VA Medical Care & Emergency Coverage

[Buckeye]

I am seriously considering pulling the plug on my current job. I am 52 and my husband is 62 so medical coverage is one of the things that has to be addressed. We are eligible for VA medical care as a result of our service although we are not retired military. Bay Pines VA hospital and local VA clinics are available near where we live.

VA medical care will be fine for regular stuff (once a year visit for a physical) but we would have no coverage if we were taken (or went) to a non-VA hospital as a result of an accident/emergency. Our car insurance could cover us if we were injured in a car accident but not if someone ran into us while walking on the sidewalk.

To resolve that issue, I applied for a high deductible policy from Assurant that would cap our expenses ($10k deductible+$7.5k out-of-pocket) and provide for contract rates if we wanted to see a non-VA provider. I was notified today we were approved at a cost of $335 per month. We started at $300 but $35 per month was added because of my chiro visits at the end of last year. My back issues were resolved when we figured out I needed a lift in my left shoe. Supposedly I can apply a year from my last chiro visit (Feb) to have the $30 extra charge removed. I'm not holding my breath.

Does this sound like a good way to deal with the lack of emergency coverage? Any other ideas? Am I worrying too much about something that may never happen?

 

[dgoldenz]

Why Assurant? Their rates are usually far from the best...

 

[Buckeye]

Why Assurant? Their rates are usually far from the best...

I talked to BCBS directly and the best they could do was $360 before any health history was taken (quote based only on age). They had a plan with a $10,000 deductible but then 100% coverage which drove up the cost.

A local agent quoted Humana Copay 70 at $340 (quote considered only age and weight) and Cigna Open Access was $577 (yikes). I think I did an online quote of UHC and it was in the $350 range before any health history.

I thought the $335 was relatively reasonable but then I expected the worst. Does it sound unreasonable to you for the coverage provided? Anyone else you would recommend?

 

[Buckeye]

Why Assurant? Their rates are usually far from the best...

My husband and I are both covered for the $335 premium. Just wanted to be sure that was clear.

 

[rescueme]

We are eligible for VA medical care as a result of our service although we are not retired military.

Are you in the VA system? In otherwords, are you really covered?

The question is asked due to your saying that you are not retired military and it dosen't say if your VA coverage is service connected, via the classification system. See:

http://www.va.gov/healtheligibility/Library/pubs/EPG/EnrollmentPriorityGroups.pdf

Even though I'm a priorty group 3, services are limited due to my income level (even though I'm retired). The only reason I go to the clinic is that they normally have flu shot doses on years when the supply is limited from other sources, and they want to update my records to ensure I get it.

It's something you may want to check on...

 

[Buckeye]

Are you in the VA system? In otherwords, are you really covered?

The question is asked due to your saying that you are not retired military and it dosen't say if your VA coverage is service connected, via the classification system. See:

http://www.va.gov/healtheligibility/Library/pubs/EPG/EnrollmentPriorityGroups.pdf

Even though I'm a priorty group 3, services are limited due to my income level (even though I'm retired). The only reason I go to the clinic is that they normally have flu shot doses on years when the supply is limited from other sources, and they want to update my records to ensure I get it.

It's something you may want to check on...

Yes, we are in the system and we have it in writing. We went through the application process.

 

[DFA]

I don't know all the instances of coverage, but have you checked into TriCare, I use it for perscriptions from my cilivian doctor (saves a bunch @ 3.00/per). I use the VA for service connected, but have used it for other things an just had to pay for meds, but it was space available, but never had to wait more then a couple of weeks.

 

[ivinsfan]

This is a very confusing area...my husband also has VA coverage... I have been doing some reading about emergency care. Some people tell me if you have a true "emergency" and need to go to a non-Va provider, there are rules in place that allow VA to pay for emergency care. This program is called "fee basis" There are quite a few rules involved, so I don't feel confident giving too many specific details, but you may want to check in to it yourself.

 

[dgoldenz]

Where do you live? I've never found a place where Assurant had the cheapest coverage. I would take a $10k HSA plan with 100% co-insurance over a $17.5k OOP max plan for a $25/month difference. $300/year to potentially save yourself $7.5k/year sounds good to me. BCBS's network is also much, much better than Assurant's.

