The Villages Health - Grandfathered?!

[trichard]

Grandfathered? Think again. If you have Medicare Original get ready to be "porked". Beginning January 1, 2017 you either switch to United Healthcare Medicare Advantage Plan or seek care elsewhere. They will tell you that it is to improve the quality of care, but it has only to do with increasing the quantity of money! They are sucking a lot of red ink due to the quality of their top management staff.

[dbussone]

Grandfathered? Think again. If you have Medicare Original get ready to be "porked". Beginning January 1, 2017 you either switch to United Healthcare Medicare Advantage Plan or seek care elsewhere. They will tell you that it is to improve the quality of care, but it has only to do with increasing the quantity of money! They are sucking a lot of red ink due to the quality of their top management staff.



That and the fact that their physicians have a very low case load which was the initial promise of the model.


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[nyclicker]

Where did you get your information?

[dbussone]

Where did you get your information?



I have been following their system since before doc recruiting began. If you research the initial PR, you'll find that the system was built upon the premise of significantly decreasing a physician's caseload when compared to avg caseloads of physicians in "normal" practices.

Here is one article. There are others that include more specific information, but you should get the point from this 2012 article.

http://villages.health.usf.edu/articles/release1.pdf

I should also note I know about the individual who was recruited to form the practices.



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[villagetinker]

Grandfathered? Think again. If you have Medicare Original get ready to be "porked". Beginning January 1, 2017 you either switch to United Healthcare Medicare Advantage Plan or seek care elsewhere. They will tell you that it is to improve the quality of care, but it has only to do with increasing the quantity of money! They are sucking a lot of red ink due to the quality of their top management staff.

Yes, where did you hear this? What is your source? I have contacted SHINE to see if they have any info on this.

[goodtimesintv]

".....Impossible Burden For The Elderly And The Disabled

About half the cost of the ACA (Affordable Care Act) is paid for by cuts in Medicare spending and the only practical way those cuts can be made is by reduced fees to providers.

The Medicare actuaries have noted with alarm that Medicare fees to doctors will drop below Medicaid levels in the near future and the combined effect of lower Medicare and Medicaid hospital spending will drive one in seven hospitals from the market in the next five years.

Although the administration talks about making Medicare more efficient, three separate reports by the Congressional Budget Office (CBO) have concluded that the pilot programs and demonstration projects that are supposed to find these efficiencies are not working.

In fact, the only place in Medicare that shows any promise at all is in the Medicare Advantage (MA) program. But the administration is determined to proceed with cuts in MA subsides and appears to be paying no attention whatever to the efficiencies MA entrepreneurs are discovering.

Because no serious budget analyst believes the Medicare spending cuts can withstand the inevitable political backlash and because they don’t believe the pilot programs will work either, both the CBO and the Medicare Trustees are annually publishing “alternative forecasts” in an effort to predict how Congress will cave. But if Congress does cave and restores the previous Medicare spending path, that means that the ACA isn’t paid for; and that, in turn, means large unfunded liabilities stretching out indefinitely into the future and increasing federal debt......"

Six Problems With The ACA That Aren’t Going Away (http://healthaffairs.org/blog/2015/06/25/six-problems-with-the-aca-that-arent-going-away/)

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[RedChariot]

Grandfathered? Think again. If you have Medicare Original get ready to be "porked". Beginning January 1, 2017 you either switch to United Healthcare Medicare Advantage Plan or seek care elsewhere. They will tell you that it is to improve the quality of care, but it has only to do with increasing the quantity of money! They are sucking a lot of red ink due to the quality of their top management staff.

How could The Villages do this to us all? I was told as many as 10,000 will be dumped unless we cancel traditional Medicare and go with the United Advantage plan. We that were grandfathered in a while back will be out. You can say it is a rumor, but some are taking the initiative and seeking a new physician before so many are cut loose.
We were at that first meeting when the physical of bellview explained the program. We signed up immediately. We are disappointed.

[RickeyD]

How could The Villages do this to us all? I was told as many as 10,000 will be dumped unless we cancel traditional Medicare and go with the United Advantage plan. We that were grandfathered in a while back will be out. You can say it is a rumor, but some are taking the initiative and seeking a new physician before so many are cut loose.
We were at that first meeting when the physical of bellview explained the program. We signed up immediately. We are disappointed.

This will be a new paradigm for the foreseeable future.

[NYGUY]

How could The Villages do this to us all? I was told as many as 10,000 will be dumped unless we cancel traditional Medicare and go with the United Advantage plan. We that were grandfathered in a while back will be out. You can say it is a rumor, but some are taking the initiative and seeking a new physician before so many are cut loose.
We were at that first meeting when the physical of bellview explained the program. We signed up immediately. We are disappointed.

When you look in a dictionary, your post will show up as the definition of "bait and switch"

[goodtimesintv]

7-15-2015

"Marilyn Tavenner is about to make an unprecedented move: From head of Medicare, to the nation’s top lobbyist for private insurers — in just six months.

Tavenner will succeed Karen Ignagni as the CEO of America’s Heath Insurance Plans, the New York Times reported on Wednesday. Tavenner had served as the administrator of CMS for more than three years, where she was responsible for Medicare, Medicaid, and much of Obamacare’s implementation.....

...“Asked about her priorities, Mr. Tavenner said she wanted to protect Medicare Advantage, the program under which private insurers manage care for more than 30 percent of the 55 million beneficiaries of Medicare.”

There’s a reason why private insurers care so much about Medicare Advantage: It’s arguably their hottest market right now.....

...The resurgence of Medicare Advantage is a stunning turnabout for a program that was supposed to be dead in the water, thanks to the Affordable Care Act....."

Full story:
Forbes Welcome (http://www.forbes.com/sites/dandiamond/2015/07/15/obamacare-was-supposed-to-kill-medicare-advantage-it-only-made-it-stronger/#5a51ef827ee1)

http://www.nytimes.com/2015/07/16/us/ex-medicare-chief-marilyn-tavenner-top-lobbyist.html

[RedChariot]

Yes, where did you hear this? What is your source? I have contacted SHINE to see if they have any info on this.

What information have you received from SHINE? Those of you on TOTV who do not want to go with United Advantage or cannot due to pension benefits restrictions, what is your plan?

[goodtimesintv]

Best of 2015 AcademyHealth Annual Research Meeting

Higher Incentive Payments in Medicare Advantage's Pay-for-Performance Program Did Not Improve Quality But Did Increase Plan Offerings

Authors
Timothy J. Layton Ph.D.,
Andrew M. Ryan Ph.D.
First published: 9 November 2015

Objective
To evaluate the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration.

Data Sources
Publicly available data from CMS from 2009 to 2014 on Medicare Advantage plan quality ratings, the counties in the service area of each plan, and the benchmarks used to construct plan payments.

Study Design
The Medicare Advantage Quality Bonus Payment Demonstration began in 2012. Under the Demonstration, all Medicare Advantage plans were eligible to receive bonus payments based on plan-level quality scores (star ratings). In some counties, plans were eligible to receive bonus payments that were twice as large as in other counties.....

