The VA as primary medical coverage?

[HES]

I am in a situation where I don't know the answer. Here is my situation. Married to the most wonderful woman, father of 3. We are both veterans, honorably discharged after our initial tours. I'm self employed. My wife is employed (RN, 12 years). She carries the benefits. She is getting close to her breaking point, mentally, with work (currently home health). She is considering becoming a per diem nurse (AKA a contractor) so that she can back off for a bit from her current stresses while still bringing in needed income and working about 32 hours a week. All of that is doable so far.

Then the health insurance question raises it's ugly head.

It looks like we can put the kids on a plan that will cover all three of them for about $150.00 per month. But what about us? My wife floated the idea that since we are both Veterans, why not use the VA for our health care needs. On the surface it sounds like it might be possible. But I have questions as to the care we would be eligible to receive since we did not retire from our branches. I also have to wonder about the accessibility of care.

We will also be looking into the fact that apparently under Florida law we can go from a group policy to a private policy with no chance of penalties for pre-existing conditions.

What am I missing? What do I not know?

[CyberM4]

Look into the VA's web site. Being Vets you can use the VA. They will do a means test as what you have for income. This is done evey year. I've used them for years. I know you and your wife are covered. You may have to pay co op. Based on how much money you both make.

[chadbag]

Other things to look in to:

-- Maybe the hospital(?) she works at now has a part time position that includes benefits (maybe with larger costs on your shoulders?) My wife is an RN and before she moved to her full time (36 hours -- 3 x 12) position at the CCU last year she worked part time at 28 hours per week. She qualified for benefits but our cost for the same benefit was higher than what the full time people paid.


-- NASE -- National Association for the Self Employed. I have not been involved with them for about 10 years but they had a pretty good insurance plan you could purchase through them when self employed

-- Many of the contracting agencies that contract out per-diem nurses offer insurance plans to their nurses

-- If your normal health needs are pretty mild and no huge pre existing conditions, look into a high deductible catastrophic plan and put away money into an HSA... Our 2 kids, 2 and 7, are healthy and so are we so we are in such a plan through the wife's work. Saves us a ton of money each year and we save a few thousand that we would be paying in premiums in our HSA instead -- money that we keep year to year available to pay our share (deductible, 20% etc) from the catastrophic plan. We were not even meeting the low deductible from our old plan anyway so why pay huge premiums when that money could stay in your HSA as your asset?

[HES]

She works home health right now. She could go back to a hospital, but she is so burned out we dont think that is going to work. She did check with her employer and some of the area hospitals and around here unless you are full time there are no benefits. We will look into the other options.

Thanks for the replies. If anyone has any other ideas or thoughts, please let me know

[RadioActivity]

I have limited experience of the VA...but have you utilized them? Timely health care isn't what they are known for...

I needed my teeth cleaned after 2 years in Iraq... they can pencil me in in 60 days...lovely. $250 out of pocket and my teeth are cleaned...that week.

[CyberM4]

Why $250 to clean your teeth thourgh the VA?

[Smuckatelli]

-- If your normal health needs are pretty mild and no huge pre existing conditions, look into a high deductible catastrophic plan and put away money into an HSA... Our 2 kids, 2 and 7, are healthy and so are we so we are in such a plan through the wife's work. Saves us a ton of money each year and we save a few thousand that we would be paying in premiums in our HSA instead -- money that we keep year to year available to pay our share (deductible, 20% etc) from the catastrophic plan. We were not even meeting the low deductible from our old plan anyway so why pay huge premiums when that money could stay in your HSA as your asset?

Be careful with that type of plan, our 8 year old has been fighting cancer for 2 yrs, 6 months, and 10 days...since we became members of the childhood cancer community I have witnessed alot of families go under and children die.

From my perspective; Keep in mind just as everyone on the range owns a gun, every family that We see at the hospital has children getting treated for life threatening illness.

OP, you're in a tough situation...chances are very good that you will have no major issues with the children. This is a decision that only you and your wife can make and once you do make it...don't look back. These types of decisions are extememly open to second guessing.

[chadbag]

Be careful with that type of plan, our 8 year old has been fighting cancer for 2 yrs, 6 months, and 10 days...since we became members of the childhood cancer community I have witnessed alot of families go under and children die.


Sorry to hear about your kid's struggles with cancer. That has really got to suck.

That sort of scenario is exactly what the catastrophic plans are made for. While we cover most routine healthcare (curiously they cover preventative care 100% except for copay), after we hit our $3k deductible, we split it 80%/20% (we pay 20%) until our out of pocket reaches $10k, and then they cover the rest. We put away $2-$3k a year into the HSA and will have that $10k saved in another 1-2 years probably. That $2-$3k we put away is the same or less than we would be flushing down the toilet with a normal plan anyway.

