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Medicare, medicare advantage, and champva. Should you go for it?

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broncovet

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While my advice on medicare/medicare advantage "depends on where you live", I can only mention how it happens here, where I live.  Its probably different in your area.  

In about 2009, when I first got my 100 percent, I was sent a letter by social security, basically stating they would enroll me automatically in medicare Part B, and deduct (what is currently about $174 per month) from my social security for Medicare Part B.  

It was also explained, that if I did chose to decline the coverage, it would cost me a penalty to try to get it later.  

Well, I reasoned if I needed a doc, I could just go to VA, so I declined coverage.  

However, when I turned 65 a few years later, I changed my mind.  And, I found out there was no penalty, because I enrolled at age 65 OR disabled.  Either one, has no penalty.  That could have changed also, check current regulations.  

I decided that "if" I got a terrible disease (cancer, or some other bad one) that my VAMC "is not the best".  Instead I would like to be able to go to, say, Cleveland Clinic, where they have state of the art technology on cancer and lots of other stuff.  

If this happened, well, it could well mean financial ruin for my family.   Cancer or some other bad disease can cost a million dollars or more to treat.  I thought my Part B was a "good bet" insurance wise.  A million dollars of insurance for around $140 or so per month back then.  

Im smarter now.  I contacted a local "medicare advantage company".  Last year, I got $50 "added back" to my social security part B.   This year, its increased to "$150 per month back" to social security.  Thats right.  I pay $174 for medicare out of my social security check, and get $150 of that back, so my net is $24 per month.  Frankly, I have no idea how they can pay back 150 out of a 174 premium per month..but, I will let insurance companies worry about their bottom line and I will take care of my families bottom line.  

Of course, my wife has Champva and medicare part B also.  That is, a medicare advantage plan, I think ours is by Anthem, but there are other good ones also.  

My wife decided to also get Medicare part D (prescription drug coverage).  Now, looking back on it, Part d was a mistake.  

Here is why.  

Champ VA has meds by mail.  They mail you prescriptions, no deductable no copay.  Just mail em to you.  BUT ONLY IF YOU DO NOT HAVE OTHER PRESCRIPTION DRUG COVERAGE.  

If you have other prescritpion drug coverage your spouse is not eligible for meds by mail at champva.  

Otherwise, if you just do prescriptions you have a copay and deductable.  Its hard to beat meds by mail no copay no deductable.  

Well, my wife needed a blood thinner.  I dont recall the name.  It was $180 per month for her share!  With insurance.  It took a while to figure it all out, but we wound up cancelling part D, and ordering meds by mail at champva, at zero dollars per month.  And, my wife has about 8 prescriptions.  I dont know what they all are, but I knew I did not want to spend 1000 per month on drugs and pay for medicare part d.  It was an easy choice to cancel medicare part d prescription drug coverage and simply order her meds by mail at champva.  

Sometimes "more insurance" is not better.  And that is true with us, with part D.  It may be different for you/your spouse, but at least look into just ordering meds by mail at champva. 

Occassionally, my wife needs "emergency" meds, that cant be delivered by mail, she needs them now.  So far, this has cost me under about $50 per year.  Its. way less than medicare part D.  I just pay them, when she needs emergency meds, but I do use those "drug app coupons" that most pharmacies accept which does save money.  

My advice is to consider your medicare advantage choices thoughtfully..ask what is important to you.  For my wife, it was important to her to keep her doctor.  That means her doctor needs to be "in network" because with that medicare advantage it saves on copays/deductables if your doctor is "in network" with the insurance company.  So consider this before choosing a medicare advantage plan.  

My social security will go up next month (Jan 1. 2024) $90 plus 3.2% because I was getting 50 dollars added back to my social security and now its $150 back..it means I get a 100 raise plus 3.2 percent on social securty.  (Medicare part b went up this year from about 164 to 174, so I have to pay 10 dollars more, thus I get 90 back instead of 100 back).  

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In addition to full VA health care coverage I have for many years been on original Medicare with a Supplemental medigap policy from AARP/United Health Care.

Every year I look at the Medicare Advantage Plans for my area in order to save money with cheap monthly premiums or no premiums.  Unfortunately the Medicare Advantage plans have many restrictions for my needs since i travel to other states a great deal and have heart disease, GERD, Sleep Apnea, etc.

For example the Renown hospital system in Reno has their Senior Care Plus Medicare Advantage Plan that of course restricts you to doctors and medical facilities only in Northern Nevada/Reno area that is in their plan.  Also Renown will not accept other Medicare Advantage Plans from other providers but always accept my AARP insurance for everything.

If I was a younger healthier vet then I would choose a Medicare Advantage Plan with their many restrictions but not now.

Often the Advantage planes will not approve costly medical procedures or expensive drug prescriptions and you have to have their PCP doctor approve specialist procedures.  Not so with my AARP medigap policy.

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