Questions for a fellow VET on VA medical care/Medicare

I have already enrolled with the VA  concerning my medical care since my VA disability was approved.  I went in person to the new VA Outpatient Clinic in Greenville.  They took all the info, looked it over, said no problem, would be qualified for 100% care.  But said it might take 4-6 weeks to get final approval from the VA in Columbia.  Once granted, I would be sent a card and information, and that they would schedule me for an initial visit with one of their doctors at the outpatient clinic.

My question is there.  Prior to the VA, I was on Medicare only the past 2 plus years.  Now that I will be getting the VA as well, will Medicare be my primary and the VA secondary, or is it the other way around? I didn't get a clear signal on that.  Or does it make a difference in my treatment options?

I was told both by the rep at the outpatient clinic and by my current doctors office, that I would not be forced to change doctors, that I could still keep the same one.  Or if I wanted a new doctor, the VA would provide from their own list.  Does this sound accurate?

Appreciate any help from any of you seasoned HW PC Vets, that are using VA medical care, or perhaps using both like I will be.

David

Post Edited (Purgatory) : 12/1/2013 10:35:53 PM (GMT-7)

Didn't get the drift of your last sentence, but perhaps I am just getting tired.

Appreciate the other info.

I have a non PC problem that has been lingering and getting worse, that is common to those that underwent extensive neck/throat radiation and for those on long term pain meds. Called "crumbling teeth". I have lost so many teeth the past 3 or 4 years. They are not due to common cavities or decay, they simply just break apart, or snap in two, and in most cases, there is no pain involved.

There was a recent thread at HW CP about this subject, and it seemed to be common to many members. So I will be needing dentures in my near future. The VA rep at the clinic said I would definitely be covered 100% for dental, including dentures. I don't look forward to having this dental work done, but if you saw my mouth, you would understand why almost non one ever sees me smile, its just plain embarrassing. In my case, it was the direct result of the neck and throat radiation back in 2000. Was told at the time that this would happen and it would catch up to me. So its great to know this should be covered.

And I plan to use the VA side of things for any new health issues not related to PC. I am fortunate at my age to have good eyes and good ears, but these things can quickly change as we age.

That sounds like you got quick action from your VSO, which is encouraging to me. Thanks for the reply.

Yes, ever since the VA approval came in, I have been endlessly busy, still working down a very long check list of things to do or things to check out. But at least this is all positive and productive work.

David

P.S. I have been putting together all the parts of a full Navy dress uniform, as it were when I left the service. It's amazing what you can find right on e-bay. In the 42 years since I have been out, I had very little left of any my original stuff. This would be the "Cracker jack" wool dress jumper, complete with my duty station badge, name tag, rank, job, etc, and all my medals. Kind of been a neat project after all these years.

I have all four of my medals intact, and recently purchased new and clean ribbons to replace the old ones, and a proper ribbon holder. Amazed how easy it is to buy things like this on-line.

I don't think one is allowed to wear a uniform, even on Vet's day, but please correct me if am wrong. I don't know this stuff like you do.

I have a great Part B and drug plan, just replaced AARP with Blue Cross. Much better coverage, less per month, and way better drug prices. Even if I stuck with that for now, I would be money ahead. While the outpatient clinic is only 15-20 minute drive, if they wanted me to have stuff down at the real hospital in Columbia, that would be more problematic for me, as it would entail a 125 mile drive each way.

I'll tell you the experience I had with my father - he had a service connected disability and had both medical and the VA. Basically the two were separate. If he went to the VA, he could only see VA doctors and could only get meds through the VA. But he could see anyone outside the VA that took medicare but the VA wouldn't fill any prescriptions not written by a VA doctor. My dad didn't have the complex medical situation you have so it was a bit easier.

We would get his regular meds through the VA and if there was an emergency or urgent issue we go to a local ER or clinic. Then we'd schedule a follow up through the VA.

That was my experience with the two systems.

and the uniform thing sounds like a great thing to do - should be fun collecting all the bits.
Andrew

David,
If you are 100% service connected you may be eligible for Tricare. it is an insurance program like the Medicare Advantage program, a supplement to Medicare that pays what Medicare does not pay, and also covers most medications with a small co-pay. There is no cost for Tricare for Life for those over 65. Tricare is an insurance program just like any another HMO or PPO, but costs much less or nothing if you are over 65. It would be secondary to Medicare.

The VA care is totally different. If you are going to the VA you must use their doctors and are required to go to a clinic once a year for a checkup. You can also get Meds through their system. They also have a priority system in which service connected get priority over other veterans in regards to appointments ect.

I've been going to the VA for over 44 years and have never used them for any health issue other than my leg. I've always had private insurance or Tricare. I would never use the VA for a serious condition, the way they treated your claim is an indication of how the system now works, it is very bureaucratic. For other issues like dental or vision they may be OK, but don't expect the same level of service you are currently getting from your private doctors.
You should talk to Sonny as I believe he got Tricare when he was classified as 100%. You should also get commissary and other base privileges.

brewer, good advice, pretty well did that, I qualified for a unit citation for my squadron, that still wasn't available when I got out. right now, I have 4 total, and pretty sure its all I "earned". great web site.

Andrew, what you said sounds about right. my current meds (mostly strong pain meds) will be kept going by my current doctor, pain meds are difficult to deal with these days, regulations, etc, and rather not mix up the flow. my new bluecross medicare plan goes into effect jan 1, and I will never have to pay more than 15 bucks even for the most expensive meds. I plan to use the VA side for other medical issues, my general health, and if/when I need advanced PC treatments, will weigh it out between both insurances to see which benefits me the best.

Michael, thanks for your info. while the new outpatient clinic here in Greenville is huge, it would be a hassle for me if I had to go to va hospital itself, as its in Columbia, which is 125 miles from where I live, so hopefully, I will be able to use as much local as possible.

JohnT, I am 100% service connected, but I am only 61 years old. Only on Medicare because I am also 100% with SS Disability, so I am not sure how that would pay out with Tri-Care. My mother is on Tri-Care because of my father being a lifer in the Navy, and she has Medicare, but she is 87. I am still working on the commissary/px part, the instructions were a little less care, I may have to call my VA contact in DC to get that clear. Also, was told I could get free life insurance, but with my cancer history, wonder if I would be disqualified? But now that we are under the ACA, not suppose to be penalized for pre-existing conditions. Need to clarify that at some point. Yeah, Sonny is a wealth of knowledge on this stuff, me and him - applied within a month of each other.

Susie, sounds like a good warning and some good advice, will keep that in mind when it all starts to happen.

David

 David, so happy to you had a productive meeting with  Vet office.  I do get confused.  I thought you had to be 65 to get Medicare?  I thought under 65 was Medicaid?  I am happy they are forwarding things more quickly!

Hugs,

Aimzee

Dave/Purg,
I am not 100% Permanent as is John T and Sonny---I would tend to follow their advice--use your civilian doctor if at all possible since the turn-over at the VA is tremendous. If I had used my HMO instead of the VA I would not be here now; just food for though and to be cautious!
Bill