With interest, I read an article on your website. Currently, I am
considered a veteran determined byVA to be unemployable due to service
connected conditions. Since I have the VA primary medical care, I also
have medicare part A and part B. I live a few hours away from a VAMC,
and in a situation where I might have to go to a local civilian hospital
or clinic. Would you suggest informing the VA that I have now medicare
part A and part B? As well, if I decide to get part D, will be charged
for prescripions from VA? I believe that VA and Medicare cannot charge
each other, due to being government departments. How does the VA and
medicare handle a situation, when an emergency or VA fee based occurs.
As a matter of fact, you and I are in the same enviable position. I'm
also 100% TDIU and I have SSDI/Medicare benefits. This places us in a
very high ranking of health insurance coverage that most people don't
have. Using it wisely is important to both maintain our health and save a
Yes. Any time that you visit the VA clinic or hospital they're probably
going to ask for any insurance card you may have. You should show them
your Medicare card. This has no impact on you personally, it's used for
statistical analysis. You're right...VA & Medicare don't cross bill
or pay one another.
"Would you suggest informing the VA that I have now medicare part A and part B?"
Most experts don't recommend that veterans who use the VA bother with
Part D. As you are rated 100%, you have no copays for pharmacy. If you
should ever need urgent prescriptions filled at a local pharmacy, the
out of pocket cost to you is likely to be far less than the yearly
premiums for Part D.
"if I decide to get part D"
Dealing with an emergency requires strict adherence to some rules. If
you go to you local civilian emergency room for an acute illness or
injury, they'll ask for insurance cards. If you hand them both your VA
card and your Medicare card, they'll bill Medicare and ignore the VA
card. Medicare is a higher payer and easier for the hospital to deal
with. As a general rule, if you contact VA immediately and seek transfer
to a VA facility, you'll be able to get VA to pay for the emergency
room visit. This can be a problem as the VA payment people are always
reluctant to cooperate. They are terribly inefficient so you have the
burden of documenting exactly who you speak with, what time it was and
"How does the VA and medicare handle a situation, when an emergency or VA fee based occurs."
The solution to this is advance planning. I urge all vets to work with a
family member or close friend to make an action plan in case you are
acutely ill and can't speak for yourself. Provide the direct number to
your VA hospital and so on so that they can begin the process to
transfer you to a VA facility. Even if you aren't transferred, the
effort is what counts.
I've also suggested that if you don't want Medicare billed for a
civilian hospital stay that you don't give them your Medicare card.
Rather, only provide your VA card. They're much more likely to assist
you with transfer to a VA facility that way and all their billing will
be directed to VA so that won't get confusing. If you do give the
civilian hospital your Medicare card, you may be responsible for the
copay and that can be expensive.
I use both VA and Part B for convenience. Part B is really pretty
inexpensive. For example, if a doctor bills $100.00 for a visit,
Medicare may allow that visit to be billed at $40.00. The doctor must
write off the $60.00 balance. Of that $40.00, you will pay 20% as the
copay. That's pretty affordable for most of us. I've used my Part B for
local civilian podiatry and orthopedic appointments because my VA
hospital just isn't doing very well in those departments. I've had
outpatient surgery procedures performed at local doctor owned
facilities and Part B covers that with similar deductibles and payments.
I don't use any Medicare supplemental insurance. I've investigated the
costs of supplemental policies to learn that they can be very expensive.
Many people report to me that even a supplemental policy leaves them
with copays that they didn't expect. Rather than paying a supplemental
insurer, I save the equal amount of money in a bank account so that I
can easily afford any copay but the most catastrophic one.
I also use a civilian general practice doctor for the times that I may
need treatment for a cold or flu-like symptoms and I just don't feel
like dealing with the VA. Don't get me wrong...I enjoy my VA primary
care doctor and I believe I get good care there. However, the telephone
calls, the triage process and so on can be an issue when I don't feel
well. My civilian primary care is 10 minutes from my home, my VA clinic
is 60 minutes and my VA hospital is 1 1/2 hours away. Often enough, I'm
willing to pay the small copay to visit the civilian and avoid the often
unfriendly VA process.