Conclusions
At great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.

Health Services Research Higher Incentive Payments in Medicare Advantage's Pay-for-Performance Program Did Not Improve Quality But Did Increase Plan Offerings - Layton - 2015 - Health Services Research - Wiley Online Library (http://onlinelibrary.wiley.com/enhanced/doi/10.1111/1475-6773.12409)

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[Bonnevie]

I, too, feel I was welcomed into the system in the hopes of getting me to go with United Health Care. They certainly have a right to make that decision but if that was their plan all along I wish they would have been honest about it to spare me the trouble of switching everything again.

[2BNTV]

Am I missing something or am I confused? Is this for people under the age of 65?

I was under the impression that I could switch to Original Medicare with a supplement when I needed to. Doesn't TV Health Care take original medicare?

If it doesn't, then I will have to find a doctor that does take original Medicare, outside of TV Health Care system.

[Bonnevie]

right now it's people who are turning 65. they are told they have to switch to the advantage plan. those that do not choose to do so have to find someone else. now, my neighbors who were 65 when they joined when it started are still supposedly grandfathered in. however, I believe the op was saying as of 2017, they will be required to make the same choice. would be best to call and ask them.

[Carla B]

As I recall, it was last year that TV Health stopped accepting patients with Original Medicare. Now, according to the OP and the OP is probably right, all the patients with Original Medicare who had been admitted at the start of The Villages Health System will be disenrolled unless they agree to switch to UH Medicare Advantage. It's ironic that the government wanted to get rid of Advantage programs due to their greater cost to Medicare but now, these programs have "risen from the ashes", so to speak.

[RedChariot]

When you look in a dictionary, your post will show up as the definition of "bait and switch"

I believe what you said is true. This is wrong of The Villages to do this to their residents.We all signed up in good faith. Bait and switch as you said. Such greed.

[outlaw]

Welcome, fellow outcasts. Ocala and Leesburg aren't that far away.

[Villageswimmer]

Folks, this is a business and the goal is $ . It is difficult to believe that VHS will remain viable after this move. Not many of us former military, Feds, and educators will give up our insurance plans--and there are a LOT of us!

Do we know whether this is official or still in rumor stage?

I haven't seen the warm, fuzzy "Marcus Welby" propaganda touted lately.

If this decision has been made, it would be considerate of them to let us know sooner rather than later.

[biker1]

Hard to say without some actual numbers.

Folks, this is a business and the goal is $ . It is difficult to believe that VHS will remain viable after this move. Not many of us former military, Feds, and educators will give up our insurance plans--and there are a LOT of us!

Do we know whether this is official or still in rumor stage?

I haven't seen the warm, fuzzy "Marcus Welby" propaganda touted lately.

If this decision has been made, it would be considerate of them to let us know sooner rather than later.

[JoMar]

I believe what you said is true. This is wrong of The Villages to do this to their residents.We all signed up in good faith. Bait and switch as you said. Such greed.

It's only greed when it's not going in your pocket right?

[Villageswimmer]

I should have added that history has shown that TV does not make poor business decisions. If this change happens, you can be sure they have thoroughly researched the pros/cons and the money is there.

Neither side--you nor VHS--signed a contract. They can do what they want even if people think it stinks. I don't see it as bait and switch at all.

If I decided to leave VHS for whatever reason, would that be bait and switch? Did I promise to remain there for life?

It's a free marketplace. All they have to lose (apparently) is some goodwill. We'll get over it; they'll make bucks. :spoken:

[Villageswimmer]

Hard to say without some actual numbers.

Correct. I was speculating and am likely wrong.:bowdown:

[RedChariot]

It's only greed when it's not going in your pocket right?

I don't know what you mean but it seems a bit harsh. I would never try to increase my income at the cost of someone's health. If you knew my history as an RN and the pains taken to insure excellent patient care, you would not be so flippant.

[golfing eagles]

I should have added that history has shown that TV does not make poor business decisions. If this change happens, you can be sure they have thoroughly researched the pros/cons and the money is there.

Neither side--you nor VHS--signed a contract. They can do what they want even if people think it stinks. I don't see it as bait and switch at all.

If I decided to leave VHS for whatever reason, would that be bait and switch? Did I promise to remain there for life?

It's a free marketplace. All they have to lose (apparently) is some goodwill. We'll get over it; they'll make bucks. :spoken:

I agree 100%. Unfortunately for us patients, health care is a very fluid situation these days, forcing both providers and patients to make difficult choices. VHS's decision is no different than a solo practitioner in Podunk deciding to no longer accept Aetna. These insurance decisions face medical practices every year, and believe me they are not easy, since sometimes it means dropping an insurance that covers a long time patient. Hardly bait and switch--you have to go to an auto insurance company for that:1rotfl::1rotfl::1rotfl:

[goodtimesintv]

I believe what you said is true. This is wrong of The Villages to do this to their residents. We all signed up in good faith. Bait and switch as you said. Such greed.

No, we signed up like any other consumer of goods and services: We can take it or leave it and can enroll in Medicare with supplement with other dr. groups in the area.

People in some other countries would love to be able to have that option with their government healthcare.

If you want cite "greed", how about calling out the "greed" for power of all those in Washington who cook up the self-serving incentives for Medicare Advantage plans to double and boom, at the expense of Medicare.

[outlaw]

You people are dumber than dirt if you think UHC Villages Healthcare didn't pull the old bait and switch on us. Go ahead and defend the developer's chosen UHC. I joined last October with assurances from three different UHC people that I would be grandfathered in. I never would have joined without those assurances. In less than three months, I get the letter; switch or leave. Quit making fools of yourselves with your pathetic defense of these charlatans. Is it legal what they are doing? Yes. Is it ethical? H3ll No!

[goodtimesintv]

You people are dumber than dirt if you think UHC Villages Healthcare didn't pull the old bait and switch on us. Go ahead and defend the developer's chosen UHC. I joined last October with assurances from three different UHC people that I would be grandfathered in. I never would have joined without those assurances. In less than three months, I get the letter; switch or leave. Quit making fools of yourselves with your pathetic defense of these charlatans. Is it legal what they are doing? Yes. Is it ethical? H3ll No!

Right, AND it's also a matter of "you get what you pay for".

People have warned on here many times that the AARP -UHC Plan, and now The Villages UHC plan like it, are HMOs that do not include the outside specialists they needed at other teaching-research hospitals in a major health crisis with aggressive cancer or other rare/complex diagnosis.

Many comments are on this board saying the AARP- and TV-UHC plan was fine UNTIL they got into a crisis that they needed Drs for in Tampa or elsewhere, but the plan didn't include that, and some were lucky to be in the enrollment window to change to regular Medicare with supplement when they needed to. There was a thread just a couple of weeks ago with a person saying this happened to him, and he was thinking of changing back and people said "don't do it" because that lesson should already have been learned--the hard way.

[wendyquat]

But wait --- "if you like your health care and your doctor, you can keep them" --- right?

