Medical Coverage For Vets

@Tommy and @oldmontana Here's more :

Priority Groups
Unfortunately, the Veterans Health Administration does not have enough resources to provide care to all veterans who need it. To address this issue, the VA has created eight priority groups for enrollment.

When you apply, the VA will assign you to a priority group. In some cases, you may be asked to agree to pay co-pays in order to be placed in a priority group. If you are eligible for more than one priority group, you’ll be put in the group that has higher priority.



How Priority is Determined
To determine which group you may belong to, see the VA's description of priority groups. If you have a service-connected injury or illness' your priority group will be determined by your disability rating. Former POWs and recipients of certain military honors are also given special priority. In addition, VA groups grants priority based on other factors, including financial need.

If you are not receiving disability compensation or pension, you will probably have to provide financial information to the VA to show that your income does not exceed the VA annual income threshold. Use the VA financial calculator to see if you qualify.

As resources increases, members of more priority groups are enrolled, and as resources decrease, members of fewer groups are enrolled. It all depends on the annual funding provided by Congress.
 

I had a problem with my insurance at United. I was injured in Vietnam. I took a hit in my left shoulder that I swore my shoulder had been blown off, but it wasn’t as bad as I thought. I did spend several weeks in Okinawa in the hospital. This happened right at the end of my tour of duty.

Fifteen years later, I re-injured the same shoulder and my insurance carrier at United wanted me to be treated at the VA. I had to argue with them for weeks that this was a separate incident. Finally, I got ahold of the Pennsylvania Insurance Commissioner’s office and filed a complaint. They handled it and after about three weeks later, I received a letter stating that my claim was approved.

I want to add that last night a few of us old Vets were talking about being in Vietnam and the one fellow brought up his story about he was shot in the front of the head, but survived. He told me that he still suffers headaches and has neuralgia in his neck from the gunshot. He goes to the VA for care, but wants to change to a Neurologist, but now Medicare is telling him no and to stay with the VA. Anyone have or heard anything familiar like this? Isn’t it up to the Vet which type of care he chooses?
I'll write my good friend, who is a disabled VA with high clearance ratings. She what she suggests.
 
I'll write my good friend, who is a disabled VA with high clearance ratings. She what she suggests.
Here's what my vet friend said about the medical issues:

My best suggestion for both is to join a veteran's service organization. DAV (disabled American Vets) or the Legion are both really good. They'll help a vet navigate the hurdles of the VA and get the care they need. All are free.
DAV is here https://www.dav.org/ phone is (877) I AM A VET
I hope they can get it worked out!!!
 

now Medicare is telling him no and to stay with the VA. Anyone have or heard anything familiar like this? Isn’t it up to the Vet which type of care he chooses?
It's complicated. I'm a 23 year retiree, Vietnam era vet as well as Gulf War. I was told that my order of payment was Medicare first, with TriCare for Life picking up the balance...Not sure where the Vet Hospital's i.e. the VA falls in. That said I use Roudebush VA in Indianapolis Indiana, awesome care. They are my first choice so I can skip the Medicare/Tricare route . Yet, it's there if I need it. Clear as mud right?
 
Things changed this year with the roll-out of the Mission Act. There is a lot of new coverage for most vets. The way I understand it is that all priority groups get full medical coverage with the exception of groups 7 & 8. 7 & 8 have a copay of about $1400 and some addition copays.
Here the one rule you need to be careful of; if the veteran is covered by Medicare Parts A & B the VA will not pay anything. This is if you go to a civilian hospital. If you go to a VA hospital you are covered as i stated before.
Look up the Mission Act yourself and read it. Asking people at the VA only made me confused.
 
I get my medical needs from Medicare. My wife, who doesn't drive, and I coordinate so that we combine visits.

I go to the VA clinic for my hearing aids.
 
I am in priority group 4 with the VA. I believe that everybody must have the basic Medicare coverage, which I got at age 65. My primary health care is with the VA. I do have a veteran's medical supplement plan for Medicare that costs $39 per month. Basically, it limits my non-VA co-pay from astronomical to huge. That would only come into play if I couldn't get to a VA hospital during some emergency such as a serious car wreck injury or something along those lines.

Tony
 


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