# Medical Coverage For Vets



## ClassicRockr (Feb 7, 2020)

What coverage do you have? Medicare and VA Medical? How much do you use Medicare and/or VA Medical? 

When I became eligible for Medicare, I read that it was high advisable for Veteran's to have both Medicare and VA Medical. So, I've got both. I don't have a Medicare PCP, but do have one with the VA that I see twice a year. All of my prescriptions come from the VA Pharmacy. I got a rotator cuff surgery/rehab thru Medicare and laser cataract surgery (both eyes) thru Medicare as well. Where we use to live, the VA hospital was over an hour away, the same as where we live now. 

From what I understand, a Veteran can now be referred to an "outside the VA" medical services, but who pays more...…….Medicare or the VA for these services? When I went to the ER last August, for a fall injury, all I did was show them both my Medicare and Supplement Insurance cards and got complete service. Don't know how it would be if I showed them only my VA Medical card. 

What I'm wondering is, how easy is it to get medical attention by using a VA Medical card only? Do I really need both Medicare, the Supplement and VA?


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## ClassicRockr (Feb 7, 2020)

Any Veteran's on here that have either Medicare or VA Medical or both??


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## squatting dog (Feb 7, 2020)

A lot depends on you specific needs. There are times medicare is better and there are other times VA is better. Again, you must fit it to your needs. I have both. the VA use depends on where you are and how much you trust your VA. I can get medications there  at little to no cost to me. (although right at the moment, I don't need any) Now, since my VA is too far away, I can go to just about any hospital (thank you Mr Trump) and that is mighty handy for me. That said, I still will use my medicare simply because I had to pay into it all these years whether I wanted to or not, and I still am leery about the VA's policy of handing out certain drugs without any recourse. (cost me a daughter).


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## ClassicRockr (Feb 7, 2020)

As far as "needs" go, the only ones I have is meds. Two meds/supplies for Diabetic II, blood pressure med, cholesterol med and a med for osteoarthritis pain in my shoulder. I get all from VA. There is a VA Clinic down the street from us, but all they do is doctor consultation for labs taken. 
What I'm wondering is how the VA handles a hospital ER visit, because the closest VA Hospital is in Cheyenne, Wyoming. If I need an x-ray done, because the VA Hospital is fairly far away, I was told that my VA doctor would send me to a non-VA place for an x-ray. 
I haven't got a PCP for my Medicare yet, so I guess I'd better get a PCP for them. Right?


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## squatting dog (Feb 7, 2020)

"I haven't got a PCP for my Medicare yet, so I guess I'd better get a PCP for them. Right?" 

Yep     Also, this is a good read.  https://www.va.gov/COMMUNITYCARE/programs/veterans/emergency_care.asp


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## ClassicRockr (Feb 7, 2020)

squatting dog said:


> "I haven't got a PCP for my Medicare yet, so I guess I'd better get a PCP for them. Right?"
> 
> Yep     Also, this is a good read.  https://www.va.gov/COMMUNITYCARE/programs/veterans/emergency_care.asp



So, from what I read, there is a difference between a "Service-Connected Medical" Veteran and a Veteran that isn't. The VA may/may not pay. What also comes into view is OHI, aka Other Health Insurance. I have OHI, as in Medicare, and my Supplement. VA doesn't like paying for something that another insurance can pay for. 

Am I about right on the above...…...what I read?


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## Pappy (Feb 7, 2020)

I have both. VA clinic and Medicare. I split up my drugs between the two.whatever is lest expensive. The VA has my heart doctor and foot doctor. 
With Medicare, a lot of my meds are free through a mail order pharmacy. I also have check ups twice a year.


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## ronaldj (Feb 7, 2020)

have both use both, some things VA don't cover, yet .  also have tri care which don't use with other two.


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## oldmontana (Feb 7, 2020)

ClassicRockr said:


> Any Veteran's on here that have either Medicare or VA Medical or both??


I have VA and also BC BS Medicare advantage.  Where I live he have a VA clinic were I do go but if you have a medical emergency you will not get it there....they will send you to the only VA Hospital in Montana.....hours from were I live.  That is why I think I also need to have a local doctor 

I do get most of my prescription drugs from the VA.  When I started to go to the VA, about 35 years ago a three month supply was $3 now they have three tiers with most at $9 for three months, no cost if you are low income... I am not.


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## Tommy (Feb 7, 2020)

I was always under the impression that VA medical benefits were for service-connected conditions only.  Did I miss something?


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## ClassicRockr (Feb 8, 2020)

Tommy said:


> I was always under the impression that VA medical benefits were for service-connected conditions only.  Did I miss something?


