Posted on Jul 1, 2019
Why can't I use my Medicare "Part D" to pay the copay for my VA prescribed medications?
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Every month I get a bill from the VA pharmacy, which I pay out-of-pocket. Meanwhile, I pay out-of-pocket for my Medicare benefits, including the Part D drug benefit, a payment that Medicare deducts from my social security payment. When I used a private doctor and filed a claim for Medicare to pay, Medicare rejected it, stating that the VA was my primary provider and I should have gone there for treatment, not to a "Doc in the Box." I am paying for a service that I cannot use.
Posted >1 y ago
Responses: 5
http://www.vetadvicates.org
That is an interesting point, one would logically think that VA benefits ought to be combinable with Medicare and/or Medicaid, certainly...I mean, God knows, no one ever listens to me, I'm just an insignificant little peon nothing nobody, however, to my mind, you do make an interesting, and, seemingly, quite logical point, as I'd said...some meds fall under Medicare Parts B or D, in our case, plus, we just got that new CHAMPVA OptumRx card for my wife, as wwll, so what you'd asked was, certainly quite thought provoking...the group I sent in the site for here, NOVA, is quite well hooked into a good deal, I'm not saying their guys could definitely answer this, however, I merely suggest it as a possible avenue to call, possibly their office directly, or use their search engine to find their guys by you...there are also law school vet law clinics you could seek out, though they done take eveeybidy, that's up to law school faculty supervising law students researching cases...another thought, you could call VA Off of Resolution Mgmt (ORM), and see if they have any ideas, also, try calling VBA and/or VHA directly...I'd also most definitely ask all three local ofc mil/cover staffs for all three of your Congress more as well, if the question involved Medicaid, ever, I'd also ask state legislators, as well as off staffs of governors, though I realize your question is a purely Federal one here, not a state one, per se...as I'd said, you do raise a quite interesting point, I'll try to give it more thought, if you've got any further thohghts, I'd be most eager to hear them, no rush...and, as mentioned below here, you could also certainly try the major vet groups...you could also call CMS directly, that supervises Medicare, and get their ombudsmen staff on the ohone, they do pick up, we've spoken with CMS staff many times, I assure you, or ask your Congress ofcs to get you a call back, as well, OK?
That is an interesting point, one would logically think that VA benefits ought to be combinable with Medicare and/or Medicaid, certainly...I mean, God knows, no one ever listens to me, I'm just an insignificant little peon nothing nobody, however, to my mind, you do make an interesting, and, seemingly, quite logical point, as I'd said...some meds fall under Medicare Parts B or D, in our case, plus, we just got that new CHAMPVA OptumRx card for my wife, as wwll, so what you'd asked was, certainly quite thought provoking...the group I sent in the site for here, NOVA, is quite well hooked into a good deal, I'm not saying their guys could definitely answer this, however, I merely suggest it as a possible avenue to call, possibly their office directly, or use their search engine to find their guys by you...there are also law school vet law clinics you could seek out, though they done take eveeybidy, that's up to law school faculty supervising law students researching cases...another thought, you could call VA Off of Resolution Mgmt (ORM), and see if they have any ideas, also, try calling VBA and/or VHA directly...I'd also most definitely ask all three local ofc mil/cover staffs for all three of your Congress more as well, if the question involved Medicaid, ever, I'd also ask state legislators, as well as off staffs of governors, though I realize your question is a purely Federal one here, not a state one, per se...as I'd said, you do raise a quite interesting point, I'll try to give it more thought, if you've got any further thohghts, I'd be most eager to hear them, no rush...and, as mentioned below here, you could also certainly try the major vet groups...you could also call CMS directly, that supervises Medicare, and get their ombudsmen staff on the ohone, they do pick up, we've spoken with CMS staff many times, I assure you, or ask your Congress ofcs to get you a call back, as well, OK?
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Pvt Anthony Baxter: The reason that Medicare and the VA will not pick up each other's tabs is that one federal agency cannot pay for another federal agency's bills. What issue you may be having will depend on what your "rating level" (not your disability rating) is within the VA. If the reason you went to the private doctor is because of a condition not covered by the VA, then Medicare should pick up the tab. If the VA does cover that condition, then you are to go through the VA. You may or may not be eligible for the VA Choice program but you should certainly look into that. Here's the VA link regarding the coverage. You may want to talk with an AARP representative who can give you further information regarding which coverage you will want to choose. My husband and I talked with an AARP representative who was able to help us navigate between the two systems.
https://www.va.gov/health-care/about-va-health-benefits/va-health-care-and-other-insurance/
https://www.va.gov/health-care/about-va-health-benefits/va-health-care-and-other-insurance/
VA health care and other insurance | Veterans Affairs
Find out how you can use VA health care along with other health insurance (like a private insurance plan, Medicare, Medicaid, or TRICARE). Get answers to questions about how VA health care works for Veterans with other insurance.
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SPC Chris Bayner-Cwik
Thank you Very much. This by far is one of the best articles I've read on this subject.
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Patricia Overmeyer
SPC Chris Bayner-Cwik - Thanks. While I am an attorney, I had a hard time navigating the federal rules and regulations for both VA and Medicare coverages. So I contacted a friend of mine who does VA/Medicare law and he told me how the laws worked. We went to our local AARP office and spoke to their medical representative regarding how to navigate the two systems. At first, I felt like a lab rat in a maze trying to get both systems to work for my husband. Still do, but I've figured out how to get closer to the cheese. LOL!!
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SPC Chris Bayner-Cwik
Patricia Overmeyer Thank you so much for sharing. I too am in the middle of the rat race....lol. I went on SSDI and effective September 1, I am eligible for Medicare. I have spent the last couple of weeks trying to find the cheese. In my case, I am the Veteran. The VA does not have the drugs I take ....they want me to switch to a once a month infusion (8 hours) instead of a pill. Obviously I don't want to do that so I will use Medicare and a supplement and Part D...and and and and..... Have a great day!
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Patricia Overmeyer
SPC Chris Bayner-Cwik - Welcome to the rat race, where the rats are winning. You just need a better nose to smell that cheese! Lol!! You need to call your local AARP representatives and they can get you to someone who knows how to work the two systems. SSDI throws a whole new level of fresh hell into the rat maze. As my husband says, "Are you confused now? Good, the military is doing its job." Lol!! To find your local AARP representative, start here. Good luck!!!
https://www.aarp.org/states/
https://www.aarp.org/states/
AARP in Your State – Find Local AARP Offices, News, Programs & Events for Boomers & Seniors
AARP has offices in 50 states, Washington, DC, Puerto Rico and US Virgin Islands. Find AARP offices in your state for news and events that affect you.
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