 

[Buckeye]

Where do you live? I've never found a place where Assurant had the cheapest coverage. I would take a $10k HSA plan with 100% co-insurance over a $17.5k OOP max plan for a $25/month difference. $300/year to potentially save yourself $7.5k/year sounds good to me. BCBS's network is also much, much better than Assurant's.

We live in Largo, FL which is west of Tampa. The insurance is mainly meant to be emergency coverage. Any non-emergency visits would be at the VA for a nominal fee. I haven't been to the emergency room since I was 3 and DH hasn't been in the 20 years I've known him. I hope our luck doesn't run out but just in case, I would purchase this insurance to limit our emergency expenses.

If I was going to spend the extra money, I would probably spend it on med pay coverage on our auto insurance to cover the deductible and OOP in the event of an injury accident since that is probably the greatest risk we face every day that would send us to the emergency room.

I suppose I could contact a BCBS agent and get a quote based on our health history. I figured my relatively recent engagement with the chiro (last visit in early Feb) would cause BCBS to add a surcharge (at a minimum) like Assurant did so our premium would be at least $380 a month. Or I might wait until my last visit to the chiro is a year old and apply with BCBS.

I found both our new and old primary care doctors (switched to a new one recently) and my gyno were in network with Assurant. Assurant's CoreMed plan provides one free wellness visit per year and one free colonoscopy every 3 years.

 

[dgoldenz]

We live in Largo, FL which is west of Tampa. The insurance is mainly meant to be emergency coverage. Any non-emergency visits would be at the VA for a nominal fee. I haven't been to the emergency room since I was 3 and DH hasn't been in the 20 years I've known him. I hope our luck doesn't run out but just in case, I would purchase this insurance to limit our emergency expenses.

If I was going to spend the extra money, I would probably spend it on med pay coverage on our auto insurance to cover the deductible and OOP in the event of an injury accident since that is probably the greatest risk we face every day that would send us to the emergency room.

I suppose I could contact a BCBS agent and get a quote based on our health history. I figured my relatively recent engagement with the chiro (last visit in early Feb) would cause BCBS to add a surcharge (at a minimum) like Assurant did so our premium would be at least $380 a month. Or I might wait until my last visit to the chiro is a year old and apply with BCBS.

I found both our new and old primary care doctors (switched to a new one recently) and my gyno were in network with Assurant. Assurant's CoreMed plan provides one free wellness visit per year and one free colonoscopy every 3 years.

CoreMed is a garbage plan IMO, but if you can get VA care would make it a bit better. You might want to look at the BCBSFL BlueSelect Hospital Surgical Plus 225 plan. It's a hospital/surgical plan, but it sounds like that's what you're looking for. The deductible is $250 and max OOP is $2,500. Premium is about $360/month. Could be a good fit if you can get care at the VA when you feel like it. Here's a link to the brochure:

http://www.ehealthinsurance.com/ehe...P-BCBS-FL-HCR-BSelect-IU-Ben-Sum-11-01-10.pdf

 

[samclem]

Buckeye,
Not to belabor the point, but is there some way you could verify that you'll be able to actually get medical services through the VA? I could apply and get approved for care, but due to their prioritization system, I'd never be able to see a doc unless the problem was service-related or I was truly indigent. If I were in your boots, I'd call the VA and try to get an appointment for treatment of an ailment before making any decisions.

 

[Buckeye]

Buckeye,
Not to belabor the point, but is there some way you could verify that you'll be able to actually get medical services through the VA? I could apply and get approved for care, but due to their prioritization system, I'd never be able to see a doc unless the problem was service-related or I was truly indigent. If I were in your boots, I'd call the VA and try to get an appointment for treatment of an ailment before making any decisions.

Yes, that's probably a good idea but I will have to cancel the appointment before going to it or I will be in trouble with my HSA. My current plan with my employer is an HSA and both I and my employer contribute each pay period (every two weeks). It is my understanding I cannot contribute to an HSA for 3 months if I receive services from the VA. The problem is there is no way for me to stop my or my employer's contribution.

I personally know people who receive care at the VA who are Priority 6 so it's not a stretch that I (Priority 3 with 10% disability rating) and DH (Priority 6/Agent Orange) would receive care. Their experience is what prompted me to fill out the application and learn I and DH are currently eligible for care.

