Jump to content

  • veteranscrisisline-badge-chat-1.gif

  • Advertisemnt

  • Trouble Remembering? This helped me.

    I have memory problems and as some of you may know I highly recommend Evernote and have for years. Though I've found that writing helps me remember more. I ran across Tom's videos on youtube, I'm a bit geeky and I also use an IPad so if you take notes on your IPad or you are thinking of going paperless check it out. I'm really happy with it, I use it with a program called Noteshelf 2.

    Click here to purchase your digital journal. HadIt.com receives a commission on each purchase.

  • 14 Questions about VA Disability Compensation Benefits Claims


    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 ...
    Continue Reading
  • Ads

  • Most Common VA Disabilities Claimed for Compensation:   


  • Advertisemnt

  • VA Watchdog

  • Advertisemnt

  • Ads

  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    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

  • 0
Sign in to follow this  
Bruce Fox

Still Need Medicare Coverage?


I currently am covered under Medicare Part 1, 2 & 3 because I was told that the VA would not reimburse for ER visits and a lot of the things that a local hospital visit ER would entail.

I just read an article saying that they now have to pay for ALL non-VA emergency care.  ( https://www.nbcnews.com/news/veterans/court-rules-va-must-pay-veterans-emergency-room-care-decision-n1052131?fbclid=IwAR39i1ses23bqJuV3prHoeEi2Xi4Pa_xKmWkAnx2OmlVAw4DWiXnuFb0BrE ).

Do I still need to have Medicare insurance???   I don't want to pay an extra $135 per month I don't have to!

Share this post

Link to post
Share on other sites

Recommended Posts

  • 0

Excellent question, and one I went through a few years ago.  

I can not decide for YOU, but here was my reasoning.

If you are satisfied with your VA care AND are certain you will be satisfied in the future, then you can skip Medicare Part B (That is the part that is 135 per month..Part A is at no cost).  

However, if you feel that all or some of your VA care is substandard, and that you may want medical care outside of the VA (now or in the future) then pay the 135 per month.  

If you opt out now for medicare part b, then a couple years later, opt back in, you can do so, but you will be penalized (pay more than 135 per month, and its a big penalty, too)

Here is what I did.  I was disabled and became eligible for medicare before I was 65 because of disabilities.  At that time, I opted out of medicare.  

However, when I became 65, I also became eligble for medicare AGAIN.  This time, I opted "into" medicare part b with no penalty.    I felt later I did not want to be "trapped" into VA care, and it was worth it for me to pay the 135 per month to be able to get private care when I wanted it.  

Share this post

Link to post
Share on other sites
  • 0

Its really a personal decision to keep Medicare or not.  I have three choices for medical care and I like to be able to pick and choose.

For me I have Tricare ( military insurance) since I am a retiree,  in my case if I want to use Tricare I have to pay for Medicare by Law. 

I can use any Military Hospital,  and I have been admitted twice this year once into  Darnell Medical Center,  and once into Brook Army Medical Center.  In the first instance, the military doctor literally saved my life. In the second instance, a military doctor performed surgery that no one else  wanted to do because of my numerous medical issues.  So, my first choice for care is the Military Medical system, its the best in the world always has been always will be.  My second choice  for SERIOUS medical issues,  is a private medical facility,  this would only happen if the military could not treat me in a given situation. If this happens, ( and it has a few times)  I don't pay a penny out of pocket. Medicare pays 80% , Tricare pays 20%. 

My last choice is to use VA Medical care.  I have found because of the VA rules that I must at least see a primary doctor at the VA every six months. This is because of my medical issues and the need for prosthetic items, like my AFO, wheelchair issue and repair and other items  the VA will not give me if I do not get medical care from the VA.  In  a few instances, I have opted to use Medicare and Tricare to pay for medical devices like my portable oxygen concentrator , or my INS blood testing equipment. This is because even though I am 100% for my lungs the va will only pay for oxygen tanks not a portable concentrator, and my INS levels for blood clotting is monitored by a military doctor, so again its a personal choice. 