Wrong impression. VA Medical covers all Veterans, service-connected or not.


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## ClassicRockr (Feb 8, 2020)

I know two military Vets that have VA, plus Medicare and a retirement healthcare. 

When my 1/2 brother is at his summer home, in the foothills area of PA, him and his wife drive several miles to the Buffalo, NY VA Hospital for different things. From what I understand, he uses his retirement healthcare, when he is in Florida (winter home). So, he pays monthly for Medicare, but doesn't use it. 
The other guy uses his retirement healthcare and Medicare, not his VA Medical.


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## ClassicRockr (Feb 8, 2020)

From what I've read, it's not as easy as 1-2-3 to have the VA pay for something done outside the VA, especially for a "non-service connected" Veteran. 
Wife and I pay over $500 a month, just for my medical monthly payment. That would be: Medicare, Florida Blue (BCBS) and Humana Rx and that doesn't include the yearly deductible for Medicare. 

But, one thing for sure, once the Medicare deductible is paid, Medicare does a great job, along with my Florida Blue, of paying the most-to-all of the cost of any "out of VA Medical System" I could need. ER visit, laser cataract surgery and a rotator cuff surgery. We were totally amazed at how much Medicare paid, after we paid the deductible (of course).


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## oldmontana (Feb 8, 2020)

Tommy said:


> I was always under the impression that VA medical benefits were for service-connected conditions only.  Did I miss something?



That is not true....
https://www.nolo.com/legal-encyclopedia/eligibility-va-health-care.html

Part of the link..

*Eligibility for VA Health Care Benefits*
If you had active duty in the military and were discharged under conditions other than dishonorable, you may be eligible for VA health care benefits. If you enlisted after September 7, 1980 or entered active duty after October 16, 1981, you must have served for 24 uninterrupted months to be eligible for health care. This minimum service time may not apply if you were discharged due to a service-connected disability or for hardship.

If you are a member of the National Guard or a Reservist, you may qualify if you had active duty by federal order and served for the full period you were called for.

Veterans who served prior to September 7, 1980 do not have to meet a minimum service requirement to be eligible for VA health care.


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## Pecos (Feb 8, 2020)

I have Medicare and Tricare-for-life.


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## cdestroyer (Feb 8, 2020)

I am not service connected.I got my disability from SS. I am under the VA eligibilty limit. The Va provides me all my breathing medicines which includes oxygen/nebulizer and inhalers.The VA pays for emergency room visits to local medical center,they do not pay for inpatient stays.For civilian hospital medicare pays. The VA pays for transport To VA hospital an hour away. VA hospital care costs me nothing! In room sign says "serving those who served."


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## Tommy (Feb 10, 2020)

ClassicRockr said:


> Wrong impression. VA Medical covers all Veterans, service-connected or not.


Hey, thanks CR!  I'll give them a call tomorrow.


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## fuzzybuddy (Feb 12, 2020)

ClassicRockr, I was an orderly decades ago at a large VA hospital. Back then, it depended on when you were a Vet as to what level of care you got, if any. WWII & Korea got the most care, then for Viet Nam Vets, the rules got a lot tighter. And the rules got more restrictive in passing years. The reason I mention this was that "service connected" was a big deal back then. If it wasn't service connected, they didn't treat it. I went through 4 years in the US Navy, unscathed. But I'm totally disabled due to spinal problems. Are you saying that I could be treated at a VA hosp?


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## squatting dog (Feb 12, 2020)

I say yes fuzzybuddy. I have a neighbor who's a vet (non combat) that lost his leg in a motorcycle accident. He receives full VA medical coverage at the VA hospital.


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## oldman (Feb 12, 2020)

fuzzybuddy said:


> ClassicRockr, I was an orderly decades ago at a large VA hospital. Back then, it depended on when you were a Vet as to what level of care you got, if any. WWII & Korea got the most care, then for Viet Nam Vets, the rules got a lot tighter. And the rules got more restrictive in passing years. The reason I mention this was that "service connected" was a big deal back then. If it wasn't service connected, they didn't treat it. I went through 4 years in the US Navy, unscathed. But I'm totally disabled due to spinal problems. Are you saying that I could be treated at a VA hosp?


I wouldn't know why not. If you have never been to the VA, you will have to fill out the paperwork to get you started. That's the least you should do now. 

I have both, but do not use the VA. I have Medicare, VA (TRICARE) and I also pay for a supplemental plan that will pay whatever Medicare doesn't. I have a Plan F supplemental.


