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Old 08-07-2013, 06:47 PM   #21
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Once again, a system- VA -where everyone seems to have a different set of rules. MY DH is boots on the ground Vietnam and we have NEVER given VA any sort of financial info what so ever. Nothing,NADA, so no income info and full BC yet completely covered by VA, in the example I used of his recent health event. We are responsible for some minor co-pays since we didn't give financial info to the VA. However, VA submits regular checkup and lab work to BC and seems to be happy with the BC payments. We never get billed for the co-pays.

All this makes me wonder how the new national health care system is actually going to work, certainly VA handles fewer patients, yet the rules and regs are a major source of confusion for the patients and the providers!
Every year, just like clockwork - I get the form letters requesting I verify our income and total net worth - do you get these? I also understood that it was not mandatory to provide the VA our total net worth (ours is above the norm). I only provided them with our annual income which was well above the priority group minimum to qualify for reduced or no co-payments, but Florida went and obtained our federal tax filings and accused us of making a nice six-figure income (as mentioned, they confused the total exchange of funds for retirement with the actual capital gains on the exchange, and I had to clarify their mistake to them).

In Illinois, I am priority group six as a Vietnam veteran exposed to agent orange, and this status supposedly applies to all Vietnam vets. Florida has me classified as priority group eight. I guess they felt I deserved it for not providing total net worth at the time (which I did when I clarified the mistake on their part). When I get the VA letter for Illinois - I just call them and they adjust their paperwork to show that I complied (they waive the financial information requirement for Vietnam Vet - agent orange exposure, priority six status).

Florida on the other hand, is difficult, but that could be because I'm a veteran of Illinois (Michigan native). I tried to use them last year when I was down there and having issues from treatment in Illinois. It was very difficult to get in and ended up going home early to get follow-up treatment at the Illinois VA. This shouldn't happen to anyone who's enrolled in the VA. As mentioned, I had to apply the year before when I was there to even get them to see me (I felt it was a good idea to enroll to have a local medical facility while we wintered there). You can't just call them up or walk in and get treatment at a VA clinic, but you can at any VA hospital. The local VA hospital is 4-5 hrs away in Florida.

I find the VA system to be lacking in nationwide ease of care and for coverage of non-VA medical care in non-service related medical emergencies, and am going to have to seriously evaluate leaving the system if it works out that we are better off financially (and medically) with the ACA exchanges. I'm forced to stay with the VA until the end of the year when the preexisting conditions on my individual policy goes away due to the ACA (thank God).
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Old 08-07-2013, 07:20 PM   #22
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Originally Posted by braumeister View Post
Mickey, I'm in a similar situation. VA Group 3, and using Medicare/TFL.

But I'm also enrolled in the VA system. There is no reason not to take advantage of both Medicare/TFL and VA.

I get all my medical care through Medicare/TFL and I'm very happy with it.

But I also go in for an annual checkup at my nearest VA clinic. There is no cost, and the first time I did this, I asked the doc if it wouldn't be better for me to simply stay away to leave their resources available for those who need them more.

Much to my surprise, she said "Absolutely not." It seems that the number of people enrolled in any VA clinic (who show up at least once a year for a very cursory checkup like I do) is something their funding is based on. So my going in for a 20 minute appointment every summer helps them out with their budget justification and actually makes medical care more available to the vets around here who truly rely on them.

Obviously, you don't have to enroll with your nearby facility, but I'm pretty sure they would be glad if you did.
I just realized this affects DH and I because we "joined" the local VA hospital over a year ago although we have yet to receive care there. We also have a high deductible policy to provide choices and guaranteed covered for emergencies.

I wonder how many people will leave the VA system due to the ACA subsidy issue and whether the exodus will have a material effect on their funding?
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Old 08-08-2013, 12:48 PM   #23
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As far as people leaving VA care it might happen, but I think there are enough people always trying to get in to keep the numbers steady. Even when you have co-pays it's virtually free. I guess the government considers VA care and subsidy money as double-dipping. But a vet earned his VA thru service and to say it's a freebie is a bit of a reach.

