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]

Used to be that way for me.  But my team changed and now they only let the "team PC " rewrite the prescriptions even when she is not there.  And she is not there a lot.  I am not going to try changing teams again.

I think Cheyenne VA is back to worrying more about bonuses than care for vets.  2012 crisis all over again.

[john999]

Interesting.  You have it covered.  My wife has ChampVA and Cigna through the NALC as do I.  We both have Medicare A and B.  She was in the hospital overnight and I expect no bills from the hospital or doctors.  My brother has a Medicare Advantage plan.  I have a bad feeling about Medicare Advantage since I often wonder with all the goodies they give and the cash back how do they make money.  I think it is denial of care in some form or other, but you don't find out until you get denied.  We all have VA to fall back on but what a thought.  I was in the VA hospital for a week a few years ago.  It was a nightmare.  I was begging to be discharged.  This was during Covid and doctors were hard to find.

[broncovet]

Its pretty easy for me to see how they make money on medicare advantage plans FOR VETERANS.  For about 3 years, I paid medicare part B and never had one claim because I simply used the VA.  So, they pretty much collected my premiums for nothing.  And, this could well happen my entire life.  I use my medicare advantage as a backup plan, "just in case" I get some disease and need to seek treatment, say, at the Cleveland clinic.  But its not real likely I ever need it.  There are millions of Veterans on medicare advantage, and much of that is just plain profit, because VA takes care of 99 percent of my medical care.  

From the Veterans point of view, it makes sense to use private care whenever possible, vs the huge government care.  Why?  

   Its called "economies of scale".  

   What it means is that very small companies (ma and pa companies with 0 to 10 employees) dont run efficiently.  The business owner often "wears all hats" and isnt that good at some of them, such as accounting or taxes.  Larger companies hire full time bookeepers and accountants who know that business well.  This is true with maintenance, buying, marketing sales, and most things a small business owner deals with.  It increases efficiency up to around 500 or so employees.  

   However, depending upon the industry, a company who keeps adding employees reaches a max efficiency and then it drops off.  The business owner probably does not even know many of the employees, and people get hired who steal from the company, sue the company or even destroy data on the companies computers, sometimes, out of anger.  

    When you have a mega large company, like our federal government, its "way past" maximum efficiency with something like 1.5 million government employees.  There is vast waste, corruption, political squables, fights on social media, office affairs, and just about everything else, that makes it run poorly.  And no one can effectily manage hundreds or thousands of people.  They have to delegate.  Often very large companies are managed by a board of directors.  Our VASEC often has little or no VA experience, its a pure political appointment.  

     This is the big reason smaller, leaner companies can operate more efficiently than our federal government.  Pretty much "all" companies are smaller than the VA.  

[john999]

The main reason I still use the VA is that they document everything which makes it easier to file a claim.  I do get free insulin and pain meds. I can also call up my congressman when VA screws up and it gets results.  Try that with a private doctor.  Now if you need major surgery I would trust private system.  You know the private sector medical world is pretty bad as well.  I just flip a coin.  The VA did take care of me during Covid.  I could not find a private doctor to even see me.  I have got to the point where I trust no one.  Is this the brave new world we feared with come upon us?

[Lemuel]

48 minutes ago, john999 said:

The main reason I still use the VA is that they document everything which makes it easier to file a claim.  I do get free insulin and pain meds. I can also call up my congressman when VA screws up and it gets results.  Try that with a private doctor.  Now if you need major surgery I would trust private system.  You know the private sector medical world is pretty bad as well.  I just flip a coin.  The VA did take care of me during Covid.  I could not find a private doctor to even see me.  I have got to the point where I trust no one.  Is this the brave new world we feared with come upon us?

What if there is a difference of opinion on the surgery?  Would you trust the surgeon being paid big bucks for it or the one who is paid a salary?

In 1965 I was working part time in the ICU unit in a Catholic Hospital.  I was on break in the Canteen.  Two physicians walked in and one was telling the other that he had seen a great boat at the marina that he just had to have, but did not have enough for the down payment.  "Would you believe it," he said, "three hysterectomies walked into my office on Monday."

Would you want your wife seeing a fee based gynecologist?  Actually, I do not believe you have a choice.  There is no other kind unless you go to England or another country with socialized medicine.

Solution--bonuses for medical contracts based upon morbidity reports for longer life with higher quality of life, not cost cutting like the VA.

[john999]

That is a problem.  I guess I would look around and talk to my private doctor about who is the best doctor to do my surgery.  I have a herniated disc in my neck.  I talked to a number of doctors about an operation.  No agreement so I did not do the surgery.   I hurt sometimes but I am still above ground.  I am not really about comparisons with VA and private for profit institutions.