[CFrance]

Originally Posted by golfing eagles

Agree with rant. My best advice is to either talk with SHINE or the UHC rep at the health centers. TOTV has nothing but anecdotal horror stories that MAY or MAY NOT have been different elsewhere. Also, about 2/3 of the perceptions of the Advantage plan is just plain wrong. People are worried about restricting their choice of specialists/hospitals. For example, it is true, if you have traditional medicare with a supp, you can go to 99.9% of the providers in Central Florida. With the Advantage plan you can only go to 98% of them---but if you have an unusual situation you can get covered for the other 1.9%. So get the facts from a reliable source before hunting for greener grass.

But I don't want 98% of the providers in Central Florida. I want the ability to access providers anywhere in the country. That's why we have a supplement as opposed to an advantage plan. If I get a rare disease, I want to go where the knowledge is and not have to jump through hoops to get there. I know how you feel about research/teaching centers, GE, but we feel differently for various reasons I won't go into for fear of being accused of giving opinion based on just anecdotal information!

[villagerjack]

Originally Posted by Mrs. Robinson

We are sticking with our Medicare and supplemental plan that we have had for years.
While we may be paying more, we can go anywhere, to any doctor, and it doesn't cost us a cent.
While a time could come when we might change our supplemental coverage, we would never go with anything the Villages offers.
This is how we look at it: Why is TV changing the health coverage? It's very simple and is based on economics. They aren't making enough money!
We find it very worrisome that TV is involved in so many -- too many things, i.e., banks, health coverage, insurance, construction, etc.

Actually the Villages was losing money. Last year they subsidized the Plan with $6 million out of their own pocket. We love the Villages Plan. We put away in a separate savings account the money we saved from not paying for a supplemental plan just in case we want to go to a doctor who is not in the Plan. So far all my doctors on NY and Florida are in the Plan.

[golfing eagles]

Originally Posted by CFrance

But I don't want 98% of the providers in Central Florida. I want the ability to access providers anywhere in the country. That's why we have a supplement as opposed to an advantage plan. If I get a rare disease, I want to go where the knowledge is and not have to jump through hoops to get there. I know how you feel about research/teaching centers, GE, but we feel differently for various reasons I won't go into for fear of being accused of giving opinion based on just anecdotal information!

Originally Posted by villagerjack

Actually the Villages was losing money. Last year they subsidized the Plan with $6 million out of their own pocket. We love the Villages Plan. We put away in a separate savings account the money we saved from not paying for a supplemental plan just in case we want to go to a doctor who is not in the Plan. So far all my doctors on NY and Florida are in the Plan.

I went back and re-read my post, and I can see how it may have been misconstrued. I did not intend to diminish anybody's bad experience, I feel bad for their misfortune. Likewise, I did not intend to throw water on anyone's great experience. My point is that these things tend to have a bell shaped curve with a norm and outliers. I just don't think tens of thousands of people should be making an important decision based on a few dozen outliers, good or bad. That is why I advocated getting the facts from the source

As far as rare diseases go, the good news is that they are RARE. The chances of an otherwise healthy individual getting a "rare" disease, then NEEDING a specialist/hospital far out of our area, and then getting denied by the insurer are quite remote. Yes, "stuff" can happen, but that scenario is highly unlikely and I question whether it should be the basis for a coverage decision. And again, the overwhelming likelihood is that the out of state care would be covered, but yes, you might have to "jump through hoops". So, if someone's number 1 concern is avoiding "hoops" to go anywhere they want in the case of a "rare" disease, then they need to stick with Medicare/supplemental insurance and opt out of TVH.

Remember, the dramatic changes in health care delivery are not a local phenomena, they are national changes based on government policy, especially the ACA. This is a 2700 page legislation with over 44,000 pages of regulations, the full impact of which just starts in 2017. All that the law mandates has been working its way into the system and planning for years, so unfortunately "repeal and replace" is far more complicated than taking a vote in Congress. The emphasis of this legislation had absolutely nothing to do with "affordability" or "quality care", its main goal was cost containment and 100% government control over health care. Since the powers that be could not get single payer government health care, the next best thing was to control all the other payers, and hospitals, and doctors with a series of financial incentives and penalties. The net effect, however, is to drive up cost, spend more health care dollars and time on administration and regulation and less on direct patient care. It forces doctors and hospitals into an alphabet soup of ACOs, PCMHs, MIPS, MACRA etc. or face penalties starting in 2017. My "good friend", Jonathan Gruber (aka "stupidity of the American voter"), architect of this plan, conceived of a system of 40 or 50 regional health care systems that control all the hospitals and providers under them. Then the government just has to tug the puppet strings of these systems, instead of thousands of hospitals and hundreds of thousands of providers. To this end they have thrown hundreds of billions of dollars out there so everyone has a massive food fight, and then they will deal with the winners. Of course, once their system is in place and they have 100% control, the squeeze will begin. The result---the one thing they could never say---will be the only reliable cost savings----rationing of healthcare. So what you WANT is irrelevant to the government. Hopefully we will at least be able to get what we NEED, at least for a while. Sorry for the bleak outlook.

