Medicare, Tricare and CHAMPVA.

If you retire from the armed services, you and your dependents are eligible for Tricare medical . The two main flavors are Tricare Standard, that is equivalent to an Health Maintenance Organization (HMO), and Tricare Prime, that is equivalent to a Preferred Provider Option (PPO).

Tricare is similar to Medicare, but it also provides prescription drug coverage. Once you reach age 65, you are eligible for Medicare. Medicare Part A covers hospital care and it is provided automatically. To maintain Tricare, you must accept Medicare part B which covers doctor visits. You are then given Tricare for Life as secondary insurance. Your spouse will continue to be covered by Tricare Prime until he or she reaches age 65. Then the spouse will be covered by Tricare for Life, too assuming Medicare Part B is accepted.

With Medicare as primary insurance and Tricare is secondary, there is no need for Medicare Part C or D that provide prescription dug coverage. Tricare for Life covers prescription drugs.

CHAMPVA is very similar to Tricare. In fact, Tricare was originally called CHAMPUS. To be eligible for CHAMPVA:

1. the spouse or child of a veteran who has been rated for total and permanent disability due to service-connected disability by the VA (that is, a VA regional office)
2. the widow/widower or child of a veteran who passed away due to a service-connected disability rated by the VA
3. the widow/widower or child of a veteran who at the time of death, was rated as permanently and totally disabled due to a service-connected disability
4. the widow/widower or child of a military man or woman who was killed in the line of duty (but not due to bad conduct– often though these will be TRICARE eligible rather than CHAMPVA)
   

Notice that dependents must have a sponsor who is (100 per cent) totally and permanently disabled or the sponsor passed away from service-connected disability (less than 100 per cent.).

If a vet never received a service connected disability, the survivors would not eligible for CHAMPVA. Of course, the death must be be related to the specific service-connected (SC) disability the VA has awarded.

Likewise the spouse and children may be eligible for Dependent Indemnity Compensation.(DIC) when a disabled veteran passes. The criteria are similar to those for CHAMPVA eligibility.

If a vet dies while a claim is being adjudicated, the survivors of a pending SC claim must open a new Accrued Claim.

Why would a survivor want to reopen an Accrued Claim? If the death is related to the claimed condition, the survivors may be eligible for both CHAMPVA a medical coverage and DIC. Even if the claimed condition is not related to the cause of death, the survivors could receive disability compensation in the form of lump sum payment.

Accrued benefits are only payable if the VA Form 21-534 was filed within one year after the veteran's death.

Once a dependent reached age 65, CHMAPVA becomes secondary insurance as is the case for Tricare. It is called CHAMPVA for Life.

Thee are also Medicare part C & D. Medicare part D does provide prescription coverage, but this private program will become more expensive in the next 10 years. This is because the program was never properly funded by the Congress and it was being subsidized by Standard Medicare FICA payroll tax receipts.

Obama removed the $10 billion subsidy form Part D and rolled the projected revenues into ACA. Medicare Part C that insurers also sell is similar to Part D.

Any vet who has either Tricare for Life or CHAMPVA as secondary insurance does not need Medicare Part C or D.

You an also purchase Medicare Supplemental or MediGap insurance to cover Medicare co-pays. This may be a better and lower cost option than Medicare Part C and D for people who need secondary insurance.

Your local Social Security office should be able to answer any questions you have on Medicare or Medigap. As a retired armed services person or disabled vet, you may have some extra medical entitlements when you reach age 65.

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Coordinating a VA Disability Benefits Questionnaire

The major recently completed a DRO hearing and the DRO asked for a Disability Benefits Questionnaire (DBQ) from the major's specialist.

The Major and his wife traveled to VAMC after the hearing and talked to the specialists nurse. She said we had to coordinate the DBQ through the primary care doctor first. 

My primary care doctor is the northern part of the county. We then talked to her nurse and the staff appeared to be unaware of the DBQ process. 

Three weeks later I talked to the primary care doctor  about the DBQ. She did not understand she could either fill the DBQs out or forward it to the specialists office. She advised me to take the DBQs to C&P. She also wanted a blank DBQ.  Of course,  DBQs can be downloaded from a VA web site (http://benefits.va.gov) on the Internet. 

Again the DBQ is a wonderful improvement to the old way the VA had been doing business, 

So Rightardia checked to see how the DBQ is supposed to be coordinated. We got some surprises. 

According to the Department of Veteran Affairs DBQ FAQ, only the following is authorized to complete a DBQ?

Providers with active medical licenses must sign and attest to a medical condition on completed DBQs. The DBQ can be completed either by:

• Veterans’ private treatment providers, or
• Veterans Health Administration (VHA) clinicians.

The FAQ further states:

Veterans have the option to take a DBQ to their private provider or Veterans Health Administration (VHA) clinician for completion, but Veteran are responsible for any related co-pay or costs, including costs for travel or testing. (A Veteran is always entitled to an examination and any required testing at no charge for a scheduled compensation appointment that has been requested by VBA.)


Asking your primary care provider to complete a DBQ is no different than asking your provider to write a letter or note providing medical evidence of a medical condition in support of a claim. The same co-pay rules apply equally to both situations.


However, Rightrdia would point out the DBQ ask for more detail than you might include in a letter. It should prevent any requirement for additional letters from you doctor. 

Also note that the use of DBQs is not mandatory. Rightardia would suggest using this form is you want your claim resolved as quickly as possible. 

Since the major had gotten several letters form his primary care and specialist already, we had little difficulty getting three DBQ signed by private practice physicians in a two week period. 


However, we are still waiting for our VMAC specialist to sign his DBQ after three weeks because the primary care doctor had not forwarded the DBQ. 


Do you want to take a DBQ to C&P? In general, that is a bad idea. C&P is the main reason the DBQs were needed in the first place and many C&P doctors will damn you with faint praise during their cursory exams. Try to get the DBQ signed off by a hospital specialist who is medical doctor, board certified preferred. 


Be aware the term clinician includes Physicians assistance, nurse practitioners and medical doctors. Most have general medical backgrounds. 


If you have Tricare or Medicare, use a private practice physician whenever possible to complete the DBQs. These will get the job done faster! 


All of the DBQ that are available to Private physicians have been published. These DBQ can be found at on the VA website at: http://benefits.va.gov/disabilityexams 

Some  DBQs are not available for use by private providers?
since There are no DBQs for the following medical examinations:

• Initial Examination for Post-Traumatic Stress Disorder
• Hearing Loss and Tinnitus
• Residuals of Traumatic Brain Injury
• Cold Injury Residuals
• Prisoner of War Examination Protocol
• Gulf War Medical Examination
• General Medical Examination for Compensation Purposes
• General Medical Examination for Pension Purposes

How do you submit completed DBQs to VA?


A:  Veterans and/or their physicians may mail or securely fax completed DBQs to the VA Regional Office handling the Veteran’s claim. 


To find mailing addresses, visit the VBA website at: www2.va.gov/directory/guide/Allstate_flsh.asp To find fax numbers, visit the VA website at http://benefits.va.gov/transformation/disabilityexams.   


Completed DBQs may also be submitted directly to the VA Regional Office. Submit them through the Veteran Assistance office. 


See the VA FAQ on the DBQ at http://benefits.va.gov/TRANSFORMATION/dbqs/FAQS.asp

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Rightardia by Rightard Whitey of Rightardia is licensed under a Creative Commons Attribution 3.0 Unported License.

Permissions beyond the scope of this license may be available at rightardia@gmail.com.