Keep in mind that not all civilian family/primary care doctors will
accept Medicare. All hospitals do accept Medicare and all doctors who
work for the hospitals are also Medicare providers. Many family practice
doctors focus their own efforts on private pay patient customers who
have a higher paying insurance like Blue Cross/Blue Shield and so on. I
had to speak with 3 or 4 doctor's offices before I found one who would
accept my Medicare. This is a business decision by individual doctors
and is legal and ethical. Many private practice family doctors no longer
have any hospital practice at all as hospitals now tend to use their
own "intensivists" (physician employees) to care for you while you're in
None of this has much to do with "fee basis". Fee basis is a
prearranged, preapproved VA process of farming you out to a civilian who
has already agreed to accept VA payments. Fee basis is often set up for
certain specialty doctors or procedures when VA can't reasonably
accommodate you. Everything other than life threatening emergencies must
be approved in advance to qualify for fee basis. Veterans who use a
civilian and then submit the bill to VA are often
rudely surprised to discover that VA takes a hard line and won't reimburse them.
Using your benefits wisely is just a matter of deciding in advance how
you want to get your care delivered and preparing for it. Once you have
your plan, you'll be getting what may be the best care at the lowest
cost in America.
I was just reading your article about using Medicare with your VA
benefits. I do have VA benefits, but have 0% rating. I have AARP
suppliment. In all your dealings with this, what do you recommend as the
My expertise, such as it is, is focused on VA benefits. I also have
Medicare Part A & Part B. I don't understand nor do I use Medicare
supplemental policies. I can't recommend any particular supplemental
I can tell you what I do personally.
I don't know what those things cost but I assume they range in the
neighborhood of $100.00 to $250.00 per month, depending on any number of
variables. Rather than paying that money to an insurance company, I put
it in my savings account at my bank. Then, when I do use a civilian
health care provider, I pay any copay out of my pocket. I try to keep a
fairly significant sum of money set aside for copays. The money is in an
interest bearing account, although the interest paid these days
probably doesn't equal the rate of inflation.
The way I do things is a calculated risk. In years past, I've saved
money by not giving it to an insurance company. If I were to have a
sudden catastrophic illness and I were admitted to a local civilian
hospital, I'd be in danger of generating a huge debt for a few days or
even a few hours of care. It's not unusual to see hospital bills that
are in the range of tens of thousands of dollars per hour for the
initial period of care.
However, my family understands that if such a thing were to happen and I
were unable to speak for myself, they are to aggressively see to my
transfer to my VA medical center. Once I'm stabilized, I'll go to the VA
facility where I trust my care will be as good as or better than the
local civilian care. With luck, VA will pick up the cost of my initial
care at the civilian center. I say "with luck" because that's usually a
difficult option and VA argues against it most of the time. If the
veteran documents well and pursues it, he or she will usually prevail.
In any case, I've used civilian providers successfully with my strategy.
Most of my care is provided by VA and I'm happy with it. I run into
occasions where I just can't get along with it though and I turn to a
civilian provider. For example, in 2011 I needed a sleep study....I have
sleep apnea. The VA sleep lab service is terribly backlogged and
studies require months of waiting. VA does a traditional sleep lab study
and most science says that isn't necessary these days. I found a
civilian provider 5 minutes from my home who offered a home sleep study.
Once I determined that she accepted Medicare, I scheduled a visit. I got
a fairly complete physical and in a week or so I stopped by to pick up
my sleep study equipment to carry home that evening. It consisted of a
headband that I was instructed to place around my forehead as I retired
for the evening. It was reasonably simple to use. I returned it the next
day. The doctor then sent the results to a pulmonary specialist who is
certified to read and interpret the results. I was prescribed a CPAP
machine and an appointment was made for me at a local office of a
nationally known provider of home medical equipment. I met with a
respiratory therapist who fixed me up with a high quality machine, mask
and instructions for use.
All of this cost me less than $300.00 out of pocket. I believe that may
be less money than if I had been paying for a supplemental policy that
may or may not have paid for all my copays. I've used this strategy for
orthopedic care and podiatry care. I've had minor surgical procedures
performed locally by these providers and copays have been less than
$100.00 out of my pocket.
My strategy has some small risk. But, to be honest, I just don't trust
that any of the supplemental insurers have my best interests as their
goal. My strategy also requires some self discipline. If you don't save
the money, you can come up short one day and be unable to pay a few
hundred dollars that will be required.
We have terrific health care benefits as veterans who have both VA care
and Medicare. The great majority of Americans don't have anything close
to our level of care. Although your 0% rating will require some small
copays at the VA, you have access into the system and that's important.
You may even ask that VA copays be waived, depending on your financial