Jim,

I was just reading your article about using Medicare with your VA benefits. I do have VA benefits, but have 0% rating. I have AARP suppliment. In all your dealings with this, what do you recommend as the best Medicare insurance supplement?

Reply:

My expertise, such as it is, is focused on VA benefits. I also have Medicare Part A & Part B. I don't understand nor do I use Medicare supplemental policies. I can't recommend any particular supplemental policy.

But I can tell you what I do myself.

I don't know what those things cost but I assume they range in the neighborhood of $100.00 to $250.00 per month, depending on any number of variables. Rather than paying that money to an insurance company, I put it in my savings account at my bank. Then, when I do use a civilian health care provider, I pay any copay out of my pocket. I try to keep a fairly significant sum of money set aside for copays. The money is in an interest bearing account, although the interest paid these days probably doesn't equal the rate of inflation.

So, rather than giving money to an insurance company, I keep it in my own pocket. It adds up quickly.

The way I do things is a calculated risk. In years past, I've saved money by not giving it to an insurance company. If I were to have a sudden catastrophic illness and I were admitted to a local civilian hospital, I'd be in danger of generating a huge debt for a few days or even a few hours of care. It's not unusual to see hospital bills that are in the range of tens of thousands of dollars per hour for the brief initial period of care.

However, my family understands that if such a thing were to happen and I were unable to speak for myself, they are to aggressively see to my transfer to my VA medical center. Once I'm stabilized, I'll go to the VA facility where I trust my care will be as good as or better than the local civilian care. With luck, VA will pick up the cost of my initial care at the civilian center. I say "with luck" because that's usually a difficult option and VA argues against it most of the time. If the veteran documents well and pursues it, he or she will usually prevail.

In any case, I've used civilian providers successfully with my strategy. Most of my care is provided by VA and I'm happy with it. I run into occasions where I just can't get along with it though (usually because of scheduling) and I turn to a civilian provider. For example, in 2011 I needed a sleep study....I have sleep apnea. The VA sleep lab service is terribly backlogged and studies require months of waiting. VA does a traditional sleep lab study and most science says that isn't necessary these days. I found a civilian provider 5 minutes from my home who offered a home sleep study.

Once I determined that she accepted Medicare, I scheduled a visit. I got a fairly complete physical and in a week or so I stopped by to pick up my sleep study equipment to carry home that evening. It consisted of a headband that I was instructed to place around my forehead as I retired for the evening. It was reasonably simple to use. I returned it the next day. The doctor then sent the results to a pulmonary specialist who is certified to read and interpret the results. I was prescribed a CPAP machine and an appointment was made for me at a local office of a nationally known provider of home medical equipment. I met with a respiratory therapist who fixed me up with a high quality machine, mask and instructions for use.

All of this cost me less than $300.00 out of pocket. I believe that may be less money than if I had been paying for a supplemental policy that may or may not have paid for all my copays. I've used this strategy for orthopedic care and podiatry care. I've had minor surgical procedures performed locally by these providers and copays have been less than $100.00 out of my pocket.

My strategy has some small risk. But, to be honest, I just don't trust that any of the supplemental insurers have my best interests as their goal. My strategy also requires some self discipline. If you don't save the money, you can come up short one day and be unable to pay a few hundred dollars that will be required.

We have terrific health care benefits as veterans who have both VA care and Medicare. The great majority of Americans don't have anything close to our level of care. Although your 0% rating will require some small copays at the VA, you have access into the system and that's important. You may even ask that VA copays be waived, depending on your financial circumstances.

How each veteran who has health care options manages his or her benefits will require some thought and planning. I've learned that many vets can have the highest quality of care as well as save a lot of money if they'll just sit down and analyze all their personal circumstances and determine what will work best for them.

Health emergencies must be planned for. The usual health emergency doesn't announce itself a week ahead of time and when it happens, there's usually little time to think about how much it will cost. If we go on vacation, we plan on how much hotels, travel and meals will cost us and we budget accordingly. If we planned for the inevitable health emergency as well as we planned our vacations, we'd be a lot better off.