Ssdi Medicare part B question

[silverdollar22]

Question, I’m 100% P&T and draw SSDI. I recently received my Medicare pamphlet and card with instructions on choosing the part B option. My question is being 100%P&T do I really need part B of Medicare? I figured no but, I wanted to ask the Experts! Thanks, Eric 

[broncovet]

I have an opinion on this.  "If" you are sure you are happy with medical care at VA, you can probably get by without it.  

However, if your VA does not offer all types of care, then you should probably spend the 140 bucks a month.  Now, here is how I did it.  

I first became eligible when I got 100 percent and I was about age 60.  I declined part B.  Later, when I reached 65, I decided that was a bad idea, because my VA MC has substandard care in some areas.  

So, I opted in at my age 65.  

There is a penalty if you dont opt in then opt in later.  However, there is no penalty if you opt in at age 65, even tho I was eligible at 60.  So, I got by saving the 140 bucks a month for 5 years.  

It is somewhat redundandt coverage, "provided that" you are happy will all your VAMC services.  

The medicare advantage plan (recommended) is better and its the same price (140 per month, deducted from social security).  For example, my Humana plan has senior sneakers, where I can get a health club membership at any participitating health club (no cost), such as La Fitness or Planet Fitness.  

 

[silverdollar22]

First of all thanks broncovet for the reply. My va here in Augusta is probably above average as far as the va is concerned so I’m ok with going there except for the knife! All 10 of my medications are covered and the next step is surgery and I’ll pass on that for now! I’m 58 and I have until November to decide. I just wanted to here it from you guys and gals because of the plethora of information found here from people who know what they’re talking about! Thanks 

[GBArmy]

I think no pat answer is going to fit for everyone. That said I do the same as Bronc. I use my VAMC for almost all my medical requirements. It has worked out well for me. My eye doc is the lone exception. But not al VA MC are the same, staffed the same, has the same specialists and medical care, etc., etc. Another factor is how close are you to your VA; will there be a transportation issue when you no longer can drive.It really is going to depend upon your individual health and what the future holds for you. In terms of dollars, going with the VA with no co-pays or deductibles is cheaper. Ask around; ask your family if that is feasible. Your decision to drop Medicare is not reversible.

[broncovet]

According to this, if you have tricare/champva, then part B is mandantory.  However, if you have VA, they say you "should" go for part B.  https://www.cms.gov/Outreach-and-Education/Find-Your-Provider-Type/Employers-and-Unions/FS3-Enroll-in-Part-A-and-B.pdf

The safest way is to opt in to part b, pay the 140 bucks a month, and cancel it if you see its unnecessary, "rather than" the penalty.  But, at your age 58, you will have an opportunity to enroll in part B WITHOUT penalty at your age 65.  BUT, I can not promise this hasnt changed since I did just that, nor can I promise that it wont change before your age 65.    I see this as a loophole to the late enrollment penalty.  

[broncovet]

Im in part B now (opted out before 65, then opted in at 65), but I use the Medicare Advantage plan.  

I think I can explain it like this.  

If you have part b, you can INSTEAD of the government ran medicare program, opt into a plan administered by an insurance company instead.  

In other words you can go with medicare, or Medicare advantage plan, either one.  

I have the medicare advantage plan, and I do think there are advantages. 

1.  Medicare advantage is more widely accepted.  Frankly doctors dont want to deal with medicare.  Its too complicated, they make them take less than they want for services, etc.  

2.  Medicare advantage has more coverage than medicare.  My humana plan offers Senior Sneakers, which is a membership to one of the health clubs that participate, such as Planet Fitness or La Fitness.  (There are others, those are just the ones I know about. 

     I have a great agent at Humana, he calls me once a year, and/or when I need him.  He knows medicare/medicare advantage, stays on top of it, and also he knows how to get stuff done.  I have been with the same agent 3 years.  He has "had my back" more than once.  My wife has the same agent.

     Now, I really have not used Humana for 3 years.  Paid premums but did not use it.  However, humana sent me about 4 boxes of frozen meals.  There were about 20 meals per box.  I liked most of them, you pop them in the microwave.  I also get the health club membership and enjoy that. 

     However, these things are not worth 140 per month.  I keep it for one reason and one reason only.  If I have a catastrophic illness, such as cancer, and my VAMC has a bad plan, or Cleveland Clinic, for example has a new treatment VA doesnt do in my VAMC, then I travel to Cleveland and get the treatment without draining my kids inheritance.  

     

[silverdollar22]

Thanks for the great information to chew on! I have another question that you might know the answer to. If I have the VA and I opt for the Medicare part A not B, I get into a car accident out of town and get taken to the nearest emergency room (Hospital), the VA will pay for it at least until I get stabilized right? If I have both Medicare and VA will they fight over who will pay and in the meantime I get Jammed with the bill? Please correct me if I’m wrong!

[JR Reihs]

You are going to get Jammed for the bill. Part A is automatic and is for long term care as far as I am aware, part B is for direct medical care. IMO, that 140 per month is not worth the risk these days, anything can happen in a second, and although you might be ok with the VA, they may not have the means to get you through what life can throw at you and the bill can be steep and 140 per month is very cheap piece of mind.

Your life, your money, your call.

[broncovet]

Not necessarily.  Va "should" pay for it, but there are rules, just like everything else VA:

https://www.va.gov/COMMUNITYCARE/programs/veterans/Urgent_Care.asp

Worse, even when VA does owe the money they are often slow (or never) with it!

As you can see, from this article, VA, like always, tries to weasel out of it, even when they owe it!

https://www.nbcnews.com/news/veterans/court-rules-va-must-pay-veterans-emergency-room-care-decision-n1052131