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## ClassicRockr (Feb 12, 2020)

fuzzybuddy said:


> ClassicRockr, I was an orderly decades ago at a large VA hospital. Back then, it depended on when you were a Vet as to what level of care you got, if any. WWII & Korea got the most care, then for Viet Nam Vets, the rules got a lot tighter. And the rules got more restrictive in passing years. The reason I mention this was that "service connected" was a big deal back then. If it wasn't service connected, they didn't treat it. I went through 4 years in the US Navy, unscathed. But I'm totally disabled due to spinal problems. Are you saying that I could be treated at a VA hosp?



Yes, but, perhaps not as fast as a "service-connected" Vet. If I have to go to the ER for something, there is no VA Hospital/ER near us. Nearest one is some 70 miles away. Now, if I go to a regular ER in my area, and show my Medicare and Supplement, plus use my Rx Plan for any meds,  all is well and I'm guaranteed help. If my yearly deductible hasn't been paid fully, I will be billed for part of the ER help. If my yearly deductible has been fully paid, both Medicare and my Supplement will totally handle the ER bill. That happened to me last August. Now, if I don't have Medicare and my Supplement, only my VA ID, I really don't know how good the ER service will be. After the ER visit, I only have so much time to contact the VA about the ER visit and then will decide how much they will pay, of which could be very little-to-nothing.


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## ClassicRockr (Feb 12, 2020)

As of now, it really appears that I need the medical coverage I have, even with the cost of it. That is: Medicare A/B, BCBS Supplement, my Rx Plan and VA. My BCBS will pay the full amount for getting into a hospital. 

Due to my wife making to much money before, and doing a Means Test (financial) would've been useless for us, we continue paying a co-pay for my VA meds. Depending on our financial status after Oct of this year, we will be ready for the Means Test and possibly no co-pay on my meds. For my labs and labs consultation with my VA doctor, the VA does require some payment from my BCBS, as well as myself. VA does not bill anything to Medicare. 

One other thing, and it being a "double-edge blade" (for to say) apparently the VA doesn't look to highly on those Veterans that have more medical than the VA Medical, but one website I read how much it is advisable that a Veteran have Medicare and a Supplement along with VA Medical. Sounds complicated to me!!


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## oldman (Feb 14, 2020)

I had a problem with my insurance at United. I was injured in Vietnam. I took a hit in my left shoulder that I swore my shoulder had been blown off, but it wasn’t as bad as I thought. I did spend several weeks in Okinawa in the hospital. This happened right at the end of my tour of duty. 

Fifteen years later, I re-injured the same shoulder and my insurance carrier at United wanted me to be treated at the VA. I had to argue with them for weeks that this was a separate incident. Finally, I got ahold of the Pennsylvania Insurance Commissioner’s office and filed a complaint. They handled it and after about three weeks later, I received a letter stating that my claim was approved.

I want to add that last night a few of us old Vets were talking about being in Vietnam and the one fellow brought up his story about he was shot in the front of the head, but survived. He told me that he still suffers headaches and has neuralgia in his neck from the gunshot. He goes to the VA for care, but wants to change to a Neurologist, but now Medicare is telling him no and to stay with the VA. Anyone have or heard anything familiar like this? Isn’t it up to the Vet which type of care he chooses?


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## rkunsaw (Feb 17, 2020)

Tommy said:


> I was always under the impression that VA medical benefits were for service-connected conditions only.  Did I miss something?


That is mostly true Tommy. You may also get VA benefits if you are considered needy because of low income. I was turned down because I don't have a service connected disability and my income was too high.


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## oldmontana (Feb 17, 2020)

rkunsaw said:


> That is mostly true Tommy. You may also get VA benefits if you are considered needy because of low income. I was turned down because I don't have a service connected disability and my income was too high.



That is not true.  I get VA coverage..no  service connected disability.  I am not low income so I pay for RX's and doctor calls.  I served for thee years,  active duty.  Most RX's are $9 for three months...doctor visits $15.


FYI...

https://www.nolo.com/legal-encyclopedia/eligibility-va-health-care.html

Part of the link..

*Eligibility for VA Health Care Benefits*
If you had active duty in the military and were discharged under conditions other than dishonorable, you may be eligible for VA health care benefits. If you enlisted after September 7, 1980 or entered active duty after October 16, 1981, you must have served for 24 uninterrupted months to be eligible for health care. This minimum service time may not apply if you were discharged due to a service-connected disability or for hardship.

If you are a member of the National Guard or a Reservist, you may qualify if you had active duty by federal order and served for the full period you were called for.

Veterans who served prior to September 7, 1980 do not have to meet a minimum service requirement to be eligible for VA health care.


