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Any ERs who get their healthcare primarily through the VA?
Old 01-19-2016, 02:46 PM   #1
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Any ERs who get their healthcare primarily through the VA?

I am 47, have a 20% service connected disability and live in an area with a VA hospital and a contracted VA clinic within 5 miles of my house. I have never received any healthcare through the VA since I have always had employer based health insurance. Now that I am on a high deductible plan through the ACA with a $4500 deductible, I am rethinking whether I should consider the VA.

I know that care related to my service connected disability (back injury) would be covered. How does it work if you go there for a routine physical and managing simple meds? I have looked at the forms for means testing, and I have resources so I wouldn't qualify for free care. How do you know how much it will cost for services? Thanks in advance.
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Old 01-19-2016, 03:36 PM   #2
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Generally speaking a service connected disability will put you in a group that doesn't require means testing.You'd need to check this out with either a county veteran service officer or a group like the DAV or VFW to confirm this.

What is the reputation of the clinics in your area, this is the biggest issue for you to think about...now if you are on a subsidized plan thru the ACA you will be disqualified from a subsidy if you enroll in VA care,and if you are not happy with the quality of VA care I don't know how or if you can un-enroll in the system. You are a long way from Medicare age so perhaps it will be a good option for you. Almost all drugs thru the VA have a co-pay of I think around 8 bucks a month so if you have meds thats another consideration.
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Old 01-19-2016, 04:03 PM   #3
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Thanks Ivinsfan! When I worked as an RN I knew many people who worked at the local VA hospital and thought highly of it. In my last job I coordinated care for VA patients on hospice and found them to be amazingly generous in what they covered for their patients. Much, much more than a private insurance would cover. I have also asked lots of VA patients/family members and the response I got from them was overwhelmingly positive. Now I don't know about the local Valor clinic that they run, I will have to look into that.

My understanding of the subsidy issue is that if you are enrolled in the VA system - meaning you collect a VA disability pension, then you are not eligible for a subsidy through the ACA because the idea is that you already have "coverage" through the VA. I don't think you have to even get care at the VA to lose out on a potential subsidy, which I think is a bummer for those of us who want to have more comprehensive coverage.

Checking with the VFW is a good idea, I have tried to figure out on the VA website what my liability for care would be without success. I know the VA tries to collect from your health insurance first, but since I have a Group Health plan with no out of network coverage the VA couldn't collect on that. Even without the high deductible.
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Old 01-19-2016, 04:51 PM   #4
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Yes, you understand the subsidy issue correctly, VA care is considered essential coverage and my DH gets a coverage letter every year. Once you hit 65 you can have VA and Medicare at the same time, no problem. VA has billed my DH Blue Cross and Medicare on occasion yet it's zero balance billing and we owe nothing..they just take what they get.

Now you should be a Priority Group 3 which has no means testing there is a listing of all groups on the U S Veterans Affairs website.

Here in Minnesota we have great care thru the VA but I believe quality can very greatly around the country.
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Old 01-19-2016, 04:54 PM   #5
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My FIL used the VA as his primary care provider even though he was on Medicare and had a federal BCBS supplemental plan. VA took care of billing his insurances and picked up the balance. Here in San Diego we were very pleased with the quality of care he got. He had a plethora of issues - was wheelchair bound, had some dementia/brain damage , circulation problems in his feet and legs that go back to damage in WWII. (They almost had to amputate his feet due to gangrene from foot infections incurred while marching through mud and freezing mud.) My husband and MIL were very impressed with the doctors.

The VA facility in Kentucky was not as good - but still adequate.
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Old 01-19-2016, 05:05 PM   #6
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Thanks Rodi and Ivinsfan.

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Originally Posted by ivinsfan View Post
Now you should be a Priority Group 3 which has no means testing there is a listing of all groups on the U S Veterans Affairs website.
I was not aware that there was no means testing for any care I received. I thought I still had to pay for care that was not related to my service connected disability. It may be time to book an appointment and see how it goes.
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Old 01-19-2016, 05:29 PM   #7
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Please check the Vets Affair website for confirmation..this is my understanding of the groups the VA uses.

