Does medicare affect eligibility to use private insurance? in Tricare, VA, ChampVA, Fee Basis, Medicare etc. Forum

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Does medicare affect eligibility to use private insurance?

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Insider

Does medicare affect eligibility to use private insurance?

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Posts: 845

Mar 2 12 12:54 AM

I am 100% P&T; OPM also saw fit to medically retire me from my federal employment (due to SCD disability) and, I continued my health insurance though that job; I was then approved for SSDI and started getting payments for this in 9/11. I am 53.

1. Must I enroll for Medicare at two-years into SSDI (or is it automatic)?

2. Will I (or family) continue to be eligible to use my private/government sponsored health insurance even if I have Medicare? While my wife and I (both veterans) use the VAMC, we, and or children, also use private providers and our private/government sponsored insurance.

3. I believe that my spouse and 17-year old are eligible to have CHAMPVA since I am P&T? How, or does, this affect the current private insurance or the future eligibility to receive Medicare for myself (since I guess my wife would not be eligible in her own right)?

4) When do dependent children lose their eligibility for CHAMPVA?

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The Old Medic

#1

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Posts: 6231

Mar 2 12 3:40 AM

Medicare enrollment is Automatic for Part A, but you need to sign up for Part B It is currently just a tiny bit under $100 per month, taken out of your SSDI.

SOME private medical insurance if affected by Medicare, some isn't. You need to check into YOUR policy and find out.

Champ-VA will cover most expenses, and a supplemental policy will likely be a LOT cheaper than any private medical insurance you could buy that covers what CHAMP-VA does.

So, instead of just asking questions here, look at, and compare costs for YOUR PARTICULAR SITUATION.

US Army 1959-1969; SFC E-7 MOS: 55G10 (60-63) , 91B40, 91C40, 91F40 (64-69)
Ed.D in Rehabilitation Counseling, Certified Rehabilitation Counselor Retired, Licensed Clinical Psychologist, Independent Social Security Contract Vocational Expert 1983-2005, Contract Medical Expert 1987-2005
80% Service Connected Disabled; Life Member of the DAV since 1980

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mazboy

#2

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Posts: 762

Mar 2 12 9:23 AM

talk to your private insurance carrier they'll tell you everything you ever wanted to know.

as for champVA, call them and ask them all of your questions: http://www.va.gov/hac/for...ciaries/champva/faqs.asp

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DEROS1969

#3

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Posts: 2840

Mar 2 12 11:47 AM

Take Medicare A&B. They will notify you when time comes. Your private insurance will act as a supplement or secondary insurane to Medicare.

Your private insurance is primary or pays first and ChampVA pays second for your family.

The best and least expensive insurance for you is GEHA or Goverment Employee Health Admin.

Continue to use VA as you and wife want too.

You will be in great shape. Your situation is exactly like mine.

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Insider

thanks for the replies!

#4

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Posts: 845

Mar 2 12 12:52 PM

DEROS1969 wrote:
Take Medicare A&B. They will notify you when time comes. Your private insurance will act as a supplement or secondary insurane to Medicare. Your private insurance is primary or pays first and ChampVA pays second for your family. The best and least expensive insurance for you is GEHA or Goverment Employee Health Admin. Continue to use VA as you and wife want too. You will be in great shape. Your situation is exactly like mine.

Yeah, the question was prompted from a situation I read of a while ago where some former federal employees (retired) did not want to have medicare, but rather, wanted to continue using their private government-sponsored health insurance. It went to court and the judge ruled against them saying that if they wanted to reject medicare then they would need to reject ALL social security related benefits.

In my area GEHA is pretty high or at least I thought it was (I will look into GEHA again at the next open season). I use NALC now (but worked for the VA prior to medical retirement). Would you happen to know when children-dependents (still in school) are no longer eligible for CHAMPVA due to age? Glad to know that keeping the federal health insurance is a good strategic move.

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hutsky

#5

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Posts: 2812

Mar 2 12 5:35 PM

Insider,

Since your current insurance is with OPM as a retired Government employee your situation may be a little different, and possibly better, than some with other private insurance. You certainly have several options available.

You probably are paying about a third of the actual cost for NALC insurance and the government is picking up the rest. It acts as the primary payer for your entire family, including yourself.

