Finally granted healthcare @ the VA, should I keep Kaiser?

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by Reasoning, Aug 26, 2010.

  1. Reasoning
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    Reasoning Active Member

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    I have been paying out of pocket for health insurance through Kaiser for many years now (apx 150/month with a 1,500 yearly resetting deductible for anything major, ie: MRI).

    It's expensive but the doctors are legit.

    I served in the Air Force apx 4 years ago for a few months and was injured in training. The USAF tried to claim that my injury was the result of a pre-existing condition that I wasn't aware of...(load of crap).

    After being honorably discharged via ELS due to the inability to be fully "combat ready" due to the injury, I started the paperwork process to attempt to get the VA to cover my medical bills that I started getting when I started getting treatment via Kaiser once I was back home.

    After 3 1/2 years the VA has finally granted my injury as "service connected" which means I can get VA health care for almost free...

    The catch...

    I have been informed by the lawyer that helped me with my claim that every 5 years or so the VA will pull me in and "evaluate" my injury to determine if it has become worse/better/same.

    Talking to several VA employee's on the phone a few of them told me that it's possible to have the % rating of my disability lowered by a douchebag doctor which would then lower the amount of coverage I would get through the VA...

    So... (If you've actually read this far, thank you =P )

    Should I keep paying for this expensive coverage from Kaiser while I have this other option available to me?

    Keep in mind that I am a broke college student lol

    The main worry I have is that if I cancel my Kaiser coverage now and then want to get it again later they will rape my prices even more due to my injury now being a "pre-existing condition" (That is what they did to my parents).

    Yes, I realize that the VA coverage might now be the as good as Kaiser, however I am weighing the pros/cons here since,

    1. I am a broke college student and every penny counts.

    2. I am young and healthy outside of my nerve damage/soft tissue damage to my foot sustained during military training.

    Thoughts?
     
  2. Greenbeard
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    Greenbeard Gold Member

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    In five years, pre-existing conditions won't exist anymore. I assume you're buying your coverage in the individual market (i.e. buying it on your own and not getting it through a job or something)?
     
  3. Reasoning
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    Reasoning Active Member

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    Yes, I am buying it out of pocket without assistance via employer.

    It was my understanding that the recent legislation might prevent a particular medical insurance company from outright denying a person coverage due to pre-existing conditions but does not necessarily prevent the company from raising rates for that person. Is this not correct?
     
  4. Greenbeard
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    Greenbeard Gold Member

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    Yes, that's not correct. The new law allows your insurance company to vary rates for a given insurance policy based on only four factors:

    (a) Prohibiting Discriminatory Premium Rates-
    `(1) IN GENERAL- With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market--
    `(A) such rate shall vary with respect to the particular plan or coverage involved only by--
    `(i) whether such plan or coverage covers an individual or family;
    `(ii) rating area, as established in accordance with paragraph (2);
    `(iii) age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with section 2707(c)); and
    `(iv) tobacco use, except that such rate shall not vary by more than 1.5 to 1;
    and​
    `(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).​


    So when you go to buy a plan, they can't charge you higher premiums based on your medical history. They can only vary rates based on family status (i.e. is it just you on the plan or a family), geography, age, and whether or not you're a smoker. This is as of January 1, 2014. Presumably your VA coverage would last until then, based on what you've said.

    edit// I should also add that in five years if you do decide to return to the individual market (which will then be made up mostly of health insurance exchanges), if you're still relatively broke you'll be able to receive a refundable tax credit to help pay for your premiums. You can get an idea of how much you'd have to pay using this calculator.
     
    Last edited: Aug 26, 2010
  5. Meister
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    Meister VIP Member Supporting Member

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    Sounds like a prescription for companies to be raising the premiums for all to cover the cost for the few. When I say this, it's raising them higher than they would without the healthcare debacle.
    Refundable tax credit?.....hmmmmm
    I'm praying that somehow this doesn't get funded in its present wording.
     
  6. Big Black Dog
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    Big Black Dog Gold Member Supporting Member

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    Have you discussed this with your lawyer? If so, what is his opinion? I know of people who were treated very well by the VA. I also know some that haven't been as lucky. It sounds to me that your situation is a crap shoot. You could come out a winner on one hand and you could also come out a loser. I think in the long run this is a decision that only you should make after you discuss it with your lawyer.
     
  7. RetiredGySgt
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    RetiredGySgt Platinum Member

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    I was judged 70 percent disabled by the VA and paid at the 100 percent rate due to unemployable. I have been at this rating since 2000 back dated to 1998.

    Are you near a VA facility? If not the VA isn't gonna help much. The VA has a major back log so your service will be slow at best. Not sure if you can get the same doctor every time either.

    If the condition does not improve no doctor is going to change your rating or advice to change it. I went from going in the hospital 2 or 3 times a year to no visits since I do not have to work. And I have passed every review. Of course I have the same set of doctors.

    The review is conducted by an independent doctor hired by the VA. He will interview you also.
     

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