We have seen that many vet groups are activists about benefits, so I expect this issue to get some attention. Those of you that are directly involved in this issue might want to contact VFW,Legion, DAV and express your concern.
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Old 08-08-2013, 02:20 PM   #24
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I recently sent in this message to the VA and got the following response. Guess it is settled for now. I will keep my VA coverage and obtain health coverage for my spouse on the exchange, even though we pay the same amount for one person as it would cost for two people.

Question to VA
Ok, I know you have been asked this already as it is timely topic. I know VA care qualifies under the ACA and I have read on your own site that if you have VA health care then you can still buy Insurance on the Health Exchange (and in fact VA wants veterans to maintain other health insurance). However, I also know that if you have VA health care you are not able to get the subsidy to help in buying health insurance from the exchange. I also know if you need emergency care outside of the VA system there is a process for the VA to pick up the cost, but there are so many loopholes for the VA to wiggle out of paying that it is pretty impractical to rely on the VA to cover all your health needs and cost. I would like to have private health insurance under the ACA (both to insure I have emergency coverage for needs outside the VA system, and to help the VA recover some cost for service) but I canít afford to buy it without the subsidy because of my limited income.
So is this issue being addressed at a higher level? What is the official answer, how is a Veteran supposed to rely on the VA when there is such a large doubt about receiving emergency care outside the VA system and we are not able to buy exchange insurance with subsidy help?
Is this something that needs Congressional scrutiny or is it something the VA can address? Does the VA have an official answer? Is the VA attempting to address these issues?
This confirms receipt of the electronic message you just sent to the Department of Veterans Affairs (VA). The reference number for your question is #130807-001037

Here is the answer I got

Recently you requested assistance from VA. Below is a summary of your request and our response.

If you wish to reopen this issue, you may do so within the next 14 days by clicking on Reply, entering your new information, and then clicking Send.

Thank you for allowing us to be of service to you.


Discussion Thread
Response via Email Via Email (Dept of Veterans Affais)
08/08/2013 12:02 PM
Mr Weir

The short answer is, all Veterans have the ability to cancel their VA coverage. If they do so, and then wish to obtain it again in the future, they will need to meet the new requirements set by congress for enrolling vets. Currently, the subsidy program is set up to assist people that are unfortunate and cannot afford heath care or qualify for it thru other means. If a veteran has benefits thru the VA he is covered at all VA facilities.

As to the emergency care, there are qualifications. They are quite basic and require little to qualify.

1. Be enrolled in the VA and have received care at a VA facility sometime in the last 2 years. If you keep up to date on your yearly physical this will be easily met. 2. Have no other coverage, including medicare, medicaid, or state funded insurance. If you have other insurance, they are expected to pay the bill.
3. You are financially liable for the care provided. If the hospital waives your charges, or care is received at a free clinic, there is no reason for the VA to pay. 4. You have no other legal recourse against a third party. If you are in a car wreck and are suing the insurance company, they VA will not pay the bill. If you are suing a homeowner, business, or property owner for an injury in which you received care, the VA will not pay the bill.
5. The care is preformed at an emergency facility, and a layperson would assume that delaying care could injure your life or limb. You cannot go into the ER for a stubbed toe and expect the VA to pay. You also cannot choose to use a primary care doctor based on personal preference and expect the VA to pay.
6. The VA will only pay for stabilization. Once you are stabilized you must contact the VA medical center for future plans. They may choose to transport you to the VA or they may choose to pay to keep you at the current facility. They will make that determination based on your needs, the resources of the VA, and the availability at the time.
These rules are not meant for the VA to "weasel out of paying the bill" but so that veterans know the policy and procedure.

If you wish to decline or cancel enrollment in the Department of Veterans Affairs (VA) Health Care System, you should contact the Enrollment Coordinator at your local VA facility.

You will be required to submit a signed and dated written statement requesting disenrollment.