Since you are rated P&T by the VA your family, but not you, is now eligible for ChampVA. By enrolling, it will become secondary payer for family members if you keep the private insurance in force. If you do not keep the private insurance, ChampVA will be the primary carrier for the family, but not you. ChampVA, without the other insurance, would provide probably about the same or as good coverage for the family as the present private insurance does. By, carrying both you will virtually avoid any deductibles or co-payments.

By not carrying the NALC insurance you would personally be without insuance for care obtained outside of the VA until such time that Medicare became available to you, assuming you elected to enroll in Part B.

Some of the earlier recommendations seem to deal with a supplemental policy to ChampVA if it were the primary carrier for the family. If you later go under Medicare it might be worth looking into this approach. You can compare the cost of a supplemental policy to the cost of continuing the NALC coverage as primary and ChampVA secondary.

OPM permits a retiree to suspend instead of cancelling government health insurance. This merely means that you can resume it in the future if you decide.

In addition, VA health care is there for you and your wife to use as you see fit. Regarding the question about coverage for your children I think they remain under ChampVA until age 18 and a dependent and the normal coverage is extended through age 22 while a full time student. I also believe that the option for coverage has been extended for dependent children to age 26 but the cost can be very high.

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Insider

#6

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Posts: 845

Mar 2 12 7:14 PM

Sweet, really sweet! happy

I will definitely keep NALC (currently the premium is $327/mth) until I am well established with medicare. Then I may suspend. I have non-service related non-hodgkin's lymphoma (I was told it was "generally" a slow growing type) and, at this point, want the opportunity to access private healthcare for that disability. Most important, though is taking care of the wife and kids!

Edited 1 time by Insider Mar 2 12 7:21 PM.

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DEROS1969

#7

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Posts: 2840

Mar 2 12 8:30 PM

"OPM permits a retiree to suspend instead of cancelling government health insurance. This merely means that you can resume it in the future if you decide" Not correct because I tried it. You can only drop dependent coverage not suspend it. Then you can reenroll dependents during any new enroll period. The problem is that if you die before the reenroll period in NOV.,Dec. then your family will be without private insurance forever. Dangerous game.

I went around and around with OPM because I thought it could be "suspended". It can not.

At $327 you must be carrying High Option. My GEHA was $173.

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hutsky

#8

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Posts: 2812

Mar 3 12 1:55 PM

Insider,

Deros1969 brings up a point about suspending OPM health insurance that I was not aware of. That fact just interjects another decision element into your individual situation. It is good to have people posting here who have personal experience with the issues that come up. It would also be important to know if the ChampVA coverage would continue in the event of your death. That would lessen the risk of not having other insurance coverage. Basically the DIC coverage, which includes ChampVA, applies when a death is due to a service connected condition or for any cause when the 100% disability rating has been in effect for 10 years.

I personally suspended my OPM coverage when I became eligible for Medicare because I also had Tricare (essentially the same as ChampVA) coverage that would have continued for my spouse. Until she also became eligible for Medicare we just absorbed the deductibles/copays which were considerably smaller than the premiums.

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LouF

#9

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Posts: 12984

Mar 4 12 9:50 AM

10,000 plus post...

Here is my situation, wife has Medicare A&B plus ChampVA. ChampVA acts the same as a Medigap supplemental but is free. ChampVa is free to her and your kids but since ChampVa has about a 25% deductible. It is important to get a ChampVA supplement but it should be a lot cheaper than your current cost.

Now as to you, Medicare A&B is great if you have a supplement, I pay about 100 each for B and a supplement, I declined D because I get all meds from the VA. The effect is that except for a small deductible, everything is free. The problem I think you may have is that I have heard that you may not be able to buy a medigap supplement until you are 65.

The best advise I can give you is find an insurance agent that just does benefit insurance and go over your options and costs.
I read everything on VBN and was still very confused, he and I ran the numbers the benefits etc and came up,with the plan

Lou SSG
Santa Fe NM
4/21 11LIB Americal
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50% PTSD
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100% IU P&T

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DEROS1969

#10

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Posts: 2840

Mar 4 12 8:14 PM

What are you talking about LouF? Excuse me but your not in the same ballpark or on the same page as this tread. What you have done is nice to hear but the relationship to what you did and insider is minimal.