 I don't trust the VA to provide quality medical care, sorry but they see  too many veterans in one day and don't spend enough time with the veteran when they do treat you. Also,  the VA hires too many foreign born doctors, some of which you can barely understand because of accents and other issues.   I also don't like to use private facilities either but only because I think they just charge too much for medical care, like $10 for an aspirin.. ( I saw this first hand when I worked for a year as a computer specialist in the Cape Valley Medical Center, in Fayetteville NC. )  

Having three choices insures that no matter what  I can get medical care almost anywhere at any time, and it never cost me anything out of pocket.  If I were to stop paying for Medicare, I would not only lose Medicare but tricare as well.

I've had Medicare since I was 45... in my situation,  if I had refused to pay for part B,  I would not have been able to keep Tricare and would only get Emergency care at a Military hospital, thus limiting my options to VA care only.   In fact,  I remember specifically in 1999, I was told that I would pay a penalty if I refused Medicare at 45 and  tried to get Medicare at a later date regardless of when I decided to opt in.... I wonder about Broncovet statement saying he didn't have to pay a penalty when he turned 65 after refusing Medicare part B at a younger age. 

You have to decide based on your situation.. I personally think its a good deal and smart to have more than one option.

Share this post

Link to post
Share on other sites
  • 0

IMO, if you are not at least 50% rated combined, I wouldn't drop it. At the 50% marker the veteran doesn't have to pay any co-pays for VA hospital stays, drugs etc. Less than 50% and you have to pay co-pay for some hospital stays, non S-C prescriptions, etc. Anyone who thinks medical care in the US isn't dynamic and will have many changes in the near future is living under a rock. Medicare and Medicaid costs are skyrocketing, and insurance companies are making people pick up more and more cost, while dropping coverages and raising premiums. Legislators are trying to add more and more Free stuff to buy more votes. The VA is cutting back on the number of medical staff, and there are less veterans to participate in the VA Health System every year. When Vietnam veterans pass away, they will be closing many VA clinics and hospitals. If they close the one you use, are you able to travel  to the next one you have to go to? It just is too dynamic to think this is a good option. Again, IMO

Share this post

Link to post
Share on other sites
  • 0

As it is well stated it is a personal decision.  I also have Tricare being medically retired and have to pay for Medicare.  If I did not have to I still would, GBArmy gives a fine reason but I believe there is another and that is that at some time in the future you may come to a place where you want to be served on the private market instead of the VA.  My situation changed when I had a bad neurologist.  At this time I stopped going to VA neurologists.  No Medicare and you do not have this option.

Share this post

Link to post
Share on other sites
  • 0

The four posters before me all have good points, but Broncovet is dead on about a reason most people don't think about concerning Part B.

If you opt out, the cost to opt back in is ridiculously huge.

That 135 now is peanuts compared to what you might have to pay if your VA care becomes harder to get to, or limited.

Bronco is right. Our benefits can change at any time. Political will is a joke when it comes to helping vets, and I mean from the Oval Office to the janitor at your local VAMC and everyone in between.


  • Like 1

Share this post

Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Answer this question...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Sign in to follow this  

  • Ads

  • Our picks

    • Peggy toll free 1000 last week, told me that, my claim or case BVA Granted is at the RO waiting on someone to sign off ,She said your in step 5 going into step 6 . That's good, right.?
      • 6 replies
    • I took a look at your documents and am trying to interpret what happened. A summary of what happened would have helped, but I hope I am interpreting your intentions correctly:

      2003 asthma denied because they said you didn't have 'chronic' asthma diagnosis

      2018 Asthma/COPD granted 30% effective Feb 2015 based on FEV-1 of 60% and inhalational anti-inflamatory medication.

      "...granted SC for your asthma with COPD w/dypsnea because your STRs show you were diagnosed with asthma during your military service in 1995.