I do not know the size of your ACA subsidy, but if you don't like the VA you can go back to regular subsidized health care. Be aware your husbands subsidy may be affected by your going on VA. I'm 62 but since my husband has essential coverage our income % for ACA is counted solely toward my premium which means I ended up going unsubsidized off the exchange.ACA is still a work in progress....your subsidy dollar amount may go down considerably.
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Old 01-19-2016, 06:46 PM   #8
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It's generally considered to be the best quality care in the country. It's very integrated and comprehensive. My husband's stepfather lived in the VA nursing home for several years prior to his death. He had excellent care which was noticeably better than the nursing home where he lived while on the VA's waiting list. If it's a benefit that you qualify for, you should jump at it.
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Old 01-19-2016, 08:17 PM   #9
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I'm VA category 3 and although I get my primary healthcare from Medicare, I make it a point to get an annual checkup at my local VA clinic just to be sure I stay active in their system.

I have been very happy with my VA care. They try their best to meet any need I might express to them. In Category 3, you'll pay a nominal fee for meds not related to your service-connected condition, but otherwise I've never been asked to pay anything.
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Old 01-20-2016, 06:30 AM   #10
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I use the VA. 10% disabled. I live about 5 miles from the Minneapolis VA. No way I would qualify for anything free if they means tested.

Give the VA your insurance info. Anything you are seen at the VA for, service connected or not, will be billed to the insurance.

After the private insurance company processes the claim, any remaining amounts that would normally be paid by the patient, do not have to be paid. It does offset any deductible you might otherwise have to pay. The only co-pay I ever have to pay is the $8 per month, per prescription. I can use a private pharmacy instead if I want, if it was cheaper.

You could meet your entire $4,500 deductible without ever having to pay a dime. I plan on getting a bronze policy after I leave my employer.

You do lose any ACA subsidy, if you are eligible and use the VA.
http://www.militaryfamily.org/featur...rvice-aca.html

Quote:
Please note that if you are a veteran enrolled in a VA health care program, you already have MEC. This means you do not have to purchase additional coverage to meet the ACA individual mandate requirement. It also means that you are not eligible for a federal subsidy to lower your cost of health insurance premiums if you choose to purchase private health care coverage outside of the VA. You may still purchase private health insurance on (or off) the marketplace to complement your VA health care, you just won’t get the subsidy.

Even if the veteran is using VA health care, family members who are not enrolled in a VA health care program can use the marketplace to get coverage and they are eligible for a subsidy to lower their costs assuming their family income is not too high.
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Old 01-20-2016, 07:55 AM   #11
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Just to add to the confusion, I have a friend that is not service disabled. He just went to VA at Ft Belvoir to get his meds. He did have a paperwork shuffle to get into the system but after the dance, he got an appointment to see a DR and told them he was looking to get his meds. He has like 5 or 6 that he takes daily. After seeing the Dr he was told no copay, and he would start receiving them in the mail every 3 months. Then he would need to visit the Dr once a year to get prescription extended for another year. This was last week, so no meds yet, but I will be following his experience for my own path in about 2 years.
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Old 01-20-2016, 08:13 AM   #12
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Just to add to the confusion, I have a friend that is not service disabled.
Almost every veteran can get healthcare from the VA. If you do not have a service connected disability, you are means tested and a co-pay may result. And you are a lower priority, 8 out of 8. A SC disability is generally a 1-3.

If you have a low enough income, it's all free. Just like Medicaid.

Priority Groups - Health Benefits
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Old 01-20-2016, 09:44 AM   #13
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Wow, thanks everyone for such helpful responses!!! You guys really made my day!

I had an appt scheduled for this week with a Group Health provider for a preventative care appt that should be covered in full through the ACA, but I found out that if there is any mention of a preexisting condition it will no longer be covered and I will be billed for the whole visit. And who knows what that charge would be. I opted to cancel that appt, not worth the trouble. I was thinking I would have to find a provider that would give me a decent cash price for a visit which seems absurd when I do have health insurance.

