VA Medical Care & Emergency Coverage

[dgoldenz]

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Originally Posted by Buckeye Followed up on your Humana recommendation. Just talked to an agent and we are submitting an aplication. He used the exact term as you, garbage, when I mentioned the CoreMed plan.Looks pretty good for $11,000 deductible, 100% co-insurance and $335 (got meds for a rash 6 months ago so they upped the premium a few bucks) per month (at least at this stage).

Which Humana plan are you looking at? They don't have one with an $11k deductible that I know of. I've replaced quite a few CoreMed plans...most people got them from their State Farm agent and don't even have any clue what they bought.

[Buckeye]

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Originally Posted by dgoldenz Which Humana plan are you looking at? They don't have one with an $11k deductible that I know of. I've replaced quite a few CoreMed plans...most people got them from their State Farm agent and don't even have any clue what they bought.

I rounded. It's $11,900. HumanaOne HSA100.

[dgoldenz]

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Originally Posted by Buckeye I rounded. It's $11,900. HumanaOne HSA100.

Make sure you are aware that plan does not cover prescription drugs. The "Enhanced" HSA plan does cover them.

[Buckeye]

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Originally Posted by dgoldenz Make sure you are aware that plan does not cover prescription drugs. The "Enhanced" HSA plan does cover them.

Thanks, dgoldenz. At this point, I'm assuming we would receive any required meds from the VA for a nominal fee. None required at this point.

[dgoldenz]

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Originally Posted by Buckeye Thanks, dgoldenz. At this point, I'm assuming we would receive any required meds from the VA for a nominal fee. None required at this point.

I wouldn't assume that. I've had people call me to buy policies because the VA wouldn't cover their prescriptions or other treatment....but I have no idea how VA coverage works, so definitely make sure to check on it. Trust, but verify, as they say.

[Buckeye]

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Originally Posted by dgoldenz I wouldn't assume that. I've had people call me to buy policies because the VA wouldn't cover their prescriptions or other treatment....but I have no idea how VA coverage works, so definitely make sure to check on it. Trust, but verify, as they say.

Verified in writing.

[dgoldenz]

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Originally Posted by Buckeye Verified in writing.

I'm curious how VA care works then....seems like I get a lot of people who are covered through the VA that still want an individual health insurance policy. There must be something missing, or is it just that you have to go to a VA care center instead of your choice of doctors/hospital?

[Buckeye]

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Originally Posted by dgoldenz I'm curious how VA care works then....seems like I get a lot of people who are covered through the VA that still want an individual health insurance policy. There must be something missing, or is it just that you have to go to a VA care center instead of your choice of doctors/hospital?

I am purchasing additional coverage to ensure we are covered for emergencies. As far as I know, I am not covered for emergencies if I go to a non-VA facility and emergency room costs can grow quickly. I think my local VA facility (Bay Pines) has an emergency room, but I may not be able to get there (or be taken there) in an emergency.

It is different for people who have retired from the military (which is not me or DH). Retirees can get care at civilian facilities paid for and are not required to use VA facilities. Non-retirees who are eligible for care at the VA don't have the same flexibility (which is appropriate).

Having choice is nice too but the main concern for me and DH is emergency care.

[dgoldenz]

Interesting. If you're only worried about emergency services, I'd definitely check out that Hospital/Surgical plan from BCBSFL. Your deductible would be $250 instead of $11,900 for about the same price.

[Buckeye]

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Originally Posted by dgoldenz Interesting. If you're only worried about emergency services, I'd definitely check out that Hospital/Surgical plan from BCBSFL. Your deductible would be $250 instead of $11,900 for about the same price.

The BlueSelect 229 policy looks like a good fit for a good price ($283). Is this policy medically underwritten? The fine print states a 24-month pre-existing condition limitation applies to all services. What exactly does that mean? They will never treat something I have been treated for in the last 24 months or is there a waiting period? What is the definition of a "condition?" Seems like one of the agents said BCBS is really tough.