 

[ivinsfan]

My DH is also included under boots on the ground AO exposure, he is 62. He enrolled at the VA 3 years are when it was reopened to certain Vietnam vets. He gets all his care under VA with minimal co-pays. He stills has BCBS thru work but they do not care if we use VA. We have never had to do any means testing or income reporting.
We live in a rural area and are 45+ minutes from VA care. The fee basis program might help him if we lose BCBS....from the reading I have done, it appears to qualify for fee basis, VA must be your only form of health care. If you have any outside insurance at all, VA will not step in and make payments for emergency care. However to use this provision you must have received some health services from VA within the last 18 months or so. I did mention the rules were confusing, also it is very hard to find someone with the answers to these questions. However eyeryone I have talked to about the VA system says that once you are enrolled it is important to use the system for healthcare on a somewhat regular basis, in order to make sure you preserve your rights to ongoing care.
Also, so many "modern" health problems have been declared AO presumptive and service connected, I really feel VA is the place to be.

 

[rescueme]

However eyeryone I have talked to about the VA system says that once you are enrolled it is important to use the system for healthcare on a somewhat regular basis, in order to make sure you preserve your rights to ongoing care.

That's why I get my annual flu shot there, even though I go for health care through my PCP using my megacorp retirement health plan. At least they scan my VA card and know I'm still around, regardless if I don't go there for regular care ...

Also, so many "modern" health problems have been declared AO presumptive and service connected, I really feel VA is the place to be.

Yes, being "one of those ", that "worked" in full spray and the burn pits, I never know what the future will bring, both in my health and the possibility of not being covered by my current commercial health coverage...

 

[JARON46]

My Brother age 62 lost his job and medical insurance, he applied to the Veterans Administration for medical and was turned down the first time (4 years in Navy in 60's).

He re-applied and was accepted, he must use Veteran's Clinics and hospitals but for an emergency they told him to go to any hospital and they would negotiate and pay the bill.

He also gets prescription drugs from them with a low co-pay

 

[rescueme]

My Brother age 62 lost his job and medical insurance, he applied to the Veterans Administration for medical and was turned down the first time (4 years in Navy in 60's).

Did they say why (just wondering)?

The reason I ask is that a lot of folks think that they qualify for VA health benefits just because they served.

I've run into folks trying to get benefits (while waiting in the local VA clinic) for their aged relatives that have served, and are running into problems getting support.

 

[JARON46]

Did they say why (just wondering)?

The reason I ask is that a lot of folks think that they qualify for VA health benefits just because they served.

I've run into folks trying to get benefits (while waiting in the local VA clinic) for their aged relatives that have served, and are running into problems getting support.

I do not know the details but I think the VA runs "Hot and Cold" when accepting applications, my understanding is that they are now accepting anyone who once served in the Military.

On another note his wife was able to buy into a state run plan for people who had pre-existing conditions and were currently un-insured.

This was in September 2010 and the money for the plan was provided by the Feds due to the new Health care law.

I think she pays about $500 per month for the insurance, but she could not get it at any cost before.

So I think the new Health Care Law is not all bad.

 

[braumeister]

The VA medical system is fairly complex, and it does change from time to time. What you get is based mainly on which of the many "priority groups" you fall under. You can go to the va.gov website and download a copy of their 10-10EZ form, which is used to apply for VA medical benefits, and the form instructions give you a pretty good feel for how it will work in your case.

For myself, I have Tricare as my main coverage, but I go in for a checkup at the nearest VA clinic every year just to keep myself active on their books. Free flu shots are a great deal, too.

 

[Buckeye]

CoreMed is a garbage plan IMO, but if you can get VA care would make it a bit better. You might want to look at the BCBSFL BlueSelect Hospital Surgical Plus 225 plan. It's a hospital/surgical plan, but it sounds like that's what you're looking for. The deductible is $250 and max OOP is $2,500. Premium is about $360/month. Could be a good fit if you can get care at the VA when you feel like it. Here's a link to the brochure:

http://www.ehealthinsurance.com/ehe...P-BCBS-FL-HCR-BSelect-IU-Ben-Sum-11-01-10.pdf

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).

 

[dgoldenz]

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]

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]

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]

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]

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.