As far as TVH not "making enough money", I suspect they are losing or have LOST money. I don't know where that 6 million figure comes from---I know people in TVH management and this is not something they would discuss, nor would I ask, so you must have better connections than I do. Also, given the immense initial investment in infrastructure, a lot of that loss may be depreciation rather than actual cash flow. But in either case, hypothetically, if a good offer came along, say from UHC, they would be idiots not to grab it

So, in summary, changes are underway nationally, so fasten your seatbelt, but make decisions based on facts and your current situation and try to avoid the "what if" game, unless you are psychic.

[Avista]

Originally Posted by villagerjack

Actually the Villages was losing money. Last year they subsidized the Plan with $6 million out of their own pocket. We love the Villages Plan. We put away in a separate savings account the money we saved from not paying for a supplemental plan just in case we want to go to a doctor who is not in the Plan. So far all my doctors on NY and Florida are in the Plan.

That is exactly what we do. We've been putting away money each month in the amount of money we would have paid for a supplement.

[raynan]

I had Medicare with BC/BS supplement. Changed over to Medicare Advantage/United Health to keep my doctor in The Villages. Started getting bills for things I never paid for before.
Switched back to Medicare, BC/BS supplement effective 1/1/17. I love my primary doctor but The Villages system doesn't work for me. Several of my neighbors are finding out the same thing and are switching out 1/1/17.

[Villageswimmer]

Originally Posted by raynan

I had Medicare with BC/BS supplement. Changed over to Medicare Advantage/United Health to keep my doctor in The Villages. Started getting bills for things I never paid for before.
Switched back to Medicare, BC/BS supplement effective 1/1/17. I love my primary doctor but The Villages system doesn't work for me. Several of my neighbors are finding out the same thing and are switching out 1/1/17.

Don't post anything negative, whether your own experiences or not, or you'll be slammed for having posted a rant. I read UH materials and thought too much seems to be left to their discretion. Just sayin...

[arickis]

Don't kid yourself folks. As nice and caring as your Dr and Insurance people might be, it is about the bottom line. Different people and health care needs make for different plans for us to choose from. No need to trash anyone about choices or offerings. Eat more chocolate.

[Leisha2]

United Health Care, The Villages has worked very well for me. I needed a specialized heart surgery done by only one doctor in the world, since he invented it. He is located at Sentara Heart Hospital in Norfolk, VA. United Health Care gave me no problems at all when I asked to go to that surgeon. No extra paperwork, nothing! It was approved within a few days. I too used their passport system.

[2BNTV]

This topic has been going around and around for the last year or so.

I feel sorry for people that got an unforseen illness and felt the plan they were on or not on, didn't work for them.

MA plans are geared toward people who are basically healthy.

Medicare and supplements are geared for people who have a recurring condition or want peace of mind they will never see a bill.

We all don't know what the future holds in terms of health so we must be our own health advocate and select what plan might be better for a particular family.

I'll take GE's word for it that one can get to see whatever doctors they need, if they have a MA plan.

I have had a MA plan since turning 65 and never had an illness, (thank goodness). I have saved $3,000 per year for many years and that works for me. I have a $4500 OOP max with my MA plan.

I don't expect this post will help anyone to decide what best for them but everyone needs to do their own research and decide what plan fits their health needs.

[Nucky]

Originally Posted by 2BNTV

This topic has been going around and around for the last year or so.

I feel sorry for people that got an unforseen illness and felt the plan they were on or not on, didn't work for them.

MA plans are geared toward people who are basically healthy.

Medicare and supplements are geared for people who have a recurring condition or want peace of mind they will never see a bill.

We all don't know what the future holds in terms of health so we must be our own health advocate and select what plan might be better for a particular family.

I'll take GE's word for it that one can get to see whatever doctors they need, if they have a MA plan.

I have had a MA plan since turning 65 and never had an illness, (thank goodness). I have saved $3,000 per year for many years and that works for me. I have a $4500 OOP max with my MA plan.

I don't expect this post will help anyone to decide what best for them but everyone needs to do their own research and decide what plan fits their health needs.

