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VA Health Care benefits. I'm kind of not understanding it.

halkunhalkun Registered User regular
edited January 2014 in Help / Advice Forum
So I'm a contractor with really bad insurance benefits. So bad in fact I had to drop my insurance because I would of got $1000 of coverage a year after paying in $1350 a year. (yes, I would of got less insurance out than what I paid in) I was going to go the the federal exchange and found an insurance plan for $380 a month. (I make too much many for any subsidies) I was going to bite the bullet and make my first payment when I got a VA letter in the mail about health care benefits. I never signed up for them after the Navy because I always heard that it was a terrible deal where you never saw a doctor and the facilities were crummy etc etc.

Well it was free so I signed up online, but I'm not quite sure what kind of coverage I'm getting. It says no deductibles or premiums, but I'm not seeing what it exactly covers, and how much...

You see I'm going to need hernia surgery pretty quick here and and the last time I had it, I had an insurance plan that covered about $8000 a year expenses. When talking with the doctor, they wouldn't give me a cost of the surgery, but assured my that it will be fine. After that I got hit with a $23,000 medical bill that I had to pay ~$15,000 on. I felt so scammed. (and it wiped out my insurance for the year). After that the most I could ever get from my employer was $1000 a year coverage that I had to pay more in to get and so I dropped it.

Keep in mind, due to Obamacare, if you are uninsured, you have to pay an extra $600 in taxes every year. (and that doesn't go to any insurance or anything, it's for not abiding by the mandate)

So pay $1300 a year for worthless insurance or pay $600 and not have any at all.

That why I went to the exchange, but, like I said, VA benefits looks like a much more attractive option, so what exactly am I getting and how would scheduling surgery work? How much is it going to cost? They paint it like it's some kind of free health care but the don't really say that, so what's the catch?

halkun on


  • spaboollyspaboolly Registered User regular
    edited January 2014
    halkun wrote: »
    I never signed up for them after the Navy because I always heard that it was a terrible deal where you never saw a doctor and the facilities were crummy etc etc.

    No matter how terrible the stories you heard were, I can almost guarantee you they were understated. My mom gets all her medical care (using the term loosely) through the VA and they have done nothing but make her life miserable for over ten years now. In fact she's spent the last few years trying to find a normal healthcare provider willing to take her on as a patient to undo the copious damage the VA doctors have done over the years, both through poor/ineffective treatment and inaction. There have been times when she's called for an emergency appointment (particularly for dental, as she has many problems in that area - caused by the VA to begin with) and had to wait six months for it, only to have it cancelled with little to no notice and be moved another four months down the road. By that point of course any problem has long since become unmanageable and they have to resort to more drastic measures (she's lost most of her teeth because of this, and now has to have them all replaced). She can't afford to get care anywhere else, which is why she puts up with the VA, but if you can I definitely suggest you stay away from them as much as possible.

    I've been in a few of their hospitals with her too. I've been in places that are worse, but the VA facilities aren't nice by any means. At least the ones I've seen.

    They will also send you through the bureaucratic ringer at every turn just to get ANY benefits, so be prepared to fight for your care. It's not the free deal it's made out to be. If they do offer you anything, make sure you get as much documentation as possible that they will pay for "this, this, and this" before you have any of it done. The VA sent my mom to physical therapy for an old shoulder injury (sustained during her service) for months only for her to later find out they had no intention of paying for it when she got the bills.

    All of that said... it's obviously better than having nothing at all. If nothing else, at least having some kind of insurance prevents a lot of doors from being shut in your face in our screwed up medical industry.

    spaboolly on
    Scribe. Purveyor of Logic. Player of Video Games.
  • SurfpossumSurfpossum A nonentity trying to preserve the anonymity he so richly deserves.Registered User regular
    edited January 2014
    This doesn't directly answer your question, but (if you decide real insurance might be a better option) consider calling up the folks at the federal exchange:

    or looking for something more local (near the bottom):

    and asking if they can explain how your situation would pan out (would your surgery be covered, maximum out-of-pocket expenses (should be $6,350 at most), etc.).

