VA and TriCare for Life + Medicare VA and TriCare for Life + Medicare - Talk of The Villages Florida

VA and TriCare for Life + Medicare

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Old 03-08-2014, 09:43 AM
caseycasebeer caseycasebeer is offline
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Default VA and TriCare for Life + Medicare

I would appreciate other TriCare for Life (TFL) beneficiaries thoughts and opinions on this.

Billings that I receive from VA seem a little strange. My experience is that having Medicare/TFL results in most "covered procedures" being free or almost free at private provider's. But that doesn't seem to be the case at VA.

My objective is to receive competent medical attention, while not costing the gov't more than necessary. I assumed that going to VA would ultimately be less costly to the gov't than receiving the same service(s) from a private provider since VA services are provided through gov't employee's.

If I go to VA there is invariably a smallish (ie. $50-$85) bill that arrives a couple weeks later. On the other hand, if I go to a private provider Medicare covers most of the cost and TFL covers virtually any remainder. When I asked VA about this I was told that since Medicare/TFL/VA are all governmental entities, "...one branch cannot bill another branch for services..." thus the cost for service is passed along to the patient. Case in point: In 2012 I had a colonoscopy done at VA/Gainesville and received a bill for $85. The test results required a follow-up colonoscopy in 2013, and I chose to use a private provider; and Medicare+TFL picked-up the whole cost. I don't want to quibble about the $85 bill (damn cheap for a colonoscopy...), but I'm also pretty sure that going to the private provider ultimately cost the gov't more (...lot's more) than having it done at VA.

One very astute advisor (at VA) told me that the best thing to do was use VA for services not otherwise provided by Medicare/TFL (ie. hearing aids) but to use private provider's for other medical needs. Does that fit with what other's have experienced, and do you have any recommendations?

...sorry for the too-long post.

Best,
Casey
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Old 03-08-2014, 03:04 PM
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That explanation doesn't seem accurate. Medicare determines the acceptable/allowable fees for the services, pays its share and forwards the claim to TFL for the remainder. Seems like two government entities working on the same event. Why can't the VA be part of that?

I suspect there isn't that much additional cost for you to use private offices because they only get paid what Medicare allows anyway. When you figure all the fixed costs to run the VA system into it, it probably comes out close.
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Old 03-08-2014, 03:07 PM
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I use Medicare w/Tricare for Life at private practices, including Duke Medical Center, and have never had to pay a dime out of pocket...except for drugs.
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Old 03-08-2014, 03:08 PM
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For me, medicare and tri care for life has made me feel like a king. I have 50 years of Humana, kaiser and blue cross. No complaints from any of those until, medicare and tricare for life. Now I truly know that I am loved by the Heath care system.
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Old 03-08-2014, 04:22 PM
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Using a private doctor get you that guy..VA lots of times gets you a resident...my choice the private doctor
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Old 03-08-2014, 05:34 PM
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My husband uses the VA and has Medicare and a Medigap policy. The VA does not bill Medicare but it does the Medigap. Apparently Medicare gives them a chunk of money to run their program like managed care. I am only surmising this from what we were told when we asked. They use the amount medicare would pay to figure the amount to bill the medigap policy and then accept the payment of Medigap. We must pay $50 every time we see a VA doctor, minus what the Medigap policy reimburses them. He doesn't have Medicare part D, the reason we have stuck with the VA. Our drugs are at a reduced rate. We are very pleased with the care he has gotten and the convenience of accessing his medical history wherever we are in the US if we go to a VA center.

Last edited by borjo; 03-08-2014 at 08:35 PM.
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Old 03-08-2014, 06:02 PM
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I have Tri Care for Life, and I honestly cannot understand why on earth you use both. The VA does have a means test, I have no idea what your circumstances are but Tri Care for Life is the best why are you going to the VA ?? I know you can get glasses but really you can get GI glasses on line.
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Old 03-09-2014, 05:41 AM
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I use the VA for glasses, hearing aids, and annual physicals - never pay a dime for those services. I use a private doctor for all other "stuff" and, between Medicare and TFL, never pay a dime for those visits either. For medications, I use the Tricare Express Scripts. I found that more reasonable than the VA meds.
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Old 03-09-2014, 02:49 PM
caseycasebeer caseycasebeer is offline
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Thanks for the responses.

I have been quite satisfied with the quality VA services, but I was simply wondering why a bill resulted when we can (with Medicare + TFL) go nearly anywhere(else) and have the services covered at no personal cost. Silly me ... I 'thought using VA might actually save the gov't some money. Silly, I know....

As for VA's means-testing ... In about 2002 I learned that VA was about to initiate means-testing, so I enrolled online beforehand, and got in under the "old" rules.

I will probably just continue to use VA mostly for hearing aids (they've provided top of the line devices so far), and go to other non-VA provider's for other stuff.

Thanks again.

Best,
Casey
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