaning they are contracted by the insurance company, in my case Cigna.  I never had a problem getting a specialist as there are many that are under contract with the insurance companies.  And you can get an appointment  in a few days about a week.  I have been with the HMO advantage plan for a couple of years (to offset the V.A.) and I am satisfied with it.  But some don't like getting a referral from a doctor to see a specialist, and I can understand.

[Buck52]

Jimmer

Thanks for the difference in the HMO...PPO

what is your Advantage plan called? is it plan HMO Advantage  or MAP A...B..C..D...F 

Some plans cost less and some cost more depending on the provider.

I have an appointment with a Medicare Specialist April 14th  and he will go over all the plans and try to find me a good reasonable Medicare plan...that would be beneficial and not over cost me  in dealing and paying for high medical care.

 

I'll certainly look at your plan too,  how much is the HMO Advantage Plan? and is there co=pays and deductible's?

Thanks Buddy