[NYGUY]

But wait --- "if you like your health care and your doctor, you can keep them" --- right?

Unfortunately, The Villages Health didn't say that!!

[nyclicker]

Grandfathered? Think again. If you have Medicare Original get ready to be "porked". Beginning January 1, 2017 you either switch to United Healthcare Medicare Advantage Plan or seek care elsewhere. They will tell you that it is to improve the quality of care, but it has only to do with increasing the quantity of money! They are sucking a lot of red ink due to the quality of their top management staff.

I'll ask this question again. Can anyone confirm this rumor?

[skieczius]

I have already been kicked out of the Villages Health,because I'm not on Medicare yet.I have insurance through my former Employer.I will not give that up for Medicare United Health Advantage.It's all about money!!!!!!

[dbussone]

I'll ask this question again. Can anyone confirm this rumor?



If I were you, I would call and ask. Then it's no longer a mystery.


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[Mikeod]

If I were you, I would call and ask. Then it's no longer a mystery.


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I asked a couple of weeks ago at the Colony facility. They would not confirm or deny that there would be a change coming up in the next enrollment period. Then they invited me to speak to the UHC rep, who did the same while trying to sell me on the plan. I requested and got a call from the manager of the Colony facility who also would/could not provide a definite answer to my question.

IMO, the VHS system was and is unsustainable if they have to rely on reimbursement rates for specific procedures and keep panel sizes down. That is why they are pushing patients to the advantage plan where they have a known sum of money to manage their patients and keep each physician's patient volume optimal.

My wife and I have been tossing the question around whether to stay with VHS using the UHC plan or continue with straight Medicare and TFL. I spoke to a rep from Tricare and was assured switching to the UHC plan had no effect on my TFL except that I lose the pharmacy coverage. And was assured that in the event I dropped the UHC plan at the next enrollment period and reverted to Medicare, all I had to do was contact TFL and let them know so my pharmacy coverage would resume.

We really enjoy the access to care at VHS. If I call, I get in soon. When I have an appointment, I am called in on time or shortly thereafter. Very different from my experience taking my mom to her appointments. It's not unusual to wait 40, 50 minutes or more past the appointment time to be seen. That's because provider reimbursement has been the main area hacked in efforts to slow the growth of health care spending. As a result, overbooking is the norm. Thus the long waits.

[spk7951]

The info below is from The Villages Health web site:

Accepted Insurance
If you are eligible for Medicare, we want you to know that the only Medicare Advantage plans The Villages Health participates in are those offered by UnitedHealthcare®.

UnitedHealthcare® The Villages® MedicareComplete® (HMO) Plan 1
UnitedHealthcare® The Villages® MedicareComplete® (HMO) Plan 2
AARP® Medicare Complete Choice® (Regional PPO)
AARP® Medicare Complete Choice® (HMO)
United Healthcare® Medicare Advantage Dual Complete


We continue to Participate with the following Commercial Insurances:

Avmed
Blue Cross & Blue Shield
Cigna
Multiplan
Private Healthcare System/PHCS
Tricare Standard
United Healthcare

[dbussone]

A significant issue with the VHS, IMO, is their failure to provide a full panel of specialists, and especially sub-specialists from places like Gainesville, Tampa and Orlando. When USF backed out of the arrangement, it really changed the capabilities of VHS, and altered the promise of VHS to meet the needs of TV residents.

Recall that Moffitt did the same thing, and Moffitt is just another arm of USF after all.


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[trichard]

A significant issue with the VHS, IMO, is their failure to provide a full panel of specialists, and especially sub-specialists from places like Gainesville, Tampa and Orlando. When USF backed out of the arrangement, it really changed the capabilities of VHS, and altered the promise of VHS to meet the needs of TV residents.

Recall that Moffitt did the same thing, and Moffitt is just another arm of USF after all.


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Totally agree! This is the primary issue for us.

[trichard]

It looks like the marketing push for MA has started. Today's article talks about how great the quality of care is at The Villages Health because they have teamed up with UHC Medicare Advantage. Did I miss the part about how it is big money-maker for TVH? I am waiting for the other shoe to drop for Medicare Original patients. Get ready to be "porked"!

[outlaw]

If I were you, I would call and ask. Then it's no longer a mystery.


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They lied to me three times. I had to wait for the letter.

[Bonnevie]

I also was told once I would be kept and later that I would not. was told by a provider there that decisions change all the time, so I doubt there is a conclusive answer.

[villagetinker]

I spoke with SHINE a week ago or so, and there has been some discussion about possible changes to the VHS health care. There was supposed to be an announcement a few weeks ago, as this affects some 15,000 current patients of VHS. There is supposed to be an informational article in either the POA or VOA newsletter (sorry I forget which was mentioned). Hopefully this article will have additional real information. Also, each patient should be getting a letter about any changes to the system.

[biker1]

What was the reason you were kicked out? I am not on Medicare and I haven't received any letter telling me that I need to go elsewhere.

I have already been kicked out of the Villages Health,because I'm not on Medicare yet.I have insurance through my former Employer.I will not give that up for Medicare United Health Advantage.It's all about money!!!!!!

[goodtimesintv]

It looks like the marketing push for MA has started. Today's article talks about how great the quality of care is at The Villages Health because they have teamed up with UHC Medicare Advantage. Did I miss the part about how it is big money-maker for TVH? I am waiting for the other shoe to drop for Medicare Original patients. Get ready to be "porked"!


By reading past threads on TV Health clinics opening, people wondered how they would be able to hire excellent primary care doctors and pay them the comfortable salaries, while still being able to have a smaller number of patients for each dr. to have needed time with each patient. Looking at the quality built into the TV Health system and clinicians, it should be evident that somebody has to pay the bills to keep it running pristinely as it is.

The more time spent with each patient, the fewer the patients seen in a day, and then the less revenue coming in to pay the bills and salaries.

AARP has its brand name on the Medicare Advantage plans and rakes in a fortune into its "non-profit" conglomerate. It seems to me that The Villages is lending its trade name to such plans, to make such royalties too, but TV is spending the royalties money on the TV Health system to keep it solvent and running as intended.

From experience here, I'd trust TV reinvesting those royalties back into the TV Health system far more than I'd trust AARP.

"An AARP spokesman declined to say how much the organization receives in royalties from UnitedHealthcare, but the most recent IRS Form 990 records available show non-profit AARP reported royalties of $762.6 million in 2013, more than half its revenue of $1.3 billion. That’s up from $723. 3 million in royalties the previous year.

The money includes a portion of the premiums collected by AARP-endorsed insurers in fields including health and auto, along with royalties from other ventures such as credit cards..."

AARP gets $762M from royalties. Do seniors get best insurance deal? | Protecting Your Pocket (http://protectingyourpocket.blog.palmbeachpost.com/2015/11/30/aarp-gets-762m-from-royalties-do-seniors-get-best-insurance-deal/)

[dbussone]

They lied to me three times. I had to wait for the letter.



Well that is just plain wrong. I'm sorry they did that to you, and others.