I'll call my local VA clinic to set up an appt to establish care and see how it goes from there. The meds that I take are of the $10/3 months at Kroger variety so it would be great if I can take the prescriptions outside the VA system.
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Old 01-20-2016, 10:16 AM   #14
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Not to be a pest but if you enter into the VA system, your ACA policy will go away ASAP.

Also you haven't actually mentioned what your DH does for health care, but the ACA payments are set at a % of income. Depending on the amount of your subsidy, it's possible that your monthly payment might not go down in price. Also, if you have a HSA no money for you if you are in the VA system. I don't believe you can test drive the VA and keep an exchange policy in force.You definitely can give up some flexibility using the VA and their rules for covering emergent non-VA provider care can be very obtuse and difficult to follow.
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Old 01-20-2016, 10:25 AM   #15
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Quote:
Originally Posted by ivinsfan View Post
Not to be a pest but if you enter into the VA system, your ACA policy will go away ASAP.

Also you haven't actually mentioned what your DH does for health care, but the ACA payments are set at a % of income. Depending on the amount of your subsidy, it's possible that your monthly payment might not go down in price. Also, if you have a HSA no money for you if you are in the VA system. I don't believe you can test drive the VA and keep an exchange policy in force.You definitely can give up some flexibility using the VA and their rules for covering emergent non-VA provider care can be very obtuse and difficult to follow.
Thanks so much for checking on this. DH decided to do some contract work so he is not eligible for a subsidy. We are now buying our policies directly through the insurer.

I don't understand the comment about HSA money. We do have an HSA plan. Does this mean the VA can take money out of that? Or that I can't do an HSA plan? I wouldn't want to have the VA as my sole source of healthcare.
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Old 01-20-2016, 10:47 AM   #16
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The VA healthcare does not meet the requirements for an HSA account...so if you have a current account I believe that's fine, but if you switch to the VA you probably will not be able to add to your HSA, that's my understanding anyway. Double check this , but VA doesn't meet the high deductible needed for an HSA plan.

I misunderstood your first post, when you said ACA I assumed the exchange, you are in a better position this way as you can test drive the VA system and keep your private pay insurance. My husband did this for awhile before he hit 65...
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Old 01-20-2016, 02:52 PM   #17
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The VA healthcare does not meet the requirements for an HSA account...so if you have a current account I believe that's fine, but if you switch to the VA you probably will not be able to add to your HSA, that's my understanding anyway. Double check this , but VA doesn't meet the high deductible needed for an HSA plan.
This is correct, however if you have a plan in addition to the VA, you can have a HSA.
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Old 01-20-2016, 03:50 PM   #18
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This is correct, however if you have a plan in addition to the VA, you can have a HSA.
I wasn't sure about this detail, is this what you do personally?
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Old 01-20-2016, 04:10 PM   #19
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Reference: Compliance Alert - New HSA and ACA Reprieves for Veterans in Latest Highway Funding Bill | The ABD Team

Quote:
HSA Eligibility Expanded for Veterans

This HSA eligibility expansion for veterans is effective January 1, 2016.

Because the VA is not a high deductible health plan (HDHP), VA coverage raises HSA eligibility issues for veterans who are also covered under a HDHP.

The general rule (see Q/A-5) (link) has always been that a veteran who is eligible for VA benefits, but has not actually received VA benefits in the preceding three months, can still be eligible to make or receive HSA contributions. Veterans who have received medical benefits from the VA at any time during the previous three months are not HSA eligible.

The new change permits veterans enrolled in a HDHP (with no other disqualifying coverage) and who have a service-connected disability to make or receive HSA contributions regardless of when they received VA benefits. In other words, veterans with a service-connected disability will not be blocked from HSA eligibility merely because they accessed VA benefits in the prior three months.

Bottom Line: Veterans will welcome this change to ease the restrictions on HSA eligibility for veterans with service-connected disabilities who are covered by an HDHP but may also receive VA medical services.
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Old 01-20-2016, 04:23 PM   #20
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Excellent information, thanks!
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