Things to consider before asking to be disenrolled:

1. If you reapply you will be considered as a new applicant and enrollment will be based upon the criteria in place at that time.
2. If you are a Veteran who is required to be enrolled to receive VA health care:
you will not be eligible for care of your non-service connected conditions.
if emergency treatment is provided at a VA facility you will be billed at the humanitarian rate. you will not be eligible for non-VA emergency care.
3. Veterans who are 50% or more service-connected are not required to be enrolled in the VA health care system to receive benefits offered in the Medical Benefits Package.

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Old 08-08-2013, 04:25 PM   #25
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I recently sent in this message to the VA and got the following response. Guess it is settled for now. I will keep my VA coverage and obtain health coverage for my spouse on the exchange, even though we pay the same amount for one person as it would cost for two people.

Question to VA
Ok, I know you have been asked this already as it is timely topic. I know VA care qualifies under the ACA and I have read on your own site that if you have VA health care then you can still buy Insurance on the Health Exchange (and in fact VA wants veterans to maintain other health insurance). However, I also know that if you have VA health care you are not able to get the subsidy to help in buying health insurance from the exchange. I also know if you need emergency care outside of the VA system there is a process for the VA to pick up the cost, but there are so many loopholes for the VA to wiggle out of paying that it is pretty impractical to rely on the VA to cover all your health needs and cost. I would like to have private health insurance under the ACA (both to insure I have emergency coverage for needs outside the VA system, and to help the VA recover some cost for service) but I can’t afford to buy it without the subsidy because of my limited income.
So is this issue being addressed at a higher level? What is the official answer, how is a Veteran supposed to rely on the VA when there is such a large doubt about receiving emergency care outside the VA system and we are not able to buy exchange insurance with subsidy help?
Is this something that needs Congressional scrutiny or is it something the VA can address? Does the VA have an official answer? Is the VA attempting to address these issues?
This confirms receipt of the electronic message you just sent to the Department of Veterans Affairs (VA). The reference number for your question is #130807-001037

Here is the answer I got

Recently you requested assistance from VA. Below is a summary of your request and our response.

If you wish to reopen this issue, you may do so within the next 14 days by clicking on Reply, entering your new information, and then clicking Send.

Thank you for allowing us to be of service to you.


Discussion Thread
Response via Email Via Email (Dept of Veterans Affais)
08/08/2013 12:02 PM
Mr Weir

The short answer is, all Veterans have the ability to cancel their VA coverage. If they do so, and then wish to obtain it again in the future, they will need to meet the new requirements set by congress for enrolling vets. Currently, the subsidy program is set up to assist people that are unfortunate and cannot afford heath care or qualify for it thru other means. If a veteran has benefits thru the VA he is covered at all VA facilities.

As to the emergency care, there are qualifications. They are quite basic and require little to qualify.

1. Be enrolled in the VA and have received care at a VA facility sometime in the last 2 years. If you keep up to date on your yearly physical this will be easily met. 2. Have no other coverage, including medicare, medicaid, or state funded insurance. If you have other insurance, they are expected to pay the bill.
3. You are financially liable for the care provided. If the hospital waives your charges, or care is received at a free clinic, there is no reason for the VA to pay. 4. You have no other legal recourse against a third party. If you are in a car wreck and are suing the insurance company, they VA will not pay the bill. If you are suing a homeowner, business, or property owner for an injury in which you received care, the VA will not pay the bill.
5. The care is preformed at an emergency facility, and a layperson would assume that delaying care could injure your life or limb. You cannot go into the ER for a stubbed toe and expect the VA to pay. You also cannot choose to use a primary care doctor based on personal preference and expect the VA to pay.
6. The VA will only pay for stabilization. Once you are stabilized you must contact the VA medical center for future plans. They may choose to transport you to the VA or they may choose to pay to keep you at the current facility. They will make that determination based on your needs, the resources of the VA, and the availability at the time.
These rules are not meant for the VA to "weasel out of paying the bill" but so that veterans know the policy and procedure.

