Medicare and medicare advantage plans for Veterans..medicare part B and part D

[broncovet]

   Its "about that time", when you will be seeing lots of commercials for medicare, medicare advantage plans, wanting you to call a toll free number.  Be cautious.  

I use exclusively a local Medicare planning company with a full time office, in my town.  Why?

   Well certain medicare advantage plans have "networks" and "out of networks" doctors, and they are treated very differently.  And a Meidcare advantage sales person in Zimbabwe probably knows very little about doctors, hospitals, etc. IN YOUR TOWN.  

   My wife, for example, wants to keep her doctor she has had for about 4 decades who knows everything about her history.  I cant say as I blame her.  So, she took her doctors name there, and we made sure she could keep that doc, that he was "in network" without higher copays, etc.  

   And, this is a big deal:

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Disabled Veterans, and their spouse with Champva, pretty much dont need a lot of health insurance with this.  So, some medicare advantage plans recognize enrolling Vets, like my spouse and I (she is not a Vet, but she is on champva), and so the insurance companies "pay cash back" to get us to enroll.  Last year, we got an additional $150 each per month added back to the social security as we are both enrolled in medicare part B.  

OF COURSE, this can be vastly different in your state, or even your zip code.  The part B premium is about $174 per month, and we essentially get a $150 discount.  I use Medicare Part b as a "backup plan" when VA medical care fails me.  Example:  Lets say, I got a disease, oh say cancer.  And I needed an experimental treatment at Cleveland Clinic to survive, and VA wont do it.  I could use my medicare part B advantage and probably get the care.  This is pretty much theory only, as I moslty dont use my medicare part B, but would, if I had evidence that my VA had bad doctors in a section, no doctors, or otherwise inferior or inadequate care, and I had a medical problem that VA was not able to handle.  

 

Do a good job considering your medicare/medicare advantage situation, and go with the plan that works for you.  That of course is different than my situation.  My wife and I have "very little" cost out of pocket for doctors, hosptials, prescriptions etc. 

I also need to tell you a trick I learned about medicare part D.  

We learned the "hard way" about medicare part D (prescriptions) and Champva.  My wife pretty much buys all insurance and I basically dont.  So, she bought Medicare part D, even tho she had Champva.  Bad idea, as we later found out.  Here is why.  My wife needed a blood thinner and medicare part D wanted "$180 per month" copay on ONE prescription.  She takes probably 8 prescriptions.  So we made about 50 phone calls to every where, and finally figured out the key here.  She needed to, and did, "CAnCEL" her part D.  Why?  Because champva "meds by mail" wont allow her on the program "if'" she has another prescription drug plan.  So, after cancelling her part D, she gets meds by mail and her $180 per month per prescription is reduced to $0 per month via meds by mail on champva.  

Now, of course I can not say whether or not this applies to your situation, but it probably would.  I forget how much part D was, but Im thinking around $40 per month, so it saved "at least" $220 per month by cancelling her medicare part d plan, and getting meds by mail.  

Caveat:  Meds by mail, is well, by mail.  So, we dont have any prescription coverage for what I call "emergency prescriptions", where she goes to the doc and he writes a perscription for some meds she needs right away and cant wait for the snail mailman.  In that case, I have one of those discount coupon things, I think mine is called Good Rx, but there are others.  My local pharmacy applies the discount code, and i have paid probably a total out of pocket of $50 in the past 5 years for her emergency prescriptions.  But that has saved us thousands by not having a medicare part D, and use champva meds by mail, which do not work together. 
 

[Lemuel]

When it comes to your health, it is better to have no Medicare advantage plan than have a bad one.  Some make their profit by denying services.

If you need specialty care, and are having trouble getting it, with CHAMPVA, or any other Medicare Advantage Plan, get a consult in hand to the specialist recommended and only show your Medicare card to get seen.  Lots of excuses to not see you otherwise because the specialist wants to be paid.  Better to pay the copay and be taken care of than be refused and dead.

[brokensoldier244th]

Also- 800 numbers and 'scary' envelopes from scammers can come from anywhere. Always verify 800 numbers, addresses on envelopes, etc- to try to ensure they are from where they say they are. Im constantly hounded by house insurance and loan providers because I have a VA loan with a really low rate (2.75) and I get envelopes every week either asking me to refiance or telling me "I might miss my only chance......" or "Interest rates are going up!!!! (no shit) REFI NOW". I also get a lot of 800 calls or spammed ph number calls from entities unknown that leave me broken up English VMs. 

 

In general, its nearing the holiday season and this time of year seems to be rife with these types of envelopes, emails, and ph calls. Its probably a good time to check your DD on VA.Gov, too, just for care's sake. It doesn't happen often but sometimes that DD gets changed by entities unknown via the website. If someone calls in to do it we verify at least 2 points of personal info, or your personal info identifier that you can set up. The website doesn't care as much, though, and if someone has your login they have everything. 