Come on 2BNTV you must have bumped your head. There can be no way your even 65 and over 65 for many years no way Jose Fooorrgetaboutit! LOL. OK I believe you because you're on the Nucky advisory staff along with many others.

[rivaridger1]

Basically it boils down to what ever works for you. If you are banking the dollars saved from subscribing to an advantage plan, good for you. It will however take a while until they total a couple of hundred thousand dollars needed should you or your spouse become seriously ill. As one poster said, Advantage plans are for the healthy. You will not stay that way forever.

[villagetinker]

Originally Posted by rivaridger1

Basically it boils down to what ever works for you. If you are banking the dollars saved from subscribing to an advantage plan, good for you. It will however take a while until they total a couple of hundred thousand dollars needed should you or your spouse become seriously ill. As one poster said, Advantage plans are for the healthy. You will not stay that way forever.

And you may in for a real shock if you decide to (or try to) go back to Medicare......

[JoMar]

But changes are acoming...lol

[2BNTV]

Originally Posted by rivaridger1

Basically it boils down to what ever works for you. If you are banking the dollars saved from subscribing to an advantage plan, good for you. It will however take a while until they total a couple of hundred thousand dollars needed should you or your spouse become seriously ill. As one poster said, Advantage plans are for the healthy. You will not stay that way forever.

Originally Posted by villagetinker

And you may in for a real shock if you decide to (or try to) go back to Medicare......

Both these posts point out the possible need to switch to Medicare and a supplement down the road, (in my particular case).

I talked with a SHINE rep last month and he said that unless you have a cancer or another condition that will need medical attention, you will not be able to switch over at that time. The supplemental plan will deny you coverage. If you are still healthy or have recovered from that illness, you can switch to Medicare and a supplement, at any time. In other words, an insurance company is not going to cover someone that they will have to pay for, a known costly illness.

The question becomes, when to do it! Who's to say when one's health will start to fail them? Only GOD knows that answer.

[Villages Kahuna]

Originally Posted by jensul619

I posted a thread yesterday about my experience with the Villages health but it doesn't seem to be showing anywhere I can find it
My husband and I are two of the 15,000 residents whose health insurance will be cancelled on 1/1/17 unless we switch to a UHC Medicare advantage plan, preferably the one the Villages is advertising everywhere.
We have original Medicare and a supplement which work very well for us. The VHC is much less expensive and provides good care, IF AND ONLY IF YOU ARE HEALTHY, which we were. We both had no serious health issues but because of our ages mid seventies), we should stay with Medicare and the supplement we had. We found a new primary care doctor outside of the Villages in early September.
THANK GOD WE DID. In mid October I was diagnosed with invasive breast cancer and saw a surgeon here in the Villages who I was not at all impressed with. I ended up having the surgery at Moffitt Cancer Center in Tampa where the care was absolutely wonderful. If I had stayed with the VHC, Moffitt is considered "out of network" and my surgery would not have been covered. So, thank you for dropping us. When I see the full page newspaper ads and receive flyers in the mailbox saying how wonderful the insurance is, I get so angry and want to tell the world that no, it is only wonderful if you have NO health issues. My advice is to please please choose very carefully.
I hope this helps anyone who is trying to decide what to do.

My wife and I were also dropped by Villages Health. My consideration of their Medicare Advantage Plan was a non-starter. I have multiple artificial joints and non of the orthopedic surgeons in their network would do "revisions" to existing artificial joints. I would have had to find a surgeon, probably in Orlando, and then pay 100% of the cost of the suirgery myself!

Similarly, I am a prostate cancer survivor. My radiation oncologist performed procedures successfully at Moffitt Cancer Center in Tampa. Follow up therapy was done by Moffitt when it was here at TVRH. Now, if I were to need followup care I would have to use one of the oncologists in their local network. Neither Moffitt or Shands in Gainesville, M Anderson in Orlando, or any other well-known cancer treatment facility or doctor is included in the VH Advantage Plan.

The Villages Health Medicare Advantage Plan works well for younger, healthy people. With their co-pays, it's not that inexpensive by the way. But when medical needs include the types of things common wioth an aging population--joint replacements, cancer surgeries and treatment, eye surgeries, etc., you quickly find that your choice of care is limited to a very narrow list of local specialists and facilities, all quite local and almost all with no well-known reputation for quality care.

Villages Health will tell you that going back to Medicare and a supplement is an option if specialized care is required. But that can only be done once per year, during the normal enrollment period. Even then you have to apply for re-admittance to a different insurance plan with no assurance that you will be accepted or that you won't be charged an elevated premium.

Be VERY careful before choosing Villages Health Medicare Advantage Plan. It's great for younger, healthier people...not so good at all for a lot of old-timers with the normal problems of aging.