Need Help With ChampVA for my wife.

[Paul Morgan]

My wife is 42.  My wife had solely CHAMPVA.  She got sick with ESRD.  She was on dialysis for several years and the state paid her Medicare Part B.  She miraculously got better and she is no longer on dialysis.  The state ceased paying her Part B.  ChampVA subsequently dropped her ChampVA because you are required to carry Part B if you have Part A.  Otherwise you lose you ChampVA.  Now my wife did not realize she needed to maintain her Part B.  At the time she did not have money to allocate for Part B.  She did not realize she would lose ChampVA.  Anyway, Social Security will not allow her to acquire Part B.  So she cannot get ChampVA back.  This all doesn't make sense to me.   My wife is 42.  She isn't 65.  She had ChampVA in the beginning.  Why would she now not be entitled to ChampVA.  Can she tell Social Security to drop her from Part A and that will make her eligible again for ChampVA?  Something is not right here.  Either they should let her acquire Part B or ChampVA should return her to her original status.  She is in limbo.  She has no insurance but has 20% Kidney function.  What should we do?

[Paul Morgan]

Thanks I will try to have the conversation with them again.  One would think that they could explain this as an option if it were an option.  I appreciate your efforts.

[broncovet]

Dont expect Champva, or medicare to be your "financial planner".  They likely do not have an interest in your welfare.  I had trouble with champva..wifey was talked into adding prescription drug plan to her medicare.  Bad idea.  Very bad.  Why?

Because "if" you have another prescription drug plan, Champva wont do "meds by mail".  (Meds by mail at Champva is at no cost).  However, the prescription plan by medicare, has deductables and copays.  Wifey was on a blood thinner (I forget which one) where our cost was $150 per month.  And the other meds were not free either.  She had "too much" insurance..as I said, champva wont do meds by mail if you have another prescription plan.  Solution:  Drop the prescription plan, save the premium and save on drugs, too.  

So, I figured out, we saved a ton of money by DROPPING our medicare (advantage) prescription drug plan, and use Champva meds by mail.  It saved thousands per year.  

If you want your finances to work well, you cant ignore them and expect it all to work out.  Study them..I do..We pay out very little in medical expenses each year.   You either need to study them yourself, or trust someone who knows the ropes.  

[bobz]

Paul my wife is in ESRF, we were able to keep CHAMPVA until she became eligible for medicare. The problem occured when Medicare dated her eligibility for January 01. We didn't get the cards until June then notified CHAMPVA. Now are having to go back to providers and straighten all the billing out between them. You say she is no longer on dialysis with Medicare you are eligible if you have ESRF so maybe a doctor or providing facility notified them that she is no longer considered end stage so they dropped her. They should have put in writing the reason for dropping her in the notification letter. Like Broncovet says stay far away from Medicare's prescription plan it will cost you a lot of money.

[Berta]

Can you scan and attach the letter that denied her CHAMPVA?

Cover C file #, name, prior to scanning it.

I was granted CHAMPVA due to my husband's 100% P & T SC PTSD.

Medicare Part A and B is required when a CHAMPVA person reaches age 65.

I assume you are both young enough that your wife's CHAMPVA was based on you 100% P & T SC rating....?

I don't get this. If we see the denial maybe we can help more.

 

 

 

[Berta]

I did some research but unfortunately this issue was a BVA denial and then a CAVC denial- based on the same premise:

https://cite.case.law/vet-app/28/112/

"Pursuant to this provision, an individual who satisfies the other requirements for the program and is entitled to hospital insurance benefits under Medicare Part A “is eligible for medical care under [ ] section [1781(d)(1)(A) ] only if the individual is also enrolled in the supplementary medical insurance program under Part B of the medicare program.”38 U.S.C. § 1781(d)(1)(A) (emphasis added). Here, the plain meaning of the word “only” as “solely” or “exclusively” creates a mandatory prerequisite to CHAMPVA eligibility: Even if a claimant satisfies the other eligibility criteria, he or she is eligible for CHAMPVA benefits “only if’ the claimant is also “enrolled” in Medicare Part B."

 

This case is also cited by NVLSP in the VBM.

 

[pwrslm]

Medicare Part B (Medical Insurance)

 

The eligibility rules for Part B depend on whether a person is eligible for premium-free Part A or whether the individual has to pay a premium for Part A coverage.

Individuals who are eligible for premium-free Part A are also eligible for enroll in Part B once they are entitled to Part A.  Enrollment in Part B can only happen at certain times.

Individuals who must pay a premium for Part A must meet the following requirements to enroll in Part B:

• Be age 65 or older;
• Be a U.S. resident; AND
• Be either a U.S. citizen, OR
• Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.

NOTE: Part B is a voluntary program which requires the payment of a monthly premium for all months of coverage.

Original Medicare (Part A and B) Eligibility and Enrollment | CMS



I think the ?? comes down to the above, if you pay a premium for Part A, you may not be eligible for Part B if you are only 42 y/o.