[dgoldenz]

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Originally Posted by Buckeye The BlueSelect 229 policy looks like a good fit for a good price ($283). Is this policy medically underwritten? The fine print states a 24-month pre-existing condition limitation applies to all services. What exactly does that mean? They will never treat something I have been treated for in the last 24 months or is there a waiting period? What is the definition of a "condition?" Seems like one of the agents said BCBS is really tough.

I think so. I don't sell BCBSFL so I don't know anything about their underwriting. The pre-ex limitation means they won't cover any pre-ex conditions for the first 24 policy months. A pre-ex condition is usually anything you've been treated for in the past 2/5/10 years depending on the company's definition. Looks like the Plan 229 is the same as Plan 225, just with a higher deductible and out of pocket costs. I don't know what the network for that plan is like, but seems like a good fit if you can get non-emergency care at the VA when you feel like it.

Definitely talk with a BCBSFL agent though, I'm just making general observations here.

[ivinsfan]

Buckeye, if you don't mind my asking, did someone in the VA system tell you that you are not allowed to use the "fee basis" program? It's my understanding that you don't have to be retired or service connected to use this option.
I have a lot of interest in this as my DH and I are self-employed business owners. We would love to have an option to lower our self paid health care costs.I have looked at an option for high ded/lower premium exactly like the one you are considering. But I see per person, since I am NOT VA.. premium per year 2500+ 10000 ded + out of pocket...7500 =20000 possible out of pocket per year.
I also see if you have NO outside insurance VA has the "fee basis" option.The problem is getting a definitive answer from someone in the know from the VA system. If "fee basis" is an option that vets have earned thru their service, it should be used to benefit them.
In your case, since you are in you early 50's the savings could add up rather quickly. When my DH turns 65 he will go on medicare and we won't have too much to worry about...medicare and VA should add up to "belt and suspenders" at a fairly low cost.

[Buckeye]

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Originally Posted by ivinsfan Buckeye, if you don't mind my asking, did someone in the VA system tell you that you are not allowed to use the "fee basis" program? It's my understanding that you don't have to be retired or service connected to use this option.

No, no one told me we are not allowed to use the "fee basis" program. I did not know about the program so I need to do some additional research. I made the assumption we would have to pay the bill if we received treatment anywhere other than a VA facility. I guess I could just go over to Bay Pines and try to talk to someone in person. They do say (in writing) that coverage by the VA is considered creditable coverage.

We received notification today we were approved for the HumanaOne policy which is the $11,900 family deductible + $0 OOP for about $335 per month for coverage for the 2 of us. DH will be eligible for Medicare in about 3 years,

[Buckeye]

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Originally Posted by dgoldenz I think so. I don't sell BCBSFL so I don't know anything about their underwriting. The pre-ex limitation means they won't cover any pre-ex conditions for the first 24 policy months. A pre-ex condition is usually anything you've been treated for in the past 2/5/10 years depending on the company's definition. Looks like the Plan 229 is the same as Plan 225, just with a higher deductible and out of pocket costs. I don't know what the network for that plan is like, but seems like a good fit if you can get non-emergency care at the VA when you feel like it. Definitely talk with a BCBSFL agent though, I'm just making general observations here.

I talked to the local agent I was working with on the HumanaOne policy about the BlueSelect 229 policy. He pointed out that only things related to surgery are covered by this policy and things such as chemotherapy would not be covered. Should something like that be required, we would probably use the VA but it explains the lower cost of the plan. He also said the network is very limited which I found to be the case when I looked for my current and past primary care physician and GYN and could not find them in the BlueSelect network.

[dgoldenz]

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Originally Posted by Buckeye I talked to the local agent I was working with on the HumanaOne policy about the BlueSelect 229 policy. He pointed out that only things related to surgery are covered by this policy and things such as chemotherapy would not be covered. Should something like that be required, we would probably use the VA but it explains the lower cost of the plan. He also said the network is very limited which I found to be the case when I looked for my current and past primary care physician and GYN and could not find them in the BlueSelect network.