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[bstenon]

I called Mulberry Medical and was told that by the end of the year unless I have advantage plan I would need to find Dr. outside. I asked about the grandfathering and was told no way. Got it direct from Villages Health

[2BNTV]

I went to the Medicare store in SS and the rep told me starting in 2017, one has to sign up for UHC Medical Advantage Plan as they will not take any other insurance.

If one signs up for original Medicare plus a supplement, they will have to go outside of TV Health system.

I may be wrong and frequently, I am...........

[RickeyD]

Who will they take in the future when the UHC plan as have the previous plans no longer serves their needs. This is why privatizing Medicare & SS is not such a good idea.

[pjolson]

Just got the letter. It says "...we have decided to no longer accept Original Medicare with a traditional Medicare Supplemental policy for all new and existing patients starting January 1, 2017. This means that as of next year, you will need to be enrolled in a United Healthcare Medicare Advantage plan to remain a patient with The Villages Health."

[RickeyD]

Just got the letter. It says "...we have decided to no longer accept Original Medicare with a traditional Medicare Supplemental policy for all new and existing patients starting January 1, 2017. This means that as of next year, you will need to be enrolled in a United Healthcare Medicare Advantage plan to remain a patient with The Villages Health."



In other words...We have decided to F you and we don't care if you walk or not.

[trichard]

My wife just received her letter stating "Our records indicate you have a commercial insurance plan that we accept. As long as you continue with the same plan, you can remain a patient with TVH. ... When you become Medicare eligible, you will need to choose a UnitedHealthcare Medicare Advantage plan to remain a patient with TVH."

[trichard]

In other words...We have decided to F you and we don't care if you walk or not.

The letter takes a "pea on their back and tell them it's raining" approach to the TVH decision.

[golfing eagles]

My wife just received her letter stating "Our records indicate you have a commercial insurance plan that we accept. As long as you continue with the same plan, you can remain a patient with TVH. ... When you become Medicare eligible, you will need to choose a UnitedHealthcare Medicare Advantage plan to remain a patient with TVH."

This is correct, I checked yesterday. IF you are 65 or over, the only medicare they will take as of 1/1/17 is UHC advantage. IF you are under 65 this does not affect you, you can continue with your current insurance (until you hit 65)

[trichard]

This is correct, I checked yesterday. IF you are 65 or over, the only medicare they will take as of 1/1/17 is UHC advantage. IF you are under 65 this does not affect you, you can continue with your current insurance (until you hit 65)

The only caveat seems to be if you are under 65 with a commercial insurance plan you need to stay with your "current plan" according to the TVH letter.

[2BNTV]

The SS rep went on to say that he didn't agree with their decision not to accept original Medicare plus a supplement starting Jan 1, 2017 but thought the decision was made purely from economics. He felt they were throwing away money from all customers.

He seem to imply they get more money from UHC Advantage plans and that might be driving their decision.

[trichard]

The SS rep went on to say that he didn't agree with their decision not to accept original Medicare plus a supplement starting Jan 21, 2017 but thought the decision was made purely from economics. He felt they were throwing away money from all customers.

He seem to imply they get more money from UHC Advantage plans and that might be driving their decision.

It is purely an economic decision. Current management is unable to generate a positive bottom line.

[RickeyD]

http://uploads.tapatalk-cdn.com/20160715/5df177a1b8a624768039dd40c6a134ab.jpg

[NYGUY]

The letter also says...."Because our superior care best aligns with Medicare Advantage". Translation: Because we make more money off Medicare Advantage.:a20:

[daveczo]

Spouse on Tri Care for Life. She receives letter that she is fine. I will be on Tri Care for Life in January, receive letter that I won't be a patient. How does that make sense??

[champion6]

Spouse on Tri Care for Life. She receives letter that she is fine. I will be on Tri Care for Life in January, receive letter that I won't be a patient. How does that make sense??If your ages differ, it might be a factor.

[vinnyc]

My wife and I both received a letter today from TVH dated July 12,2016 signed by Tom Menichino, CEO and Jeffrey Lowenkron,MD, Chief Medical Officer which states,"Because our superior care best aligns with Medicare Advantage,we have decided to no longer accept Original Medicare with a traditional Medicare Supplemental policy for all new and existing patients starting January 1, 2017.
Therefore,for many of us, we will have to change to UHC Medicare Advantage which is an HMO and will decide the rationed type of treatment you will receive or find providers outside The Villages. The TVH powers to be have decided that money is more important the health and welfare of its residents.
This is really an outrage and a slap in the face to all of us who trusted them to insure our healthcare

[trichard]

My wife and I both received a letter today from TVH dated July 12,2016 signed by Tom Menichino, CEO and Jeffrey Lowenkron,MD, Chief Medical Officer which states,"Because our superior care best aligns with Medicare Advantage,we have decided to no longer accept Original Medicare with a traditional Medicare Supplemental policy for all new and existing patients starting January 1, 2017.
Therefore,for many of us, we will have to change to UHC Medicare Advantage which is an HMO and will decide the rationed type of treatment you will receive or find providers outside The Villages. The TVH powers to be have decided that money is more important the health and welfare of its residents.
This is really an outrage and a slap in the face to all of us who trusted them to insure our healthcare

You may want to check with Shine. It is my understanding that once you switch to a Medicare advantage product you can only get back to original Medicare during an initial 6-month period. Otherwise you will never be able to have original Medicare again.

[dbussone]

You may want to check with Shine. It is my understanding that once you switch to a Medicare advantage product you can only get back to original Medicare during an initial 6-month period. Otherwise you will never be able to have original Medicare again.



At least In my case that was not accurate. I had a Medicare Advantage plan for 2 years through FL Blue (FL BcBs). Then switched to Medicare + supplement in 2015.


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[trichard]

At least In my case that was not accurate. I had a Medicare Advantage plan for 2 years through FL Blue (FL BcBs). Then switched to Medicare + supplement in 2015.


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Thanks. I will re-check this.

[Rapscallion St Croix]

My letter says that since I have Tricare For Life, I will be "fine." They did encourage me to pick up their supplement to Tricare. OK, Medicare now pays part of my bill. Then they bill Tricare for the balance. Tricare For Life, which costs me nothing, gives them some chump change, and since there is no balance billing with Tricare for network care, I pay nothing. So, now, let me get this straight...they want me to pay a premium to gain nothing at all?

[Carla B]

Thanks. I will re-check this.

When we wanted to apply for a Medicare supplement and we were past age 65 + six months, we had to be able to answer several "health" questions satisfactorily, otherwise no go. So, yes, it is something you should check out.

[NYGUY]

Thanks. I will re-check this.

It is my understanding you can only switch back under certain circumstances, i.e. your plan stopped offering your plan or you moved to an area where they do not offer your plan, but, yes, by all means you should check it out....good luck.

[NYGUY]

....Therefore,for many of us, we will have to change to UHC Medicare Advantage which is an HMO....

UHC also offers a Medicare Advantage Plan that is a PPO, not an HMO, and a better product in my opinion.

