[hillncea]

Originally Posted by 2BNTV

Excellent post!!!! :bigapplause:

When emotions rule the mind, the intellect goes out the window.

One thing I haven't seen mentioned in any of these posts is concern over how easily TVHS has changed the rules that people thought they were operating under, and how easily they might change again in the future. My wife and I are going to leave TVHS because of this new ruling, not because we think it is the better way for us to go now, but because we are concerned about what new adverse decisions TVHS might put forth in the future.

A critical element of health care is confidence. If you have lost confidence in the system (as we have because of the way this recent decision was made and communicated), it's time to go. Who's to say The Villages won't close the entire system three or four years from now because it's not making enough money for them then (and with the number of people walking because of this recent decision, that's not such a far-fetched scenario). Where will be people who stick with the system now be then?

[ValSetz]

When I signed up for Medicare 3 years ago, I was told that if I initially signed up with Advantage and then later on wanted to change to Supplemental that my medical history would be considered and I could be denied. Not sure if this is true or not but it made an impact on my choice. Anyone from SHINE that can verify whether this is true or not?

[Jpicchi]

I hope everyone that is going to buy a home in The Villages is well informed of this health insurance clinch before buying ......some how I doubt that will happen.

[Carla B]

Originally Posted by ValSetz

When I signed up for Medicare 3 years ago, I was told that if I initially signed up with Advantage and then later on wanted to change to Supplemental that my medical history would be considered and I could be denied. Not sure if this is true or not but it made an impact on my choice. Anyone from SHINE that can verify whether this is true or not?

I'm not with SHINE but it is true. I know this because we chose to drop an unsatisfactory employer-sponsored PPO plan for a supplement a few years ago. Approval by the insurance co. that provided the supplement required answering several health questions satisfactorily.

[Marciastef]

From what I heard from my doctor up north all is going to change for Medicare anyway when the new MACRA laws go into effect.

[LynnWM158]

I moved here primarily for the healthcare system that was so loudly touted as a model system. I have only been in the system for two years. I changed my primary care physician after a couple of months as I felt like just a number with my initial physician. I really like my current physician but the change to their accepted insurance 'only' has really forced me to make a decision that I need to make for myself. The out of pocket cost in higher premiums, plus a co-pay which I do not have with my current carrier, is a no-brainer for me. The fact that hospitals and facilities receive a payment from plans for their acceptance of preferred plans has been going on for years. After many years working in the healthcare field I am very aware that 'kick back' is a common practice. The care I received here has been adequate but not up to the standard I received in rural Tennessee. I have an appointment with my new physician out of TV Healthcare system this week. The location of the practice is not convenient but I need to move on. I'm sure there are many who will make the same decision but, for everyone of us who choose to leave there will be another person to fill our place.

[champion6]

Originally Posted by hillncea

One thing I haven't seen mentioned in any of these posts is concern over how easily TVHS has changed the rules that people thought they were operating under, and how easily they might change again in the future. My wife and I are going to leave TVHS because of this new ruling, not because we think it is the better way for us to go now, but because we are concerned about what new adverse decisions TVHS might put forth in the future.

A critical element of health care is confidence. If you have lost confidence in the system (as we have because of the way this recent decision was made and communicated), it's time to go. Who's to say The Villages won't close the entire system three or four years from now because it's not making enough money for them then (and with the number of people walking because of this recent decision, that's not such a far-fetched scenario). Where will be people who stick with the system now be then?

Sadly, you might find the same situation when you change to another individual doctor or another group. You never know ... it's a jungle out there.

[golfing eagles]

Originally Posted by hillncea

One thing I haven't seen mentioned in any of these posts is concern over how easily TVHS has changed the rules that people thought they were operating under, and how easily they might change again in the future. My wife and I are going to leave TVHS because of this new ruling, not because we think it is the better way for us to go now, but because we are concerned about what new adverse decisions TVHS might put forth in the future.

One thing I haven't seen mentioned in any of these posts is concern over how easily ANY MEDICAL PRACTICE IN THE US has changed the rules that people thought they were operating under, and how easily they might change again in the future (and probably will).