I agree with your local agent and that's why I would only consider that plan if you have care available elsewhere, like through the VA. As stated, I don't know how VA coverage works or what they will pay for, but if you are only looking for something in an emergency like you noted, the BlueSelect plan looks like a good option. The Humana policy will give you more network flexibility and cover more services, but with higher out of pocket costs.

[samclem]

Buckeye,
The info at this article discusses pending legislation designed to reduce the number of folks eligible for VA medical care. I don't know if you are affected or not, but be sure to look carefully before boarding the VA hospital ship.

[Buckeye]

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Originally Posted by samclem Buckeye, The info at this article discusses pending legislation designed to reduce the number of folks eligible for VA medical care. I don't know if you are affected or not, but be sure to look carefully before boarding the VA hospital ship.

Thanks for the link. I have purchased a high deductible policy (Humana100) which is what I would purchase without VA backup. Starts May 1 since my last day at work is April 29th. Gave 2 weeks notice on Monday.

Edit: Looks like they are not cutting the priority level for DH (6) or I (3) this time around but it's only a matter of time.

[fritz]

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Originally Posted by Buckeye Thanks for the link. I have purchased a high deductible policy (Humana100) which is what I would purchase without VA backup. Starts May 1 since my last day at work is April 29th. Gave 2 weeks notice on Monday. Edit: Looks like they are not cutting the priority level for DH (6) or I (3) this time around but it's only a matter of time.

I use the VA (6) and have BCBS in Illinois. Use a $5k deductible 80/20 with $3k out of pocket max @ $220/mos. This is primarily for emergency only and the plan's deductible coverage is actually lower for emergency coverage (a benefit). You should download/fill out the VA 1010EZ application and keep the electronic version on file - will need it. VA outpatient clinics will not accept anyone that did not register with them. If you have another place, you will need to reapply for that areas VA clinic (crazy, I know). You would be accepted at "any" VA hospital as a Veteran. VA meds are aro $6-$8/mos for a thirty day supply ($24/90 days).

[Buckeye]

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Originally Posted by fritz I use the VA (6) and have BCBS in Illinois. Use a $5k deductible 80/20 with $3k out of pocket max @ $220/mos. This is primarily for emergency only and the plan's deductible coverage is actually lower for emergency coverage (a benefit). You should download/fill out the VA 1010EZ application and keep the electronic version on file - will need it. VA outpatient clinics will not accept anyone that did not register with them. If you have another place, you will need to reapply for that areas VA clinic (crazy, I know). You would be accepted at "any" VA hospital as a Veteran. VA meds are aro $6-$8/mos for a thirty day supply ($24/90 days).

Our VA 1010EZ's have been saved electronically but I probably need to scan and save our acceptance letters. We registered with Bay Pines so I guess the local clinic will not accept us without some additional paperwork.

[fritz]

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Originally Posted by Buckeye Our VA 1010EZ's have been saved electronically but I probably need to scan and save our acceptance letters. We registered with Bay Pines so I guess the local clinic will not accept us without some additional paperwork.

Each VA clinic wants you to reapply - takes appx 30 days to find out if they will accept you. It's a good idea to apply and get acceptance for the Va Clinic in your primary/second home areas, or if you're thinking of moving.

In my local area - several clinics are associated with the VA hospital. Pretty sure I could go to any of them, but I couldn't go to the local one when in Florida w/o applying (affiliated with another VA hospital system). This is really odd (and not cost effective), as a lot of Veterans utilize the VA clinics, and it's virtually impossible to access your medical records at any of them while traveling/at your second residence if you get ill. Go to any VA Hospital, and they'll take care of you. Isn't that what we fault the uninsured for doing...

I have been told by my VA clinic - that in an emergency, the VA does cover non-VA hospital costs (the golden words in an emergency are "I'm a Vet - take me to a VA hospital"). I've also heard complaints to the contrary. Carrying our own insurance to cover all the bases and for peace of mind. The VA is a very fine medical care facility. Copays for doctor visits are $15.00 and you can rest assured they'll take very good care of you (not just flu shots)