[wendyquat]

When I looked into an Advantage plan no one could assure me that I could switch back to my regular UHC supplement if I wanted to do so. I even talked with two UHC agents and told them my health needs and both advised me to stay with the traditional supplement. It's a shame as we liked our doctors at TV and enjoyed the beautiful offices. I hope they will be able to get enough patients to switch to allow them to remain open! I can't help but doubt it!

[champion6]

UHC also offers a Medicare Advantage Plan that is a PPO, not an HMO, and a better product in my opinion.Are you referring to AARP Medicare Complete Choice (Regional PPO)?

[trichard]

When I looked into an Advantage plan no one could assure me that I could switch back to my regular UHC supplement if I wanted to do so. I even talked with two UHC agents and told them my health needs and both advised me to stay with the traditional supplement. It's a shame as we liked our doctors at TV and enjoyed the beautiful offices. I hope they will be able to get enough patients to switch to allow them to remain open! I can't help but doubt it!

If you recall, last year TVH had a big push to get patients to sign up for UHC MA. Did not seem that they had many takers. Will be interesting to see how many patients they can "force" to this plan this year or if the patients will move on to other providers.

[Bonny]

My letter says that since I have Tricare For Life, I will be "fine." They did encourage me to pick up their supplement to Tricare. OK, Medicare now pays part of my bill. Then they bill Tricare for the balance. Tricare For Life, which costs me nothing, gives them some chump change, and since there is no balance billing with Tricare for network care, I pay nothing. So, now, let me get this straight...they want me to pay a premium to gain nothing at all?
We also have Tricare and told we were good.

[MSGirl]

Yep! Got the letter! I'm not Medicare eligible so I can stay until I am!

[RickeyD]

Yep! Got the letter! I'm not Medicare eligible so I can stay until I am!



Reminds me what my first wife wanted from me while she planned the divorce with a me first exit strategy. I did extend her medical only because she needed a procedure, other then that she got nothing.

[LvmyPug2]

What they are doing is what we in healthcare used to call "Patient Dumping". A despicable practice of dumping the costliest and/or lowest revenue producting patients into a community with no regard as to where/how these patients will get their care in the future. To do this is extremely unprofessional. Really shows you how "caring" our developer and these so called "caring professionals" really are.

[trichard]

What they are doing is what we in healthcare used to call "Patient Dumping". A despicable practice of dumping the costliest and/or lowest revenue producting patients into a community with no regard as to where/how these patients will get their care in the future. To do this is extremely unprofessional. Really shows you how "caring" our developer and these so called "caring professionals" really are.

What I call it is a lack of business ethics.

[ColdNoMore]

What they are doing is what we in healthcare used to call "Patient Dumping". A despicable practice of dumping the costliest and/or lowest revenue producting patients into a community with no regard as to where/how these patients will get their care in the future. To do this is extremely unprofessional. Really shows you how "caring" our developer and these so called "caring professionals" really are.

What I call it is a lack of business ethics.

You both nailed it! :thumbup:

[kandmroberts]

Just got a cancellation letter today from Villages Health. What a scam! I have the best Medicare secondary coverage plan F, and now they only take United Healthcare Advantage Plan? Read your policies folks. That plan has serious deductables and if you are outside of "The Villages" and require a doctor or surgery you WILL HAVE AN EMPTY WALLET when they finish will you. They will try to get you to "convert" to this lower quality plan or quit taking you as a patient effective 12/31/2016. I've been with them since day one. Is this a prelude to our way of living in "America's Favorite Town?

[kandmroberts]

Grandfathered? Think again. If you have Medicare Original get ready to be "porked". Beginning January 1, 2017 you either switch to United Healthcare Medicare Advantage Plan or seek care elsewhere. They will tell you that it is to improve the quality of care, but it has only to do with increasing the quantity of money! They are sucking a lot of red ink due to the quality of their top management staff.
Just got a cancellation letter today from Villages Health. What a scam! I have the best Medicare secondary coverage plan F, and now they only take United Healthcare Advantage Plan? Read your policies folks. That plan has serious deductables and if you are outside of "The Villages" and require a doctor or surgery you WILL HAVE AN EMPTY WALLET when they finish will you. They will try to get you to "convert" to this lower quality plan or quit taking you as a patient effective 12/31/2016. I've been with them since day one. Is this a prelude to our way of living in "America's Favorite Town?

[MSNPA]

We have been extremely happy with the Villages Health and our physicians. I have Cloukey and my husband has Kelly. We received our letters and will be fine until we are eligible for Medicare. This will occur in 2017 and 2018. As of this moment we do want their advantage plan and realize in the not so distance future we will need to look for new doctors. We find this disconcerting and are hoping something changes before we need to leave the practice. Hate looking for new doctors.

[Grand Islanders]

I should have added that history has shown that TV does not make poor business decisions. If this change happens, you can be sure they have thoroughly researched the pros/cons and the money is there.

Neither side--you nor VHS--signed a contract. They can do what they want even if people think it stinks. I don't see it as bait and switch at all.

If I decided to leave VHS for whatever reason, would that be bait and switch? Did I promise to remain there for life?

It's a free marketplace. All they have to lose (apparently) is some goodwill. We'll get over it; they'll make bucks. :spoken:


Whether it is good business or greed is open to debate. What is not open for debate is that we were lied to when TVH said we were grandfathered. We have been with the VHS since the beginning. We were told current patients could stay. Lying is never right...even if it is to make more $$ money!

[patoonya]

I.m one of the TV being dumped. This not the way it was advertised in the beginning, but its obvious the United Healthcare and the Villages are out to make money and we the dumpee's they could care less about. Real Hometown freindly????

[gomsiepop]

I received the letter today and would like to know if I currently have Medicare and United Healthcare (not an Advantage Plan) as my secondary am I ineligible to remain with the Villages Healthcare?

[Grannygail]

I don't know how many people are being dumped, but I question if they have enough United Health Advantage participants to keep them in business. Once the UHA have a major illiness, they will be jumping ship theirselves.

[spuds51]

I received the letter today and would like to know if I currently have Medicare and United Healthcare (not an Advantage Plan) as my secondary am I ineligible to remain with the Villages Healthcare?

As I read it you won't. You can call and ask for sure but it seems pretty clear. If you don't have UHC Medicare Advantage you're out.

[spuds51]

You may want to check with Shine. It is my understanding that once you switch to a Medicare advantage product you can only get back to original Medicare during an initial 6-month period. Otherwise you will never be able to have original Medicare again.

I believe you can go back during the open enrollment period each year but you will be subject to underwriting.

[champion6]

I received the letter today and would like to know if I currently have Medicare and United Healthcare (not an Advantage Plan) as my secondary, am I ineligible to remain with the Villages Healthcare?No.

[champion6]

Attached is a scan of the now infamous letter from TVH.

[obxgal]

My birthday is in July and was put on medicare/Freedom blue through my husbands benefits plan.