      First, check the date of your 2018 award letter. If it is WITHIN one year, file a notice of disagreement about the effective date. 

      If it is AFTER one year, that means your claim has became final. If you would like to try to get an earlier effective date, then CUE or new and material evidence are possible avenues. 


      I assume your 2003 denial was due to not finding "chronic" or continued symptoms noted per 38 CFR 3.303(b). In 2013, the Federal Circuit court (Walker v. Shinseki) changed they way they use the term "chronic" and requires the VA to use 3.303(a) for anything not listed under 3.307 and 3.309. You probably had a nexus and benefit of the doubt on your side when you won SC.

      It might be possible for you to CUE the effective date back to 2003 or earlier. You'll need to familiarize yourself with the restrictions of CUE. It has to be based on the evidence in the record and laws in effect at the time the decision was made. Avoid trying to argue on how they weighed a decision, but instead focus on the evidence/laws to prove they were not followed or the evidence was never considered. It's an uphill fight. I would start by recommending you look carefully at your service treatment records and locate every instance where you reported breathing issues, asthma diagnosis, or respiratory treatment (albuterol, steroids, etc...). CUE is not easy and it helps to do your homework before you file.

      Another option would be to file for an increased rating, but to do that you would need to meet the criteria for 60%. If you don't meet criteria for a 60% rating, just ensure you still meet the criteria for 30% (using daily inhaled steroid inhalers is adequate) because they are likely to deny your request for increase. You could attempt to request an earlier effective date that way.


      Does this help?
    • Thanks for that. So do you have a specific answer or experience with it bouncing between the two?
    • Tinnitus comes in two forms: subjective and objective. In subjective tinnitus, only the sufferer will hear the ringing in their own ears. In objective tinnitus, the sound can be heard by a doctor who is examining the ear canals. Objective tinnitus is extremely rare, while subjective tinnitus is by far the most common form of the disorder.

      The sounds of tinnitus may vary with the person experiencing it. Some will hear a ringing, while others will hear a buzzing. At times people may hear a chirping or whistling sound. These sounds may be constant or intermittent. They may also vary in volume and are generally more obtrusive when the sufferer is in a quiet environment. Many tinnitus sufferers find their symptoms are at their worst when they’re trying to fall asleep.

        • Like
    • Precedent Setting CAVC cases cited in the M21-1
      A couple months back before I received my decision I started preparing for the appeal I knew I would be filing.  That is how little faith I had in the VA caring about we the veteran. 

      One of the things I did is I went through the entire M21-1 and documented every CAVC precedent case that the VA cited. I did this because I wanted to see what the rater was seeing.  I could not understand for the life of me why so many obviously bad decisions were being handed down.  I think the bottom line is that the wrong type of people are hired as raters.  I think raters should have some kind of legal background.  They do not need to be lawyers but I think paralegals would be a good idea.

      There have been more than 3500 precedent setting decisions from the CAVC since 1989.  Now we need to concede that all of them are not favorable to the veteran but I have learned that in a lot of cases even though the veteran lost a case it some rules were established that assisted other veterans.

      The document I created has about 200 or so decisions cited in the M21-1.   Considering the fact that there are more than 3500 precedent cases out there I think it is safe to assume the VA purposely left out decisions that would make it almost impossible to deny veteran claims.  Case in point. I know of 14 precedent setting decisions that state the VA cannot ignore or give no weight to outside doctors without providing valid medical reasons as to why.  Most of these decision are not cited by the M21.

      It is important that we do our due diligence to make sure we do not get screwed.  I think the M21-1 is incomplete because there is too much information we veterans are finding on our own to get the benefits we deserve

      M21-1 Precedent setting decisions .docx
      • 5 replies
  • Ads

  • Popular Contributors

  • Ad

  • Latest News
  • Create New...

Important Information

{terms] and Guidelines