[golfing eagles]

Originally Posted by LynnWM158

I moved here primarily for the healthcare system that was so loudly touted as a model system. I have only been in the system for two years. I changed my primary care physician after a couple of months as I felt like just a number with my initial physician. I really like my current physician but the change to their accepted insurance 'only' has really forced me to make a decision that I need to make for myself. The out of pocket cost in higher premiums, plus a co-pay which I do not have with my current carrier, is a no-brainer for me. The fact that hospitals and facilities receive a payment from plans for their acceptance of preferred plans has been going on for years. After many years working in the healthcare field I am very aware that 'kick back' is a common practice. The care I received here has been adequate but not up to the standard I received in rural Tennessee. I have an appointment with my new physician out of TV Healthcare system this week. The location of the practice is not convenient but I need to move on. I'm sure there are many who will make the same decision but, for everyone of us who choose to leave there will be another person to fill our place.

1) What premium???? Someone with supp. plan F and a part D plan is paying $238/mo. in premiums, there is no premium with UHC MA plan 1. Saving $2856/yr. will cover a lot of co-pays. If someone has very high utilization of medical services, they could theoretically lose on the copays. On the other hand, MA plans are based on average utilization. Maybe rightfully so. I'm not so sure I should pay the same at the all-you-can-eat buffet as the 600 lb. customer, nor the same for an airline seat, especially since they charge me extra for a 25 lb. checked bag but not for his 400 lb. of excess weight.

2) Kickbacks????? Please explain what planet you spent years working in healthcare on.

[gerryann]

Originally Posted by Carla B

I'm not with SHINE but it is true. I know this because we chose to drop an unsatisfactory employer-sponsored PPO plan for a supplement a few years ago. Approval by the insurance co. that provided the supplement required answering several health questions satisfactorily.

This possibly may have changed due to "the affordable care act" or "Obama care" . Maybe pre-existing is not allowed? Don't know....just asking.

[Carla B]

gerryann: You may be right but for reasons not due to Obamacare, YET. I just looked at the Medicare book for 2016. On page 103 it states: "If you had a Medigap policy before you joined (Medicare Advantage) and aren't happy you have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining (the Advantage plan)."

However, in another paragraph on the same page it cautions, "In most cases, if you drop your Medigap policy to join a Medicare Advantage Plan, you won't be able to get it back." Maybe that must have something to do with the 12-month limitation and is why we had to go through underwriting when applying for a supplement.

[jpforster]

Spuds51 - Thank you SO MUCH for posting! This video (and other videos) by Christopher Westfall address just what we needed to know - and at just the right time. My husbands just turning 65. Thanks again! Very grateful!

[Happydaz]

Originally Posted by golfing eagles

One thing I haven't seen mentioned in any of these posts is concern over how easily ANY MEDICAL PRACTICE IN THE US has changed the rules that people thought they were operating under, and how easily they might change again in the future (and probably will).

It is one thing to have one or possibly two insurances not accepted in a medical practice but this is a rejection of all insurance plans except United Healthcare Advantage plans. As far as Medicare patients go, TVH has turned their medical practice into an HMO. As a physician yourself could you imagine your former medical practice dropping all insurances except one? You would lose so many patients that it wouldn't be a smart decision.

[shmoo1]

You are correct in the statement that one year past your sign up anniversary date....you CANNOT go back to original Medicare with a supplement and drug plan....

[Johnd]

Originally Posted by shmoo1

You are correct in the statement that one year past your sign up anniversary date....you CANNOT go back to original Medicare with a supplement and drug plan....

And yet, right from the Medicare.gov website it says:

"Follow these steps if you're already in a Medicare Advantage Plan and want to switch:

To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. You'll be disenrolled automatically from your old plan when your new plan's coverage begins.

To switch to Original Medicare, contact your current plan, or call 1-800-MEDICARE.

Unless you have other drug coverage, you should carefully consider Medicare prescription drug coverage (Part D). You may also want to consider a Medicare Supplement Insurance (Medigap) policy. Remember, you may only be able to switch at certain times of the year."