A few years ago I had a doctors appointment in November and being I went on medicare/Freedom Blue in July,
they would not take me for my November visit, I had to sign up for the UHC and reschedule my appointment to
January after the UHC insurance took effect. So if your 65th birthday is coming up between now and December 31st
they will not honor you currant insurance.

[champion6]

I don't know how many people are being dumped, but I question if they have enough United Health Advantage participants to keep them in business. Once the UHA have a major illness, they will be jumping ship themselves.I have been wondering the same thing. My gut tells me that in about two years, we will receive "We Want You Back" letters.

[trichard]

I received the letter today and would like to know if I currently have Medicare and United Healthcare (not an Advantage Plan) as my secondary am I ineligible to remain with the Villages Healthcare?

No!

[trichard]

Whether it is good business or greed is open to debate. What is not open for debate is that we were lied to when TVH said we were grandfathered. We have been with the VHS since the beginning. We were told current patients could stay. Lying is never right...even if it is to make more $$ money!

Exactly! When the grandfathering issue was brought up TVH denied having said it and, if they did, things change!

[marennorge]

I have a United Healthcare Supplemental Plan and just got a letter today from TV Health Systems stating I have to switch to an Advantage plan or find other doctors outside their system. So much for being grandfathered.

[NYGUY]

Are you referring to AARP Medicare Complete Choice (Regional PPO)?

I have AARP Medicare Complete Choice Plan 2 (Regional PPO)

[NYGUY]

I got my own letter today (telling me I was OK). It also said if you "would like to provide feedback" to call 352-674-8789. Sounds like an opportunity to voice you displeasure.

[skyking]

But wait --- "if you like your health care and your doctor, you can keep them" --- right?

Who said that?? 😃

[studylady]

If all of us still "grandfathered" leave now maybe they will decide differently when they can't pay the providers without payments from our better insurance companies?

[zendog3]

I got the notice today that I can switch to Big Brother's cash cow or get out. When I signed on, as a client to TV Health System's their association with one Medicare Advantage plan looked too cozy. I asked my doctor (Dr. Welby) if I was going to be squeezed out later. "Oh no. perish the thought.)

Here is the message to all the Doctors and staff of TV Health: Marcus Welby is FICTIONAL! A COMPANY THAT WILL MISLEAD AND DECEIVE ITS PATIENTS WILL MISLEAD AND DECEIVE ITS EMPLOYEES. This is a MARKETING-based company not a VALUES-based company. You are a cost column in their spreadsheet and sooner or later they will find a way to move money from your cost column to the profit column.

[NYGUY]

Who said that?? 😃

Certainly not The Villages Health!!

[trichard]

I got my own letter today (telling me I was OK). It also said if you "would like to provide feedback" to call 352-674-8789. Sounds like an opportunity to voice you displeasure.

They don't care about your displeasure. Decision is made.

[rustyp]

I read much displeasure about The Villages dictating what medical plan you must have and also understand they have gone back on their word about grandfathering. What I don't understand is if you like The Villages health system why not switch to United Healthcare Medical Advantage ? Is there something bad about this plan?

[trichard]

I read much displeasure about The Villages dictating what medical plan you must have and also understand they have gone back on their word about grandfathering. What I don't understand is if you like The Villages health system why not switch to United Healthcare Medical Advantage ? Is there something bad about this plan?

If you want superior healthcare you will want to take original Medicare. Otherwise, UHC's MA is okay.

[rustyp]

If you want superior healthcare you will want to take original Medicare. Otherwise, UHC's MA is okay.

I don't understand - I thought any policy that replaces Medicare must have equal or better than coverage by law.

[trichard]

I don't understand - I thought any policy that replaces Medicare must have equal or better than coverage by law.

Covered services are equal. MA is great as long as you do not have serious health issues. Then access to the best specialty physicians and hospitals in the country is limited.

[donbettyr]

I have said from the start that this would be the end result. Villages Health gets payed per head. They want you to join, but not show up for treatment - that is how this system makes money.This is a capitation plan. You do not get something for nothing. There are copays, and the biggest problem, most of the good specialists do not participate. That is why we know people who have to travel to Cleremont, Tavares, etc. to get treatment. Have been on tradational Medicare with supplement for 6 years, and have never payed a penny for anything. Know patients in the Villages Health who pay $500-1000 out of pocket as their copay for treatment.

[rustyp]

I have said from the start that this would be the end result. Villages Health gets payed per head. They want you to join, but not show up for treatment - that is how this system makes money.This is a capitation plan. You do not get something for nothing. There are copays, and the biggest problem, most of the good specialists do not participate. That is why we know people who have to travel to Cleremont, Tavares, etc. to get treatment. Have been on tradational Medicare with supplement for 6 years, and have never payed a penny for anything. Know patients in the Villages Health who pay $500-1000 out of pocket as their copay for treatment.

Help me - What plan do you have and how much is it? How much is United Healthcare Advantage and what is different about it Vs. your plan ?

[OCsun]

As much as I love living in TV, I am so irritated at this latest change. I wish when TV announced that they were building medical facilities, they would have made room for medical providers to set up their practices within them. Much needed easy access to primary care within our villages is still going to be missing.

[Carla B]

As much as I love living in TV, I am so irritated at this latest change. I wish when TV announced that they were building medical facilities, they would have made room for medical providers to set up their practices within them. Much needed easy access to primary care within our villages is still going to be missing.

That's exactly right. "Easy access" is the main thing we have liked about going to the The Villages Health.

[goodtimesintv]

See:

Medicare Advantage | The Henry J. Kaiser Family Foundation (http://kff.org/medicare/fact-sheet/medicare-advantage/)

[Stdole]

I think the question has been answered several times.... Why not stay with TVH under their new plan (gimmic)? If you switch you give up your ability to pick the very best Physicians at Mayo..Cleveland Clinic .. Johns Hopkins and other teaching hospitals.. Where you now have that option... To choose. If we you remain fairly healthy doing your lifetime and only need your ankles checked and routine blood work well for heavens sake you would be a fool not to go with their system...

[manaboutown]

This is sadly probably all about the money.

[RedChariot]

I got the notice today that I can switch to Big Brother's cash cow or get out. When I signed on, as a client to TV Health System's their association with one Medicare Advantage plan looked too cozy. I asked my doctor (Dr. Welby) if I was going to be squeezed out later. "Oh no. perish the thought.)

Here is the message to all the Doctors and staff of TV Health: Marcus Welby is FICTIONAL! A COMPANY THAT WILL MISLEAD AND DECEIVE ITS PATIENTS WILL MISLEAD AND DECEIVE ITS EMPLOYEES. This is a MARKETING-based company not a VALUES-based company. You are a cost column in their spreadsheet and sooner or later they will find a way to move money from your cost column to the profit column.

I hope the employees read this. Who knows what evils await them. Shameful what they are doing to so many seniors. Just shameful.

[spk7951]

While my wife & I have liked using TVH since it's inception we will be leaving them before the end of this year. Even though we both have a couple of years to reach 65 we feel it makes no sense for us to eventually pay out more money to stay there so time for a change. So much for patients first.