[broncovet]

Agree broken soldier.  You posted:

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 "Interest rates are going up!!!! (no shit) REFI NOW". I also get a lot of 800 calls or spammed ph number calls from entities unknown that leave me broken up English VMs. 

Fed Chairman Powell (the guy who decides where interest rates are going) pretty much said there will be rate cuts in September.  

Some of these people want to dupe you, and steal your information.  Name social security number and all other private information to apply for a loan to refinance. 

Its called "social engineering", where someone on the phone deceives his/her purpose in order to rob from you electronically by hacking.  

[john999]

I suggest that vets get regular Medicare rather than Medicare Advantage which is just private insurance.  With original Medicare you have many appeal rights.  It is a true government program.  I have Medicare and union insurance and I never pay a penny for hospital visits.  Medicare Advantage is just republican attempt to destroy Medicare and they do a good job at this task.  When there is no Medicare left I bet Medicare Advantage costs will sky rocket.

[broncovet]

"True government" medicare is not necessarily better than a medicare advantage.  My medicare advantage has a $150 cash back, so my medicare advantage costs

$24.00 instead of $174.

Indeed, I dont have copays or deductables either.  The only thing I ever paid for was when my spouse had medicare part D, because Champva does not allow 

us to use Champva meds by mail, "when we have another prescription plan" which includes medicare part d.   

They wanted $180 per month for just one prescription.  By cancelling medicare part D, my wife gets her meds by mail at champva with no copayment and no deductable. 

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It saved us thousands.  The $150 per month extra, added back to the social security check, with my private health care plan amounts to an extra $1800 per year for me, and another extra 1800 per year for my wife.  Thats $3600 per year, or $300 per month less than traditional medicare.  (Anthem medicare advantage vs medicare)

Since I saw no difference when I did have medicare, I will take the extra 300 per month any day.  Yours may be different, it goes by zip code.  

Even worse, some doctors in my area dont like medicare patients, and often dont accept medicare probably because its the government and probably takes as long to get your money as it took with VA.  

Its another example of private companies running more efficiently than our federal government.  They need to let Veterans decide what health care they want, VA or otherwise, and not "mandatory VA", because VA is often substandard care.    VA hates this idea, as many who have a choice choose private care.  They dont want to raise the VA level of care to that of private industry, but would rather force Veterans to choose inefficient, costly, VA over private care.  

Edited September 12 by broncovet

[x020574]

I'm 73 and 100% P & T, which entitles my spouse CHAMPVA and MEDs by Mail. I have a VA PCP and a private PCP, have Medicare A & B. plus an AARP United HealthCare Medicare supplemental. I don't have a drug plan (Part D) as I rely on the VA to fill my medications... If a private PCP gives me a script, I send it to my VA PCP who rewrites it and submits to the VA Pharmacy. If it's a low cost script I simply rely on GoodRX. One of my medications, an infusion, from a private hematologist is extremely costly, Ultomiris... fortunately for me since I get the infusions at an infusion center's  affiliated with my  Hem/Onc doctors hospital, it is covered under Medicare Part A. (The company charges approximately $500K per year, although Medicare has negotiated amounts they allow, which is substantially less... I get infusions every 8 weeks (26 times a year)  I am reluctant to give up my UNH supplemental because if they ever force me to get infusions at home, it's not covered under Part A and Id be on the hook for 25% of the cost.

My wife is 63 and not yet eligible for Medicare. She is quite content with her doctors who participant in CHAMPVA/TriCare (95% of the time they also participate in Medicare and have negotiate contract fees.) She also has a CHAMPVA/TriCare supplemental called Sellman & Company, LLC that covers the 25% that CHAMPVA doesn't cover in full. It has been working out well, but we recently ran into a small glitch. Her private PCP submitted to Meds By Mail a script for Ozempic... MbM will not fill injectable medications like  GLP-1... maybe this will change down the road. The provider then re-submitted the script to OptumX (CHAMPVA pharmacy) and it was honored at 75%, just as they do for other meds. I pick it up at CVS and pay the copay of $279 - that I can submit to Selman & Company, LLC for reimbursement. MedByMail and OptumX are two different entities and do not abide by the same formularies. All in all, I'm comfortable keeping the supplementals in case somewhere they decide to change the rules.

I got the AARP UHC  Medicare supplemental when I signed up for Medicare... this is extremely important to know... they can not deny you coverage or adjust your rates due to preexisting conditions at the time you start Medicare... you rates are determined by age. BUT!!! If you choose to signup for the AARP UHC Medicare supplemental at a later date, all bets are off, you can be denied supplemental coverage and/or they can restrict claims for a period of time and adjust rates considering your pre existing conditions.