CHAMPVA question.

[56pan]

"The spouse or child of a Veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office." That's from the VA website covering CHAMPVA eligibility requirements.  My disability rating is 80% but my TDIU decision letter states that: "Basic eligibility to Dependents' Educational Assistance based on permanent and total
disability status is established from August 8, 2022." I called my local VA medical center, Salisbury NC, about a year ago and asked them if I was eligible for VA dental care and told the fellow there that my TDIU decision letter stated that I was permanently and totally disabled. I had read that you had to have a 100% disability rating for VA dental care.  He told me that I was eligible since I was considered permanently and totally disabled. So, I'm getting the dental care.  But I cannot find an answer to if my wife is eligible for CHAMPVA with my 80% disability rating but am considered permanently and totally disabled by the VA?  I did all the paperwork for her CHAMPVA last week and submitted it along with my DD214 and TDIU decision letter.  I'm just wondering if anyone here knows the answer to whether my wife is eligible or not?  

[56pan]

Thank you, sir, for that good explanation of the CHAMPVA drug plan.  On the application I sent in last week, it asked if my wife had a prescription drug plan, which she does, Part D medicare and it was shown on her medicare card that I had to scan and attach with the other paperwork. Also, they wanted a scan of her medicare supplemental ins. card. The supplemental has no drug coverage offered however. I figure it will be several months before she gets the CHAMPVA card in the mail.  Once I've got it, would it be best to cancel her medicare part D and attempt to get prescription drug coverage through CHAMPVA?  I would expect a paperwork hassle.  Once that was taken care of, I would just sign her up for meds by mail then?  All her prescription drugs come by mail now anyhow.  Rarely does she have to have something immediate from a drugstore. And damned if this isn't a helpful forum.

 

[broncovet]

I cant speak for your situtation, but for my family, canceling the medicare part B was a no brainer, for the reasons I stated above.  

If your family goes to the ER a lot, and uses few or no "regular" by mail drugs, then you should maybe keep the medicare part D.  The downside of the champva meds by mail program (no deductable, no copay) is that its by mail.  You need to think ahead a couple weeks ahead and order those refills in advance.  It does take planning or you will run out of meds.  

As far as the other Champva, when combined with medicare or medicare advantage, we pay almost nothing out of pocket.  Its as good as it gets.  I used to be in the insurance business, and there is. none better than champva.  My wifes is better than mine.  She can go to almost any doctor or hospital, while I have to go to the VA, regardless of whether or not VA has good departments (such as eyeglasses, hearing aids, dental, prime care, respiratory, urology, etc etc) or not.  More choices in health care is a good thing, and champva has many more choices than VA.  WIth VA, I either like it, or drive to another VA for care.  

[56pan]

There's another thing I'm confused on.  My wife has medicare supplemental insurance which covers anything medicare doesn't pay after she pays the yearly medicare deductible. Does CHAMPVA pay on the same limits for medical bills as medicare?  Would she need to keep the supplemental ins. policy for what CHAMPVA doesn't cover.  The vets advocate at my local VA medical center told me on the phone that CHAMPVA pays on the same "schedules" as medicare. Yeah, I should have asked the guy to explain it further at the time but didn't.

[broncovet]

Maybe this will explain.  Now, you should consult with your own financial advisor as he knows your situation and I dont.  

Medicare, and medicare advantage vary a lot. There are many companies which handle the medicare advantange and I dont know which one(s) you have.  These also vary with your zip code.  

This said, my spouse's champva plus medicare advantage (currently Humana) is more than enough health insurance as it covers pretty much it all, with maybe about 100 per year not paid, such as her (emergency prescriptions) and maybe some other things I cant recall.  

With that, a medicare supplement is not needed.  At least not for us.  Its redundandt and unnecessary insurance.  

If you are confusing the terms "medicare supplement" and medicare advantage, that is quite possible.  

Medicare advantage:  You can voluntarily sign up for a company to administer your medicare.  The medicare advantage plans often have more benefits than straight medicare.  Check with your medicare advisor.  I do not call those toll free numbers, but instead, get a LOCAL medicare advantage company, which knows my market, my zip codes, and which health care plans cover which medical (doctor) groups.  

This is especially true if you want to keep your doctor.  If you sign up for a plan on the phone, your doctor may or may not accept this insurance.  So you would have to change doctors, or pay out of pocket.  They have something called "in network".  This means that doctors and insurance companies co operate and establish "networks" where some fees are reduced.  "Out of network" often means you will pay higher deductables and co pays.  

Medicare supplement:  This means you have medicare "and additional coverage".  For me, medicare supplements are not needed at all.  Your situation may be different.  IDK if your spouse has been diagnosed with kidney disease, cancer or other illnesses.  So I can not opine on your situation.  Again, I have a local medicare advantage company I deal with, who knows my situations and they recommend a medicare advantage plan.  I trust them and generally go with their recommendations.  I dont talk to a medicare advantage company with a toll free number advertised by Joe Namath or anyone else.  

Edited November 20, 2023 by broncovet

[john999]

Yes, if you have ChampVA you don't need a Medicare supplement.  My wife's insurance with regular Medicare is better than mine.  I have insurance via the National Association of Letter Carriers.  Very good insurance.  With Medicare I pay nothing except for drugs.  My wife pays nothing.  I stick with regular Medicare and steer clear of Medicare Advantage since Part C is private insurance and not Medicare.  To me it is a scam to destroy regular Medicare. Part C advertises non stop and is misleading people. Part C can change their benefits any time they like and then you can lump it.  I know lots of people get Part C because they cannot afford part D and the supplement. I am talking about non-100% vets and their wives and kids.

[56pan]

I've got an appt. at the VA med. ctr. in Salisbury, NC in a couple weeks and I'm going to sit with the vets advocate and get the exact story. I was also advised against medicare advantage by an ins. guy we've used for years and I trust. I'd really like to drop the medicare supplemental ins. on my wife once her CHAMPVA is approved.  My situation is this: I need to get all this straightened out as soon as I can.  I have stage 4 pancreatic cancer and am being told I've got about a year.  I will say that the VA in Salisbury, NC has treated me very, very well.  They've agreed to pick up all my chemotherapy bills, meds, doc visits, everything from the cancer center that is treating me.  Which is going to allow me to drop everything I've got with medicare and save us a few bucks every month.  Thanks fellows very much for your time and advice.