    Surfpossum on
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  • UncleChetUncleChet N00b Lancaster, PARegistered User regular
    @OP I personally receive VA medical care and have exclusively used VA med benefits for close to 5 years now. I receive : General care (as in standard doctor), I receive specialist care (Pyschiatrist and therapist if i want that too) I also receive ER care, Eye care (1 pair of new glasses (not fashionable) every 2 years. I make around 35k/year in Amish Country PA. My copays are currently: $8/month Per medicine, I can pick up or have them refilled online and mailed at no extra cost. My payment for General medical such as bloodwork, standard doctor visit type stuff is 15$. My Specialist visits (mental health) are 50/visit. My ER I believe is a flat $25, even if I have wo whaaambulance it in.
    Here's how the VA medical system works if you're a veteran. They look at your Last years income + the COL for your residential area and on a sliding scale, determine your copay if any. I am not eligible for VA dental, as I am not a retiree, or homeless. My copay when I signed up was 0, as I was unemployed and has maintained at the same rate now for about 5 years. I had surgery recently to correct some serious lazy eye issues. I think I'm in for about $100 for that one, though the total costs + follow ups were around 8500. The Quality of care that you will receive is very honestly based on what doctors your assigned to work with. My GP: Awesome, my initial pyschiatrist: a train wreck. Current pychiatrist: Amazing. Therapist: no so hot. ER: Amazing (thought I was having a heart attack, turned out to be only a panic attack. cost of treatment $25. I go to our local outpatient clinic for little stuff, but my psychiatrist and med distribution are all at a major VA center about 35 miles away. If you have not yet done so, you MUST go to your local VA Med center, and there, you must take a "means assessment test". VA coverage IS qualified for the Affordable Healthcare act, meaning if you receive VA care, you're not obligated to get any other care. Once you've done your means assessment, you're issued a VA medical card. If you then take that card to another spot at the VA MC, you can get registered for "myhealtEVet" aka where you can view upcoming appointments, order med refils, email any # of your care providers, keep track of supplements and other stuff. There's a Lot of quality care out there, if you know to ask and accept it.

    I'm sometimes grumpy and random, feel free to overlook the strange man in the corner.
  • bowenbowen How you doin'? Registered User regular
    The VA is fine if you are okay with dealing with VA medical centers.

    All of my family use them since they're all ex military. The only one who bitches lives in a super rural area.

  • EvigilantEvigilant VARegistered User regular
    edited January 2014
    I use the VA for medical care and in my area they have been nothing but amazing. It really depends on the VA Med center you go to.

    What UncleChet said is what you need to do: Go to your local VA and take a means assessment test and they'll calculate your costs for services for the next year or so (I forget how often you need to update your records).

    Fill this out it will give you a quick dirty info on what you could receive. Obviously, this is subject to change once you sit down at a VA MC and go through the means test.

    Additionally, if you do plan on going to the VA MC, go as early as you possibly can because it will be packed and you will have to wait in a long ass line before you can get the mean test done. After you go through the means test, you'll get assigned a care provider and GP, and they'll set you up with the initial appointment to assess your needs/care from which you then set up appointments afterwards. You should try to see them at least once a month, and it's free just to go to that appointment and be seen.

    Evigilant on
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  • zepherinzepherin Registered User regular
    Here is what our residents say about the VA, and 100% of them use tricare. The VA centers are fine enough for minor shit and prescriptions. For anything where you need anesthesia, or really any sort of major surgery, get it done on base.

    "Don't go to Walter Reed if you need a blood clot removed from your leg, go to Andrews or Bolling. You go to Walter Reed they might take the leg off."

    P.S. I know Walter Reed is shut down.

  • UncleChetUncleChet N00b Lancaster, PARegistered User regular
    Speaking from personal experience. My gp is awesome. He's been nothing short of awesome. He's helped me in many areas of care including meds for mental health, specialisg referrals and fast prescriptions. Eyecare had been hot and cold. It took about a year, but I got approved for eye surgery and all follow ups at Little cost to me. Mental health sucked at first. I have bipolar, ocd, and generalized anxiety disorder. My first psychiatist was a train wreck. I told my gp I wanted a different doctor. He made it happen and new doc is awesome. I've also had a living will created, and am welcome and able to take my same gender partner to any appointment with zero issues. I'm in pa. Lebanon is my major center and they do not meds around.

    I'm sometimes grumpy and random, feel free to overlook the strange man in the corner.
  • spaboollyspaboolly Registered User regular
    Reading everyone else's responses I guess it is better in some areas than others (general healthcare in my area is absolutely terrible, particularly for women as I live in one of those places, and this I do unfortunately know from my own personal experience rather than other people's). My mom is also on disability benefits, not normal health insurance/care, which I guess I should have specified. Apparently that makes a big difference.

    Scribe. Purveyor of Logic. Player of Video Games.
  • YoSoyTheWalrusYoSoyTheWalrus Registered User regular
    My understanding is similar to UncleChet and others (I don't work for VA but have colleagues who do). It's pretty much dependent on your facility. You will have better luck if you are in a large urban area, or can travel to one. This holds true for almost any hospital. Don't try to navigate it on your own. Go to a facility or call and ask for help with the process, and then see if you like it.

    If you don't like it, I'd also suggest trying to buy a plan directly from the website of BCBS or another major insurer in your area. The Exchange only has a subset of their available plans. Due to delays in ACA implementation you can buy a non-Exchange plan which isn't ACA compliant for another year. I found an Anthem plan for myself that is cheaper than the cheapest Exchange plan, subsidies or no. Worth a shot.

  • TaranisTaranis Registered User regular
    edited January 2014
    VA healthcare is definitely worth it for me. The only downsides I've experienced are my hospital's horrible lack of parking (even after they added two new parking garages), and the constant need to check that I'm not receiving medications which lower my threshold for seizures. Though neither of those are really all that bad.

    As long as you don't need treatment due to anything combat related, I can endorse it without any major caveats.

    Taranis on
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