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hutsky

#11

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Posts: 2812

Mar 5 12 2:17 AM

One other point to keep in mind when dependents are covered by ChampVA and considering whether or not to carry other insurance, primary or supplemental. There is a cap of $3000 on out of pocket expenses with ChampVA so to pay that much or more for other insurance would not be necessary. Unless there was a big problem it is doubtful that expenses would reach this level.

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chicagobob25726

#12

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Posts: 3174

Mar 5 12 12:07 PM

Th only insurance I took from OPM when I retired from DOJ was VISION!!

"The NAVY CHIEF IS ALWAYS RIGHT"

CPO "INITIATED AND PROUD"
100% I.U/P&T/Combined 80%
70% G.A.D/MAJOR DEPRESSION
30% Headaches
10% Back
10% Knee

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nickfuhs

#13

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Posts: 1970

Mar 6 12 10:27 PM

The following is my understanding not from personal experience with these plans but based on 15 years in the private health insurance business and reviewing what is on the web on these situations. Whenever you have moe than one health insurance, the question becomes which is primary and which is secondary.

You indicated that your wife is also a veteran receiving care at the VA. Does this apply?

"An eligible CHAMPVA sponsor may be entitled to receive medical care through the VA health care system based on his or her own veteran status. Additionally, as the result of a recent policy change, if the eligible CHAMPVA sponsor is the spouse of another eligible CHAMPVA sponsor, both may now be eligible for CHAMPVA benefits. In each instance where the eligible spouse requires medical attention, he or she may choose the VA health care system or coverage under CHAMPVA for his/her health care needs. If you have been previously denied CHAMPVA benefits and you believe you would now be qualified, please submit an application following the guidelines as listed on the “How to apply” section."

-http://www.va.gov/hac/for...ries/champva/champva.asp

from same website:

"CHAMPVA is always the secondary payer to Medicare. If you are eligible for CHAMPVA, under age 65 and enrolled in both Medicare Parts A&B, SSA documentation of enrollment in both Parts A&B is required. "

With regard to your private (OPM) insurance, CHAMPVA would always be secondary, by law, to that insurance - meaning that you would have to follow the rules of your private insurance (when seeing providers outside of the VA) and CHAMPVA would then consider any balances remaining after your private insurance had paid/processed your claim.(if you didn't have the FEHB plan) See http://www.va.gov/hac/fac...ampva/FactSheet01-23.pdf

If you keep FEHB (as a FEHB retiree), Medicare would be primary and FEHB would be secondary, and CHAMPVA ( if eligble as a spouse) would be third in line. For your wife and children, FEHB would be primary and CHAMPVA secondary. When deciding to keep or drop FEHB , consider the age that children become ineligible for coverage under CHAMPVA and FEHB as they may be different.

If you intend to travel outside the US, be aware that Medicare generally doesn’t cover health care while you are traveling outside the United States.

Nick

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hutsky

#14

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Posts: 2812

Mar 7 12 11:55 AM

nickfuhs wrote: (actually quoted)

"An eligible CHAMPVA sponsor may be entitled to receive medical care through the VA health care system based on his or her own veteran status. Additionally, as the result of a recent policy change, if the eligible CHAMPVA sponsor is the spouse of another eligible CHAMPVA sponsor, both may now be eligible for CHAMPVA benefits. In each instance where the eligible spouse requires medical attention, he or she may choose the VA health care system or coverage under CHAMPVA for his/her health care needs. ........."

I interpret this to mean that both spouse are 100% P&T veterans or are entitled to CHAMPVA by some other means. No doubt this is possible, but unlikely.

Your presentation of the rules governing health care payment responsibilities was very good.

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Insider

#15

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Posts: 845

Jun 25 12 4:32 PM

Right, my spouse is SC at only 60%, so I am not eligible for ChampVA. The biggest thing driving our insurance needs at present is to ensure that the kids are covered for as long as possible. My oldest graduated from college with straight-As save one lower grade last year. Despite intelligence and a definite drive to find work, is only working a part-time job with no health benefits at the moment. The others are either in high school or college. So, I want all covered as long as possible. Sounds like ChampVA won't do this as well as my FEHB insurance. As such, I will get my eligible family members enrolled in ChampVA now and keep NALC even after I become eligible for Medicare. Who knows what's to come from the Supreme Court this week???

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