Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

For those Vets, enrolled in the VA healthcare system...

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JR Gabbard:
I started going to the VA 2 years ago, after 15 years of Medicaid and/or Medicare (and 12+ years totally uninsured).  I've gotten care from the best and worst clinics available with those kinds of insurance, or lack of.  The care I'm getting from the VA is far better than anything I've ever gotten, anywhere else.  If you can hook into it, you really owe it to yourself.  Plus, you've earned it.
If you are a veteran (Army, Navy, Air Force, Marine) who served on active duty, and your discharge is not dishonorable (no brig, no AWOL) you should apply (google VONAPP).  If you have bad paper, you can try to get your discharge upgraded (through VA).  They are fairly forgiving.
Your priority will be based on income and degree of disability, and often changes once you are in the system.  Right now, priority determines how much your out-of-pocket expenses are.  Meds are $9 each and there is a co-pay for visits, but no monthly premium.  Out-of-pockets are capped at $1000 per year.  All of this is waived if your VA docs determine that you are catastrophically ill, or if you are low income.
Once you're in the system, you arrange to see your primary care team.  Tell them that you're HIV+ and they will refer you to the ID clinic, usually at the Med Center.  Then you're set.  According to my primary doc, in order to maintain your eligibility, you only have to show up for your primary care appointment once a year, although the website (va.gov) says something different.  ID appointments will be on another schedule. 
The dental thing isn't really new, but they have been pushing it a little harder recently.  Basically, it is available if your ID doc determines that it is necessary for your overall health.  You have to be referred.  The other way it is available is if you have a service-connected total and permanent rating.
VA healthcare is very similar to the healthcare you got when you were in the service.  It is the kind of "single-payer" government-run healthcare that so many are terrified of.  But you will be cared for by multiple teams of health professionals whose goal is not just to keep you from getting sick (or sicker), but to get you healthy.
For me personally, it has meant a 50% increase in my CD4 count, my wasting symptoms have all but disappeared (though I still can't gain back any weight), and my cholesterol is under control, down from stroke and heart attack levels.  I feel better now than I have in 20 years.  And I thank the VA.  Just my 2 cents.
 edited to add:  The program Ray linked to IS new.  It is an outside dental plan that would pay for non-VA dentists.  So, cool!  Thanks, Ray!

vaboi:

--- Quote from: phildinftlaudy on November 16, 2013, 10:19:18 AM ---And, last time I was enrolled - a year later they disenrolled me, because based on my priority level for access, my income was over the limit....

--- End quote ---

From what I understand is that the VA doesn't dis-enroll anyone once you have successfully enrolled.  The only way you can be dis-enrolled is if you request it in writing, and who would do that?  Well perhaps someone might to qualify for Obamacare subsidies, but even that is pushing it.. because all you have to do is not see a VA doc for so long and you'd even qualify for that.   From what I understand, the VA won't dis-enroll once you've enrolled, even if your income goes above the applicable limits.  They probably just dropped you to Priority group 8c.  I find it hard to believe they would deny you access after being enrolled and especially if you were already receiving treatment.  Taken from www.va.gov:

Priority Group 8
...
Veterans eligible for enrollment: Nonservice-connected and:
    Subpriority c: Enrolled as January 16, 2003, and who remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status
    Subpriority d: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less

I mean, even someone who doesn't qualify and is not enrolled can receive care, but only for SC conditions.


--- Quote ---The thought has occurred to go to VA though, at times, as I have heard that they give out the good meds   ;)

--- End quote ---

I believe all FDA approved HIV meds are on the VA's formulary.  Only like $9/mo too unless you are 50% SC, then all free.

vaboi:

--- Quote from: JR Gabbard on November 17, 2013, 11:24:38 AM ---I started going to the VA 2 years ago, after 15 years of Medicaid and/or Medicare (and 12+ years totally uninsured).  I've gotten care from the best and worst clinics available with those kinds of insurance, or lack of.  The care I'm getting from the VA is far better than anything I've ever gotten, anywhere else.  If you can hook into it, you really owe it to yourself.  Plus, you've earned it.
If you are a veteran (Army, Navy, Air Force, Marine) who served on active duty, and your discharge is not dishonorable (no brig, no AWOL) you should apply (google VONAPP).  If you have bad paper, you can try to get your discharge upgraded (through VA).  They are fairly forgiving.
Your priority will be based on income and degree of disability, and often changes once you are in the system.  Right now, priority determines how much your out-of-pocket expenses are.  Meds are $9 each and there is a co-pay for visits, but no monthly premium.  Out-of-pockets are capped at $1000 per year.  All of this is waived if your VA docs determine that you are catastrophically ill, or if you are low income.

--- End quote ---
Also waived based on how disabled you are.  e.g. no doc co-pays if >0% SC and if 50% or higher, meds are all free.


--- Quote ---Once you're in the system, you arrange to see your primary care team.  Tell them that you're HIV+ and they will refer you to the ID clinic, usually at the Med Center.  Then you're set.  According to my primary doc, in order to maintain your eligibility, you only have to show up for your primary care appointment once a year, although the website (va.gov) says something different.  ID appointments will be on another schedule. 

--- End quote ---

Another helpful hint, just request that your ID doc become your primary care physician.  This reduces the overall number of appointments you need to make, reduces your co-pay from $50 to $15 (if applicable), and you don't have to wait as long for an appointment since you are out of the long cow lines that everyone else has to go through to see the mainstream PC teams.  You can call the ID doc's office (or sub-specially) directly to make your appointment.

You won't be dis-enrolled if you don't make an appointment.  But ugly things will happen if you don't schedule them on time, e.g. your refills will run out, also if you need to go to the ER at a non-VA hospital without seeing a VA doc in the last 2 years, good luck getting them to pay for it, additionally, you might have to have to do another entrance appointment at your VA med center after a certain period, etc.   But you won't be dis-enrolled out of the VA healthcare system.

J.R.E.:

--- Quote from: vaboi on November 21, 2013, 06:45:55 AM ---Also waived based on how disabled you are.  e.g. no doc co-pays if >0% SC and if 50% or higher, meds are all free.


--- End quote ---


I pay $8.00 for all medications, and have no doctor/specialist  co-pays.  I get annual vision, plus I managed to get free hearing aids. The VA must really think I am disabled. although I don't get my glasses through the VA, I believe I can probably get the next pair through them.

But yes, when I enrolled, I told them I was HIV positive, with an AIDS diagnosis. My t-cells were still pretty low back then.

Also when I enrolled in November of 2009, I informed them that I would have no healthcare insurance effective January 1, 2010. 

One more thing, I should have received my annual questionnaire about now from the VA, but I haven't got it yet.  Wonder if ACA has something to do with that.  :-\

So far, I haven't had to pay for anything, except my $ 8.00 copay. I believe my cat rating is #5

I've been treated very well  !

Ray

J.R.E.:

--- Quote from: vaboi on November 21, 2013, 06:45:55 AM ---... also if you need to go to the ER at a non-VA hospital without seeing a VA doc in the last 2 years, good luck getting them to pay for it,

--- End quote ---


I also received some material in the mail about this. If you use a non-VA hospital, you need to notify the VA, within, 72 hours, of going to the emergency room, or being admitted.

I will have to look for the letter, and the exact language.

I have no problem not seeing a VA doctor.  My primary sees me twice a year ( every 6 months,) and the ID doctor sees me once every 4 months.

And fortunately renewing my meds, has never been a problem, They are very insistent on making sure that I don't run out ! They've been great!

Ray

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