If you wish to decline or cancel enrollment in the Department of Veterans Affairs (VA) Health Care System, you should contact the Enrollment Coordinator at your local VA facility.

You will be required to submit a signed and dated written statement requesting disenrollment.

Things to consider before asking to be disenrolled:

1. If you reapply you will be considered as a new applicant and enrollment will be based upon the criteria in place at that time.
2. If you are a Veteran who is required to be enrolled to receive VA health care:
you will not be eligible for care of your non-service connected conditions.

if emergency treatment is provided at a VA facility you will be billed at the humanitarian rate. you will not be eligible for non-VA emergency care. (what's this mean - you've lost coverages ?)
3. Veterans who are 50% or more service-connected are not required to be enrolled in the VA health care system to receive benefits offered in the Medical Benefits Package.

You mentioned that you currently have outside insurance at work that would cover non service related emergencies at non VA facilities, but cannot afford to buy insurance off the exchange w/o the subsidy for yourself in retirement - just your wife.

Are you planning to forgo purchasing outside insurance for yourself when you stay with the VA, and just purchase your wife's health insurance off the exchange? I can't bring myself to do that given the uncertainty of their responses to non service related care at non VA facilities.

Purchasing insurance off the ACA exchanges for you and your wife costs pretty much the same with the subsidy as if she or you were purchasing it as a single (just the subsidy amount changes - the out of pocket is identical for the most part according to the Kaiser calculator). Even the ACA website is touting the Kaiser calculator. Since you mentioned that you cannot afford the ACA insurance for yourself w/o the subsidy - your ACA health insurance costs should be very attractive for you and your wife based on your income in retirement, vs. the additional costs of outside insurance and staying with the VA.

Our estimated costs using the ACA for both me and my wife would run under $3k annually out of pocket (I can manipulate our investment income to keep our MAGI fairly stable until we reach medicare age). Even with a $2500.00 deductible on the silver plans subsidy estimate - the savings of me "not" having to buy outside insurance w/o the subsidy currently at $4k @62 yrs old (with a $5k deductible) makes the ACA exchange pricing very attractive. I would imagine we might also be able to purchase a better plan (gold or platinum off the exchange for better coverage with the $6,500 we'd be spending with her only on ACA and my staying with the VA and outside coverage, but we'll see what the future brings). It makes leaving the VA healthcare system financially attractive, even though it would be a real loss personally.