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## rkunsaw (Feb 18, 2020)

@Tommy and @oldmontana  Here's more :

*Priority Groups*
Unfortunately, the Veterans Health Administration does not have enough resources to provide care to all veterans who need it. To address this issue, the VA has created eight priority groups for enrollment.

When you apply, the VA will assign you to a priority group. In some cases, you may be asked to agree to pay co-pays in order to be placed in a priority group. If you are eligible for more than one priority group, you’ll be put in the group that has higher priority.



*How Priority is Determined*
To determine which group you may belong to, see the VA's description of priority groups. If you have a service-connected injury or illness' your priority group will be determined by your disability rating. Former POWs and recipients of certain military honors are also given special priority. In addition, VA groups grants priority based on other factors, including financial need.

If you are not receiving disability compensation or pension, you will probably have to provide financial information to the VA to show that your income does not exceed the *VA annual income threshold*. Use the VA financial calculator to see if you qualify.

As resources increases, members of more priority groups are enrolled, and as resources decrease, members of fewer groups are enrolled. It all depends on the annual funding provided by Congress.


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## Liberty (Feb 19, 2020)

oldman said:


> I had a problem with my insurance at United. I was injured in Vietnam. I took a hit in my left shoulder that I swore my shoulder had been blown off, but it wasn’t as bad as I thought. I did spend several weeks in Okinawa in the hospital. This happened right at the end of my tour of duty.
> 
> Fifteen years later, I re-injured the same shoulder and my insurance carrier at United wanted me to be treated at the VA. I had to argue with them for weeks that this was a separate incident. Finally, I got ahold of the Pennsylvania Insurance Commissioner’s office and filed a complaint. They handled it and after about three weeks later, I received a letter stating that my claim was approved.
> 
> I want to add that last night a few of us old Vets were talking about being in Vietnam and the one fellow brought up his story about he was shot in the front of the head, but survived. He told me that he still suffers headaches and has neuralgia in his neck from the gunshot. He goes to the VA for care, but wants to change to a Neurologist, but now Medicare is telling him no and to stay with the VA. Anyone have or heard anything familiar like this? Isn’t it up to the Vet which type of care he chooses?


I'll write my good friend, who is a disabled VA with high clearance ratings.  She what she suggests.


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## Liberty (Feb 20, 2020)

Liberty said:


> I'll write my good friend, who is a disabled VA with high clearance ratings.  She what she suggests.


Here's what my vet friend said about the medical issues:

My best suggestion for both is to join a veteran's service organization. DAV (disabled American Vets) or the Legion are both really good. They'll help a vet navigate the hurdles of the VA and get the care they need. All are free. 
DAV is here https://www.dav.org/ phone is (877) I AM A VET
I hope they can get it worked out!!!


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## Skyking (Feb 24, 2020)

oldman said:


> now Medicare is telling him no and to stay with the VA. Anyone have or heard anything familiar like this? Isn’t it up to the Vet which type of care he chooses?


It's complicated. I'm a 23 year retiree, Vietnam era vet as well as Gulf War. I was told that my order of payment was Medicare first, with TriCare for Life picking up the balance...Not sure where the Vet Hospital's i.e. the VA  falls in. That said I use Roudebush VA in Indianapolis Indiana, awesome care. They are my first choice so I can skip the Medicare/Tricare route . Yet, it's there if I need it. Clear as mud right?


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## lukebass (Mar 16, 2020)

Things changed this year with the roll-out of the Mission Act.   There is a lot of new coverage for most vets.   The way I understand it is that all priority groups get full medical coverage with the exception of groups 7 & 8.  7 & 8 have a copay of about $1400 and some addition copays.  
Here the one rule you need to be careful of;  if the veteran is covered by Medicare Parts A & B the VA will not pay anything.  This is if you go to a civilian hospital.  If you go to a VA hospital you are covered as i stated before.  
Look up the Mission Act  yourself and read it.  Asking people at the VA only made me confused.


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## Manatee (Mar 26, 2020)

I get my medical needs from Medicare.  My wife, who doesn't drive, and I coordinate so that we combine visits. 

I go to the VA clinic for my hearing aids.


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## Manatee (Apr 26, 2020)

My low level VA coverage covers my hearing aids, the rest I get from my Medicare Advantage plan.


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## tbeltrans (May 1, 2020)

I am in priority group 4 with the VA.  I believe that everybody must have the basic Medicare coverage, which I got at age 65.  My primary health care is with the VA.  I do have a veteran's medical supplement plan for Medicare that costs $39 per month.  Basically, it limits my non-VA co-pay from astronomical to huge.  That would only come into play if I couldn't get to a VA hospital during some emergency such as a serious car wreck injury or something along those lines.

Tony


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