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Carl the Engineer

Question

So, now the promise from the Army I received when I entered is going to be broken again.

First time was, Tricare for Life, being FREE, "FREE HEALTHCARE FOR YOU AND YOUR FAMILY", well that's not correct.  Even if I except paying the monthly fees and the co-pays, because of where I live, I would have to pay everything not covered by Tricare or Medicare, etc.  Last year my wife's care cost $245,000.00.  Tricare told me they can't tell me what is covered and where my wife would go until I register with them.  I can't take that chance.

I have a local (region) Medicare advantage plan that I only pay the monthly fee and a fixed copay of $1200.00.  So, I am not taking Tricare.  Tricare is Humana, which is not "in Network" anywhere around here.

And now, I find out that if I get to 100%, I am entitled to ChampVA, but NO, you don't get ChampVA if you are eligible for Tricare, which we are, so, Humana, again.  

I am able to get all my care from the VA, but I was hoping to get Tricare for Life, and then I could go to a private doc once and a while when I needed help with my claims, but that got dashed.

Is ChampVA also Humana?

Anyone know?

Thanks,

Hamslice

Why would the gov get mixed up and locked into a private company that dose not support ALL Veteran's evenly.  Just a thought.

 

 

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Im at 100 percent, over 65, and wife gets Champva.  We also have Humana as our medicare advantage plan.  Its medicare, administered by Humana.  

No, Champva and Humana are not the same "for us, here" but I can not promise that is the same way in your neck of the woods.  

So far, Champva with Humana medicare supplement is the best insurance we cant buy.  And I have heard that before.  One "peculiar" aspect, follows:  

Wifey previously had Humana WITH prescriptions (part d, I think).  That was terrible.  Her copays on meds were often 150 per month, with ONE drug.  

Through many phone calls, we found out the best way for prescription drugs is to cancel the medicare prescription and go "exclusively" with Meds by mail at Champva.  We did that, no deductable, no copays.  (There may be 50 per year deductable, I cant recall).  

So, no more 150 per month, AND we dont have to pay for the prescription plan premiums.   VA wont allow "meds by mail" UNLESS you "do NOT have a prescption drug plan elsewhere".  Therefore it was way cheaper for us to cancel prescription drug plan, and use champva meds by mail exclusively.  

 

Drawback:  When she needs "meds now", we generally have to pay it all.  But that is not often, and I use "Good Rx" which gives us discounts on prescriptions, when we have to have them NOW, and cant wait for meds by mail.  (usually 1 week to 2 weeks).    Its an app.  

In our situation, it works best, and Im not messing with it.  We pay very little for medical, probably under 100 per year.  

Even better.  Last year around December, we each got a $500 Humana gift card.  (Total 1000).  Its good for "anything medical related", but expired in a month.  We used every cent.  Wife used it for copays for dental work, and we got a six month supply of vitamins, as well as masks, and even shampoo, if I recall.  With the 500 card, our medical annual expenses were "less" than zero.  

She also got one or more 50 dollar walmart cards "for doing certain things" like getting a mama gram, (preventive health care).  

Since I almost never go anywhere but VA I did not get a walmart gift card.  

But, my humana pays for gym membership, but I havent gone since covid.  Will go back when it blows over.  

We called a LOCAL humana agent.  He takes care of us.  He calls us once a year to make sure everything is working.  We dont speak to someone in China, a different agent each time.  We call Allan with medicare/health/presciption questions and are very pleased with the service.  This and I HATE insurance companies, I used to work for one.  Im pretty much "anti" insurance for the most part.  

In our area, Champva is known as "the best available".  True, you can not get TRICARE AND Champva.  They are mutually exclusive to each other.  Since there are not many disabled vets in my area, the docs offices rarely have heard of champva.  But when we say similar to tricare, they get it.  

I have spoken to elderly (over 65) medicare who spend 1000 a month or more on prescriptions.  My best advice:  Stay healthy and stay off prescription meds.  Exercise and eat right.  I think Humana "gets" its cheaper to keep us healthy than try to fix us with meds (drugs).  I do my stairs usually 10 to 15 (flights) of stairs at least 3 times a week.  Preventive medicine beats repair medicine every time.  

Edited by broncovet
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broncovet, thanks for the reply.

I turned sixty last week and now I get my non-regular retirement from the Army and I am eligible for Tricare for Life for me and my family.  The TFL sounds great, but not when I dig into it and also, they won't tell me what they will cover and what they won't.  And they are Humana which is not good around here.  Security Health has almost all the insurance around here and they own almost all the hospitals, too.  So, they  probably have their own racket going on.

My wife has had Primary Progressive Multiple Sclerosis for at least 28 years, and maybe more.  Her condition is pretty much at a stand still, no better, no worse, because of an experimental drug she is on.  The good news is that it has to be administered at a hospital and Medicare pays it all.  $37,000.00, twice a year.  She is also on 12 prescriptions twice a day.

With all that said, I think I will wait until the end of the year before I do anything to rock the boat.  I pay 226 a month, 1200 co-pay a year on medical, and we have the drug program with the different steps for co-pays.  I just looked and we average about 350 a month on drugs.  It might sound like a lot, but when TFL can't tell me what it would cost me to change, it's too much of a gamble.

I read the fine print on one of TFL, Humana East, and they state that we would only have to pay 35% of the bill for out of network, but it then says, we would have to pay all of the difference between what the doc/hosp bills over the going rate.  Well, that could be a bunch after a week stay in intensive care.  Which is my wife's annual average.

I'm currently commenting in another post about suing docs, etc., maybe I should sue the recruiter that promised me free healthcare for me and my family. 

LOL  "looking for representation".

More studying,

Hamslice

 

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