From the last comments on the VA email reply - kind of comes across as a threat (fact) of loss of coverage of future non service related emergencies at VA "or" non VA facilities when considering disenrolling. If I didn't know better, it sounds like don't bother coming back, it won't be there for you anymore...
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Old 08-08-2013, 05:29 PM   #26
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Fritz, well of course you will lose coverage for emergencies (and everything else) if you choose to give up your VA coverage. They are not going to provide service if you dis-enroll. I could dis-enroll, take the Exchange coverage with my wife and re-enroll back in VA coverage if the situation made it more attractive at a later date. Due to my priority 3 status I donít think they will ever bar me from being able to get coverage. But although there are limitations in the VA system and some concerns about emergency care given outside their system, I think I will work within their system since I have no co-pays with them. Will still be a lot of co-pays and other cost with the Exchange coverage that I donít have with VA Health Care. Nothing is perfect but I am very happy with the ACA at this point as it makes it possible to get insurance for my spouse, and this will allow me to retire a little early.
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Old 08-08-2013, 05:52 PM   #27
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Fritz, well of course you will lose coverage for emergencies (and everything else) if you choose to give up your VA coverage. They are not going to provide service if you dis-enroll. I could dis-enroll, take the Exchange coverage with my wife and re-enroll back in VA coverage if the situation made it more attractive at a later date. Due to my priority 3 status I donít think they will ever bar me from being able to get coverage. But although there are limitations in the VA system and some concerns about emergency care given outside their system, I think I will work within their system since I have no co-pays with them. Will still be a lot of co-pays and other cost with the Exchange coverage that I donít have with VA Health Care. Nothing is perfect but I am very happy with the ACA at this point as it makes it possible to get insurance for my spouse, and this will allow me to retire a little early.
We purchased a high(est) deductible policy as back-up for VA care in case of emergencies (don't trust that we'll be reimbursed and it could get expensive quickly) and we signed up for VA care as back-up for our high deductible policy. I guess we can continue with this strategy if the rates are acceptable (i,e, we are paying no more than we are now) and we forego the subsidy. We will balance the lack of subsidy with protection again possibly having to pay the high deductible for one or both for multiple years. I guess our decision will be made when prices are posted some day on the exchange for Florida.
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Old 08-08-2013, 07:28 PM   #28
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Fritz, well of course you will lose coverage for emergencies (and everything else) if you choose to give up your VA coverage. They are not going to provide service if you dis-enroll. I could dis-enroll, take the Exchange coverage with my wife and re-enroll back in VA coverage if the situation made it more attractive at a later date. Due to my priority 3 status I don’t think they will ever bar me from being able to get coverage. But although there are limitations in the VA system and some concerns about emergency care given outside their system, I think I will work within their system since I have no co-pays with them. Will still be a lot of co-pays and other cost with the Exchange coverage that I don’t have with VA Health Care. Nothing is perfect but I am very happy with the ACA at this point as it makes it possible to get insurance for my spouse, and this will allow me to retire a little early.
I misread as a re-enrolling limitations (given item #1 is listed as starting over and being subject to current regs) and not as what you lose when leaving the VA (disenrolling). As for disenrolling in the VA to go on the ACA exchanges - it somewhat works out that my doing this would be at no additional out of pocket cost (it costs the same for one as it does for two. Enrolling my wife will improve her coverage and reduce her price, but if I join her - the costs are the same. It would also eliminate my personal requirement of purchasing outside emergency VA coverage, which currently costs me $4k annually (I've never used it and it has a $5k deductible). It would be a significant cost if I were to have to utilize that policy ($5k upfront out of pocket and 80/20 for an additional $3k before the bleeding stops). That $4k annual cost would pay for a lot of deductibles and/or out of pocket co-pays for either of us on the ACA exchange, or possibly upgrade us to a different plan level. Another worry is if BCBS chooses to eliminate my current outside policy with the implementation of the ACA exchange, and I have to buy a different policy. My cost increases are based on my joining at 59. I've checked pricing and it would be higher to acquire another policy now at 62 all things being equal. These are just things that I'll need to evaluate, but the financials do point to ACA exchange scenario. I have ongoing issues that would cost out of pocket where the VA covers them, but can't determine direction until I see the ACA actual policy costs with the subsidy.
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Old 08-31-2013, 01:17 PM   #29
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I wanted to do an update for those of you in the VA system.

As I mentioned in some previous posts on this thread, VA did an emergency admit for my husband who has VA care. They signed off on paperwork that said they would be responsible for all of the bills related to that admission.
The update is that after about 90 days the VA has submitted all the bills from the admission directly to Blue Cross. Even though the care was provided at another hospital the bills are going in under the VA claim.

This will not affect our out of pocket costs in any way, as my husband needed a surgery to correct the original problem. We elected to have that done under our Blue Cross policy so that we could hurry things along and pick which doctor we wanted to use.
So, we have already met our out-of-pocket max for the year. VA is an approved Blue Cross provider so they will have to accept the amount they are paid from Blue Cross as a final payment.

Now, if we hadn't met our max out of pocket, I don't know what VA might do or not do in regards to collecting any more payment, such as the original out of pocket. I would think that we would only have been liable for the standard co-pays but I don't have a certain answer for that.

I just wanted to provide this additional info for those of you wondering what the VA covers and doesn't cover.
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Old 08-31-2013, 02:57 PM   #30
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Obviously, you don't have to enroll with your nearby facility, but I'm pretty sure they would be glad if you did.
Thanks for the suggestion braumeister. I think I'll take advantage of the opportunity.
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