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Stephanie O Joy, Esq
Stephanie O Joy, Esq, Soc. Sec. Attorney
Category: Social Security
Satisfied Customers: 13283
Experience:  19+ years legal exp. - 10+ years owning/operating her own SSD Law practice.
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I am 75 old veteran. I have VA Health & Part A Medicare. I

Customer Question

I am 75 old veteran. I have VA Health & Part A Medicare. I had an accident recently that requires orthopedic care. My nearist VA facility offering this care is 147 miles from my home. I am considering signing up for Part B which would provide me options, but when calculating late sign up penalities the cost is nearly two hundred & thirty dollars a month! Is there a way to avoid this near 100% peanality.
Submitted: 7 months ago.
Category: Social Security
Expert:  Stephanie O Joy, Esq replied 7 months ago.
Is this Tri-Care?
Customer: replied 7 months ago.
I am not familiar with what Tri-Care is?
Customer: replied 7 months ago.
Day two!,,,and all I've got is,...Is this Tri-Care?
Expert:  Stephanie O Joy, Esq replied 7 months ago.
Day 2? Actually, it is less than a day since I asked you a question. More than 5 minutes of waiting for your response told me that you had left, however temporarily, and being a lawyer running a practice, I could wait no longer.
Expert:  Stephanie O Joy, Esq replied 7 months ago.
Tri-Care is a VA provided health care insurance, and since you mention VA health, it may be helpful to determine what exactly you are covered by. You are interested in knowing if you will have the premium penalty, vs. avoid it, yes (for Medicare coverage)?
Customer: replied 7 months ago.
Thank you. My apology for the misunderstanding. In regard to Tri-Care. No mention of it from the VA and I've been with them 9 years. They do have a program called Choice. An option for local referral,...in the event a patient cannot drive to a VA care facility.In my case, my VA Primary doctor, in State College PA, has decided I can drive to the nearest VA orthopedic team at the VA hospital in Pittsburg, PA, 147 miles from my home. At 75, able to do only limited walking with a cane and no night driving while recovering from a shattered hip this is not a possiblity. so I am considering Medicare Part B, but the 10 per cent penalty per twelve month periord since 65, means nearly $240 a month. My question is since I am legally handicapped in PA is it possible to get a waiver for the sign up penalty?I look forward to your response. D. Barnes
Expert:  Stephanie O Joy, Esq replied 7 months ago.
Have you yet determine IF your current coverage constitutes creditable coverage? For instance, VA's tri-care coverage does cover Part D as creditable. So I would double check that first. However, assuming you don't have creditable coverage sufficient for Part B purposes, (which is pathetic, why do our Vets VA coverage NOT have coverage as good as medicare (and medicare isn't a prize either, but they should at least have that))... there is no waiver I am aware of. Most people needing Medicare are at some point disabled, so they aren't about to develop a waiver program.That said, I find it deplorable that you can't get an ortho in a reasonable distance! What kind of unique orth treatment is only available 150 miles away? And what about your coverage that says you CAN use local referral if you can't get to VA facility 3 hours away? Are you saying your Dr refuses to give you that local referral? Maybe you would be best off asking him to reconsider, and getting a second opinion that refutes his. Aside from that, if this trip to Pittsburgh is not expected to be a repeat need it may be worth it to pay a driver to get you there this time, vs. paying that extra money for Part B, over and over and over again. Or, is the cost of using an outside local dr. not coverage by VA choice insurance, still better than paying for Medicare over and over? I guess this depends on whether you need repeated non-VA treatment, right? I am throwing out thoughts here, although your real question was, is there a waiver. To be clear, no known waiver, no.
Expert:  Stephanie O Joy, Esq replied 7 months ago.
I hope this helps! My goal is to provide you with excellent and accurate service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions. Kindly rate me "excellent" when you are done. I look forward to assisting you in the future, should you have legal questions. Be sure to start future posts with "To ***** Esq., ONLY" if you want me to specifically answer it. Sincerely, ***** ***** Joy, Esq.Your online SS legal resource!

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