Won claim!. Insurance and SS questions

[nancygail]

Hello!

Not been on for a while but we just received notice my husband won his claim. The VA called and  scheduled  "meeting"  with him next month to go over the  decision. I've been searching the forum but what I've found is older so I'm unsure if its accurate so I hope I can get some clarity here. I have several questions but I'll start with these.  Below is a screenshot of his proof letter. 70% for combined eval and 100% for unemployability. 

 

HEALTH CARE

1. As his wife will I get insurance?
2. Will there be a cost? 
3. Will his health care change or does he still have to go to the VA hospital as always. 

SOCIAL SECURITY

He can get SS retirement this year. Does that impact anything?

 

Thanks so much!

Nancy Ü

 

 

 

 

[nancygail]

23 hours ago, Berta said:

CHAMPVA is wonderful- I am glad you have it-

I have a $50 annual co pay for my meds, but if I choose to have the VA fill my Prescription  (it is called Meds by Mail) I would have no PX co pay.

I only take  one low dose statin med twice a week so I prefer the Co pay-and can avoid dealing with the local VAMC.

However my shingles shot cost 240 and I only paid 59, under CHAMPVA and also the boosters shots had a pharmacy fee, and also I think my tetanus shot did too.

Other than that between Medicare A & B, and CHAMPVA I have had plenty of tsts etc etc and never had a bill.

 

I sure understand not having to deal with the local VAMC. Its been a nightmare for my husband. It appears he has to stick with the VA though from what they told him. Which means driving 90 minutes to the closest hospital and watiing all day in the waiting room. Not a good system.   I'm still not quite sure how CHAMPVA works  along with my Medicare... If Medicare is my primary insurance. 

Thanks Berta for the extra info!

Nancy

 

 

 

 

 

 

[nancygail]

23 hours ago, GBArmy said:

NancyGail Don't discount the work issue; He is TDIU; about $3100 a month BECAUSE he is being paid for not being able to work. If he earns over the max, they will find out and reduce his ratings. They are tied into SS and IRS so understand what the risks are. Maybe he could do some "volunteer" gigs that don't pay but would be important to him?

The sad part is we've struggled for so long to just survive so when he finally had three shows come up a few months back, despite not being well, we desperately needed the money to make bills. The shows were not till later this but but he got a deposit for each and we paid our bills for 3 months.  However, since he was just approved for the TDIU he now has to cancel and return the deposits which kinda sucks.

Despite being sporadic and never enough, music has been his only income for years, though as he got worse he could do it less and less. Still, even two or three shows a year kept us afloat for a few months. I'm so sad he can't do the thing he loves, at least at that level anymore. He can of course sing and play anytime but this is a guy who sold out Red Rocks twice. He does big shows when he does get them.  I guess it would be different if he was 100% through the VA only. But he had to do TDIU as we were going to lose the house and that was faster.   

But still glad for the overall win. Ü 

Edited February 28, 2020 by nancygail

[nancygail]

23 hours ago, broncovet said:

Yes, its the VA's goal to keep Veterans confused.  They do it well.  

Champva is the best insurance you can get.  I recommend you do NOT get medicare prescription coverage.  Why?  Because Champva will do "meds by mail" but only if you do not have other (prescription) insurance.  No copays or deductables for meds by mail.  This is always a better deal than paying copays or deductables.  Champva is more widely accepted than medicare.  Only drawback is people confuse Tricare with Champva.  Tricare and Champva are similar but are mutually exclusive of each other.  Tricare is for retirees of the military, Champva is for disabled Vets.  

I always cringe when I hear "he was told"....  TDIU keeps track of annual income, not monthly.  If he earns less than the poverty level, then he does not have "substantial" gainfull employment, using VA's defination.  If his earings are less than 12,000 per year, you should be ok.  But, use this to be more precise, since I dont know how many dependents you have.  

https://militarybenefits.info/veterans-pension-rate-table/

Yes, I know the article which says to "keep going" even if you are 100 percent.  While I do agree it has some validity, (It was done by Chris Attig, attorney), its not for everyone.  Im tired of dealing with VA and want to get on with my life after dealing with Va for 17 years, so Im not applying for any new benefits unless stuff changes. (Im 100 percent plus SMC S.)  It makes zero sense to me to apply for more benefits when it wont change my benefit amount.  In other words, if I applied and got arthritis of the knee for an additonal 50 percent, it changes my compensation zero, and Im not going to do it, even tho I broke my leg in service and have a total knee replacement.  

EXCEPTION:  You need to understand DIC (widows benefits).  You should get DIC when the Veteran dies "provided that" he dies either from:

1.  Any service connected condition.  OR

2.  He dies for any reason AFTER he has been service connected 100 percent for 10 years.  

     The DIC is important to me, to take care of my wife, but I have been 100 percent for over 10 years, so my cause of death wont matter.  She should get about 1500 per month when I die with DIC...if she knows to apply.  

I so appreciate all that info. Yeah, we've been told different things by almost everyone we talk too. They said if he makes over 1k in any given month it will hurt him. Its only him end myself. I'll let him know this info. He might have been able to keep the three gigs he had on the books. He got deposits weeks ago for shows later in the year. That was the only way we could pay any bills was to use those deposits, though he's not really well enough to do them easily. We needed to live. According to what he was told he'll have to cancel and return the deposits which sucks, as each one was over 1k in a single month. Last year we only made 12k barely. I have no idea how we lived but we did. 

Thanks so much!

Nancy

  

[nancygail]

23 hours ago, broncovet said:

......

Yes, I know the article which says to "keep going" even if you are 100 percent.  While I do agree it has some validity, (It was done by Chris Attig, attorney), its not for everyone.  Im tired of dealing with VA and want to get on with my life after dealing with Va for 17 years, so Im not applying for any new benefits unless stuff changes. (Im 100 percent plus SMC S.)  It makes zero sense to me to apply for more benefits when it wont change my benefit amount.  In other words, if I applied and got arthritis of the knee for an additonal 50 percent, it changes my compensation zero, and Im not going to do it, even tho I broke my leg in service and have a total knee replacement. .. 

 

We were going to try and get him 100% disabled through the VA only and not TDIU as then he could do shows without worry from what we learned, though they said that could take up to 3 years. 

[Berta]

to add to the CHAMPVA questions:

https://www.va.gov/health-care/family-caregiver-benefits/champva/

Lots of info there and also a PDF of the large annual CHAMPVA pamphlet - it usually comes to my mail box around this time of year-I had one problem with a pharmacy issue year ago -and called the  CHAMPVA number in the handbook and within 10 minutes that problem was resolved.Champva called the Pharmacist, and he then called me to tell me they had a refund awaiting me.He had overcharged me, saying the med (maybe an antibiotic ?)was not approved by CHAMPVA, but he did not even  try to run it through CHAMPVA. I pulled out my CHAMPVA pamphlet  as soon as I got home, as the med  is listed right in the pamphlet  and  it is CHAMPVA approved.

Also we have interviewed Glenn Johnson of CHAMPVA many times in the radio shows we have done- those shows are available under a search here and his VA contact inf is in them for anyone with a CHAMPVA issue.

[GBArmy]

Nancygail One thing to keep in mind that sometimes TDIU gets converted eventually to P&T status. I don't recall how old your husband is, but if he continues with treatments and sessions he will also have periodic re-evals. Once he has reached late 50's and assuming it he has been rated several years, when he goes for a re-eval, he can ask the examiner that if he agrees he hasn't gotten better, could he be put in for P&T. So, if he kept his feet wet, so to speak, if he did get the P&T, he could maybe do more (paying) gigs. Just something to consider long range. The very best to you both.