The normal plans (which are typical) that we have access to as well with much higher premiums, have a $750/person $1500/family deductible or lower, but also split things 80/20 after that up to some limit before they kick in 100%.

So there is really no down side to it. We even had a baby under the catastrophic plan and my calculations showed it was about a wash that year.



From my perspective; Keep in mind just as everyone on the range owns a gun, every family that We see at the hospital has children getting treated for life threatening illness.

OP, you're in a tough situation...chances are very good that you will have no major issues with the children. This is a decision that only you and your wife can make and once you do make it...don't look back. These types of decisions are extememly open to second guessing.

[Smuckatelli]

Sorry to hear about your kid's struggles with cancer. That has really got to suck.

It does suck but he is doing well in treatment, he should be finished on 12 November this year. He's getting treated at one of the better childhood cancer clinics.



That sort of scenario is exactly what the catastrophic plans are made for. While we cover most routine healthcare (curiously they cover preventative care 100% except for copay), after we hit our $3k deductible, we split it 80%/20% (we pay 20%) until our out of pocket reaches $10k, and then they cover the rest. We put away $2-$3k a year into the HSA and will have that $10k saved in another 1-2 years probably. That $2-$3k we put away is the same or less than we would be flushing down the toilet with a normal plan anyway.

The normal plans (which are typical) that we have access to as well with much higher premiums, have a $750/person $1500/family deductible or lower, but also split things 80/20 after that up to some limit before they kick in 100%.

So there is really no down side to it. We even had a baby under the catastrophic plan and my calculations showed it was about a wash that year.

Thanks for breaking that down Barney style for me, it looks like you have all bases covered. I actually feel better knowing that your kids are covered.

[chadbag]

It does suck but he is doing well in treatment, he should be finished on 12 November this year. He's getting treated at one of the better childhood cancer clinics.


Good for him. I always have a hard time reading about kids getting sick with serious issues. (Also get sick and mad hearing about kids and abuse, etc. I am a real softy on kids)



Thanks for breaking that down Barney style for me, it looks like you have all bases covered. I actually feel better knowing that your kids are covered.

There are probably bad examples of these sorts of plans, just like anything you get good and bad instances. But in general, if you are not already battling some serious thing and are now healthy (you and your family), you are probably better off with this sort of catastrophic plan (as long as you don't sign up for a loser version). (you being generic and not you personally)

Even though the routine care is submitted to the insurance company, so they do have some overhead there, they really cut their overhead and outlays with them so they pass that along to you. You cover your normal routine care yourself (and you should be putting money into an HSA which you keep and accumulate money into year to year -- it does not expire and can be taken out for non health care reasons at retirement, paying taxes at that time on it as it is tax free into the account) which for most people is less than they pay anyway with their deductibles even on expensive low deductible plans...

[Caeser25]

Definitely look into a High Deductible Health Plan vs a regular plan, compare premiums vs deductibles. With a HDHP you put money into a HSA tax free up to $5,950 per year per family, it's yours for the rest of your life, as long as you have a qualifying HDHP you can use those funds for medical care. If you stick with a large plan Blue Cross Blue Shield, Aetna, Cigna they don't skimp on coverage but are pricey for direct pay, just like everything else you get what you pay for.

[Caeser25]

I used the VA once, between the time periods when my Tricare ended and i was able to pick up coverage through an employer. I dislocated my knee and tore my ACL. I had to wait 4 weeks for an MRI and would've had to wait 6 months for surgery but after 3 months of physical therapy I decided not go through with the surgery b/c I was almost as good as new, it still gets sore from time to time with some hard pt.

[RadioActivity]

Why $250 to clean your teeth thourgh the VA?

Because I wanted my teeth looked at and cleaned right now. I already waited the length of my stay in Iraq...I wasn't waiting two months more.

So I paid out of pocket. To have my teeth clean that week was worth every cent.

EDIT - I should of been more clear, to have them cleaned at a private practice, not the VA. The VA couldn't even schedule me for 60 days at the earliest!

[CyberM4]

I paid my local Dentist $94 for my cleaning plus XRays. I can't use the VA for Dental.

[DragonDoc]

Just because you were in the Army doesn't mean that you are eligible for VA benefits. Take a look at the VA Health Benefits page to make sure you are even eligible for VA benefits. I can tell you right now that most beneficiaries chose to use military facilities over VA so they can have decent access to care.

http://www4.va.gov/healtheligibility/

Here is question number two from the VA eligibility questionnaire. If you answer no to this question they ask about financial status.

Do You Qualify For VA Health Care?

2. Are any of these statements true?

* You were discharged or separated for medical reasons, early out, or hardship
* You served in theater of combat operations within the past 5 years
* You were discharged from the military because of a disability (not preexisting)
* You are a former Prisoner of War
* You received a Purple Heart Medal
* You receive VA pension or disability benefits
* You receive state Medicaid benefits