[trichard]

I hope the employees read this. Who knows what evils await them. Shameful what they are doing to so many seniors. Just shameful.

If TVH does get enough takers for MA could layoffs be next?

[Navy (SSBN 633)]

I would like to hear from all of my fellow Military Retirees who are currently using Medicare/Tricare for life who has got their "walking paper" from the Villages Health. I was original member into the Villages health under Medicare/Tricare for life. If United Healthcare Medicare advantage plan is so good they are telling us we must convert to why we were we not on it to begin with??.......All of my associates who are retired and in the Villages Health are on straight Medicare/Tricare for life. Call me skeptical........feel duped....and the ole bait and switch.

I do understand Tricare for life accepts Medicare advantage Part C....however all my reading so far says stay on straight Medicare/Tricare for life. I am NOT going to give up Express scripts pharmacy and don't want a plan with part D......

[Rapscallion St Croix]

I would like to hear from all of my fellow Military Retirees who are currently using Medicare/Tricare for life who has got their "walking paper" from the Villages Health. I was original member into the Villages health under Medicare/Tricare for life. If United Healthcare Medicare advantage plan is so good they are telling us we must convert to why we were we not on it to begin with??.......All of my associates who are retired and in the Villages Health are on straight Medicare/Tricare for life. Call me skeptical........feel duped....and the ole bait and switch.

I do understand Tricare for life accepts Medicare advantage Part C....however all my reading so far says stay on straight Medicare/Tricare for life. I am NOT going to give up Express scripts pharmacy and don't want a plan with part D......
.
I got my letter. Medicare and Tricare for Life. Letter says I can stay.

[Carla B]

Sounds like they're making an exception for retired military. I told my husband he should have stayed in the military after Viet Nam. Just kidding...I didn't know him then.

[ColdNoMore]

I'm sure at least a few designees of the developer (or even a family members themselves?) are members here and read TOTV.

Since I believe they are motivated purely by their own self interest, I wouldn't expect all of those here who have felt (rightfully) betrayed to get any honest answers...but it sure would be nice if the developer's rep's had the guts to come here and start explaining.

I know, I know, wishful thinking at best. :(

[trichard]

I'm sure at least a few designees of the developer (or even a family members themselves?) are members here and read TOTV.

Since I believe they are motivated purely by their own self interest, I wouldn't expect all of those who have felt betrayed to get any honest answers...but it sure would be nice if the developer's rep's had the guts to come here and start explaining.

Wishful thinking of course. :(

Do you think any of the Medicare-eligible members of the developer are member of a Medicare Advantage Plan?

[Grannygail]

When we look at how much Medicare plus our 20% suppliment payment is, it makes sense they couldn't continue
in business. But, it's not like they didn't know this when "Marcus Welby" concept was announced. I think this was just another way to sell more houses! Now, developer is tired of footing the bill.

[Jayhawk]

I.m one of the TV being dumped. This not the way it was advertised in the beginning, but its obvious the United Healthcare and the Villages are out to make money and we the dumpee's they could care less about. Real Hometown freindly????

Sorry, I just don't understand this thought process. No one is being DUMPED according to the letters I have seen (and received).

YOU CAN STAY with The Villages Health if you have or obtain the accepted insurance. Kind of like you can get NFL Ticket, as long as you have Direct TV. You have cable and refuse to change? No NFL Ticket.

YOU say they are "out to make money" which I hope is true, so they will be here for years to come for those who elect to stay in the system. People say it is GREED but nearly all who say that add that they don't want to pay the freight by purchasing the accepted insurance. So, Greed? Really?

This is a business decision. Companies don't make decisions hoping to LOSE money or LOSE customers. As the letter says, they hope everyone receiving it will remain.

For those who 1). Don't agree to have the acceptable insurance, 2). Refuse to get it, 3). Can't afford it, I get that it may be a bummer. But we all looked for new doctors when we got here, and the beauty is the final decision IS YOURS TO MAKE.

Negativity breeds stress and that is going to affect everyone who lets this issue drive their attitude. Make a decision and move on.

Cheers :wine:

[Bonny]

Sorry, I just don't understand this thought process. No one is being DUMPED according to the letters I have seen (and received).

YOU CAN STAY with The Villages Health if you have or obtain the accepted insurance. Kind of like you can get NFL Ticket, as long as you have Direct TV. You have cable and refuse to change? No NFL Ticket.

YOU say they are "out to make money" which I hope is true, so they will be here for years to come for those who elect to stay in the system. People say it is GREED but nearly all who say that add that they don't want to pay the freight by purchasing the accepted insurance. So, Greed? Really?

This is a business decision. Companies don't make decisions hoping to LOSE money or LOSE customers. As the letter says, they hope everyone receiving it will remain.

For those who 1). Don't agree to have the acceptable insurance, 2). Refuse to get it, 3). Can't afford it, I get that it may be a bummer. But we all looked for new doctors when we got here, and the beauty is the final decision IS YOURS TO MAKE.

Negativity breeds stress and that is going to affect everyone who lets this issue drive their attitude. Make a decision and move on.

Cheers :wine:
Best thing I have read all day !! Thank you!! :bigbow:

[ColdNoMore]

Sorry, I just don't understand this thought process. No one is being DUMPED according to the letters I have seen (and received).

YOU CAN STAY with The Villages Health if you have or obtain the accepted insurance. Kind of like you can get NFL Ticket, as long as you have Direct TV. You have cable and refuse to change? No NFL Ticket.

YOU say they are "out to make money" which I hope is true, so they will be here for years to come for those who elect to stay in the system. People say it is GREED but nearly all who say that add that they don't want to pay the freight by purchasing the accepted insurance. So, Greed? Really?

This is a business decision. Companies don't make decisions hoping to LOSE money or LOSE customers. As the letter says, they hope everyone receiving it will remain.

For those who 1). Don't agree to have the acceptable insurance, 2). Refuse to get it, 3). Can't afford it, I get that it may be a bummer. But we all looked for new doctors when we got here, and the beauty is the final decision IS YOURS TO MAKE.

Negativity breeds stress and that is going to affect everyone who lets this issue drive their attitude. Make a decision and move on.

Cheers :wine:

:popcorn: :popcorn: :popcorn:





As for those that no longer (or never did) believe that the developer walks on water, I'm sure the Happy Paper will soon do a multi-part, unbiased investigative exposé with a timeline and detailing the lies/promises told regarding this entire issue.

Or mebbe not. :D

[villagetinker]

Jayhawk,
Well said. I am working on a list of questions (up to 22 so far from reading the various comments and concerns) that I will be taking with us when we go to talk to SHINE and Villages Health. I will also need to contact all of our existing doctors (around 10) to see what the impact will be on them and our relationship with them if we opt out of our existing coverage for the VHS advantage plan.

Personally I think this could have been handled much better, by providing a year or 2 to allow a transition period, and providing a financial reason for people to change to the VHS advantage

[Villageswimmer]

People aren't stupid. Rather than send the self-serving letter they did, why not come clean, be honest, and tell folks they're sorry and this decision was financially driven--a business decision. We all know it was.

