Ask the Medicare Specialist

QUESTION:

I’m a Veteran and use the VA for all my medical needs. Why should I pay $ 135 for Part B?

ANSWER:

I answer, I would like to take the time to thank all our Veterans for their service to the country. I believe you deserve the best health care in the world! Answer: No one is forced to take Part B, including those who receive VA benefits. I’ve met a few Vets who have chosen to go forgo Part B, although I never recommend doing so for several reasons.

I keep hearing that the rules regarding receiving care outside VA facilities are loosening. However, I recently spoke to an individual who had over a yearlong battle trying to get bills paid for services provided at a nonVA facility. The experience was described as extremely time consuming and unpleasant. If there’s one negative about the VA health care system, I would have to say it’s the amount and levels of bureaucracy that can make dealing with them very frustrating. I attempted to get in touchwith and left messages for representatives who could provide answers to questions for this column and they went unreturned. My own father, a Korean War Vet, has also experienced problems getting approval for much needed services.

Over the years it’s my understanding that unless you’re 100% Service Connected, only services rendered at VA facilities are covered. That includes the Emergency Room, which the VA does not have. Both Ambulance and Emergency Room benefits are covered under Part B. So, if you didn’t have it and were ambulanced to the closest hospital you could be forced to pay thousands of dollars out of pocket. A ride in an Ambulance for just a couple blocks costs more than $ 1,000. A broken bone cast in an Emergency Room can be as much as $ 5,000. I’ve seen Air Ambulance bills in the $ 20,000 range. If you didn’t have Part B, those costs could be your responsibility.

I’m not sure if this would still be the case today, but years ago I had a Vet from Fayette County come visit me in my Connellsville office looking for advice. 10 years prior he had opted out of Part B to save what at the time was around $ 100/ month. He used his local clinic and went to Pittsburgh if he needed to see a specialist or get care that wasn’t routine and that worked well for years. Unfortunately, he’d been diagnosed with Cancer and needed Chemo. His health was such that he couldn’t make the hour- long drive from his home to the VA in Pittsburgh because riding in a vehicle made him sick. I was shocked to find out that the VA wouldn’t approve his Chemo at the closest Cancer center. Immediately applying for Part B isn’t necessarily a solution for someone in this situation either. When you opt out of Part B without having insurance through an employer or a spouse’s employer, there’s a 10% penalty for every year you go without. That means someone who hadn’t had it for 10 years would have to pay $ 271/ month for Part B as opposed to $ 135.50. Also, you can only apply for Part B from January to March and it doesn’t go into effect until July. This particular Veteran didn’t have the luxury of waiting that long.

Those who live close to Pittsburgh or another fullservice VA hospitals wouldn’t have this issue. However, there are others to consider. What if the VA didn’t have the capability to treat a condition or disease? I had a client in 2017 who got a rare parasite from tainted romaine lettuce. Only two hospitals in the country had the technology to treat her, Cleveland Clinic and Mayo Clinic. She spent 115 days in the hospital and needed dozens of follow up visits. Last I spoke to her about six months ago, she was still going to Cleveland on a pretty regular basis.

Another item to consider is having choices. I know the doctors at the VA care a great deal about their patients. However, I would never want to be limited to just one hospital or surgeon. We are blessed to live in one of the top regions in the country for health care with both UPMC and AHN close by. Is $ 135/ month worth giving up access to some of the country’s best doctors and hospitals?

When we meet Veterans who enjoy using the VA and are happy with their care, we recommend they take Part B and choose a $ 0 premium or another low- cost Medicare HMO Advantage Plan. It provides the choices I mentioned, doesn’t interfere with access to the VA, costs little or nothing, and can provide some nice ancillary benefits they may not be provided by the VA like dental, an OTC ( Over the Counter) allowance, gym access, and possibly others.

We also recommend that every Vet who is eligible for benefits apply and keep them active even if they don’t want to use the VA as their primary health care provider. The VA supplies prescription coverage that can be very valuable. They also can cover glasses, hearing aids, Diabetic Supplies, Durable Medical Equipment, and other services at no cost that Advantage Plans either don’t provide or have costly co- pays for. We advise Veterans who wish to use non- VA doctors and hospitals to choose between a Supplement or Advantage Plan that best fits their needs and budget.

If anyone has information and experience on how the VA is now covering services outside the VA, please contact me so we can pass that information on to others.