Folks wouldn't be happy but at least they would feel like the Villages Health System has some integrity and credibility. Why do they choose to lie when they can tell the truth?

[Polar Bear]

People aren't stupid. Rather than send the self-serving letter they did, why not come clean, be honest, and tell folks they're sorry and this decision was financially driven--a business decision. We all know it was...

Regardless of their motivation, don't claim to speak for me.

[RickeyD]

People aren't stupid. Rather than send the self-serving letter they did, why not come clean, be honest, and tell folks they're sorry and this decision was financially driven--a business decision. We all know it was.



Folks wouldn't be happy but at least they would feel like the Villages Health System has some integrity and credibility. Why do they choose to lie when they can tell the truth?



Your statement defines a business entity as having the following attributes. Self-serving, come clean, honesty, integrity, credibility and finally truth. Unfortunately these attributes can only apply to human beings.
It is a business, the bottom line is it's business. I am amazed that people today still feel that anyone or anything owes them. I am not critiquing you, only pointing out to all here that a business is a business. It has no heart nor will it ever. Don't ever trust or rely on a business, it will always let you down because it doesn't care about you.


Sent from my iPhone using Tapatalk

[Gailh]

I agree that the decision to dump all but those who are insured by United seems ruthless. The letter came as a shock. The explanation was lame. Don't they understand they are dealing with actual humans here?

If their financial straits are that dire, why would we choose to stay and risk losing our current supplemental package? Once I leave mine, I lose the option to return. It is just too risky.

It is difficult to have to find new providers. One of the reasons we moved to The Villages was the health care system. I am very upset by this callous decision. I don't understand why grandfathering isn't an option.

[trichard]

I agree that the decision to dump all but those who are insured by United seems ruthless. The letter came as a shock. The explanation was lame. Don't they understand they are dealing with actual humans here?

If their financial straits are that dire, why would we choose to stay and risk losing our current supplemental package? Once I leave mine, I lose the option to return. It is just too risky.

It is difficult to have to find new providers. One of the reasons we moved to The Villages was the health care system. I am very upset by this callous decision. I don't understand why grandfathering isn't an option.

Well stated.

[Bogie Shooter]

I'm sure at least a few designees of the developer (or even a family members themselves?) are members here and read TOTV.

Since I believe they are motivated purely by their own self interest, I wouldn't expect all of those here who have felt (rightfully) betrayed to get any honest answers...but it sure would be nice if the developer's rep's had the guts to come here and start explaining.

I know, I know, wishful thinking at best. :(

Do you really believe any statement would be acceptable to all the posters here??

[Villageswimmer]

Your statement defines a business entity as having the following attributes. Self-serving, come clean, honesty, integrity, credibility and finally truth. Unfortunately these attributes can only apply to human beings.
It is a business, the bottom line is it's business. I am amazed that people today still feel that anyone or anything owes them. I am not critiquing you, only pointing out to all here that a business is a business. It has no heart nor will it ever. Don't ever trust or rely on a business, it will always let you down because it doesn't care about you.


Sent from my iPhone using Tapatalk


But, but, but what about Marcus Welby? :icon_wink:
You are correct. Obviously.

[zonerboy]

Ever wonder why "the developer" raised rents for competing primary care providers in all their commercial rental properties, thus forcing many of them to relocate? Wasn't this just laying the groundwork for the current announcement?

[golfing eagles]

I have said from the start that this would be the end result. Villages Health gets payed per head. They want you to join, but not show up for treatment - that is how this system makes money.This is a capitation plan. You do not get something for nothing. There are copays, and the biggest problem, most of the good specialists do not participate. That is why we know people who have to travel to Cleremont, Tavares, etc. to get treatment. Have been on tradational Medicare with supplement for 6 years, and have never payed a penny for anything. Know patients in the Villages Health who pay $500-1000 out of pocket as their copay for treatment.


Haven't you paid $178/mo for your supplement, $50/month for your part D and $112/month for your part B premium = $4080/year even if you never see a physician?????

[golfing eagles]

Sorry, I just don't understand this thought process. No one is being DUMPED according to the letters I have seen (and received).

YOU CAN STAY with The Villages Health if you have or obtain the accepted insurance. Kind of like you can get NFL Ticket, as long as you have Direct TV. You have cable and refuse to change? No NFL Ticket.

YOU say they are "out to make money" which I hope is true, so they will be here for years to come for those who elect to stay in the system. People say it is GREED but nearly all who say that add that they don't want to pay the freight by purchasing the accepted insurance. So, Greed? Really?

This is a business decision. Companies don't make decisions hoping to LOSE money or LOSE customers. As the letter says, they hope everyone receiving it will remain.

For those who 1). Don't agree to have the acceptable insurance, 2). Refuse to get it, 3). Can't afford it, I get that it may be a bummer. But we all looked for new doctors when we got here, and the beauty is the final decision IS YOURS TO MAKE.

Negativity breeds stress and that is going to affect everyone who lets this issue drive their attitude. Make a decision and move on.

Cheers :wine:

Finally, a voice of reason. No one is being "dumped". You can choose to stay in TVH, or you can choose to change insurance. This decision comes to millions of Americans every year as medical practices change the insurances that they accept. This is simply a business decision. There have been insurances that have dropped their reimbursement down to Medicaid rates, and therefore were dropped ASAP. If you think a medical practice can survive taking 11 cents on the dollar, think again. It has nothing to do with greed, nothing to do with ethics, it's simply a matter of survival. TVH does no good for anyone if they close their doors.

[wendyquat]

I read much displeasure about The Villages dictating what medical plan you must have and also understand they have gone back on their word about grandfathering. What I don't understand is if you like The Villages health system why not switch to United Healthcare Medical Advantage ? Is there something bad about this plan?

The Advantage Plan is perfect - AS LONG AS YOU ARE HEALTHY!

[graciegirl]

Sorry, I just don't understand this thought process. No one is being DUMPED according to the letters I have seen (and received).

YOU CAN STAY with The Villages Health if you have or obtain the accepted insurance. Kind of like you can get NFL Ticket, as long as you have Direct TV. You have cable and refuse to change? No NFL Ticket.

YOU say they are "out to make money" which I hope is true, so they will be here for years to come for those who elect to stay in the system. People say it is GREED but nearly all who say that add that they don't want to pay the freight by purchasing the accepted insurance. So, Greed? Really?

This is a business decision. Companies don't make decisions hoping to LOSE money or LOSE customers. As the letter says, they hope everyone receiving it will remain.

For those who 1). Don't agree to have the acceptable insurance, 2). Refuse to get it, 3). Can't afford it, I get that it may be a bummer. But we all looked for new doctors when we got here, and the beauty is the final decision IS YOURS TO MAKE.

Negativity breeds stress and that is going to affect everyone who lets this issue drive their attitude. Make a decision and move on.

Cheers :wine:

Excellent post.

[rustyp]

The only negative I read here about United Health Care Medical Advantage is not having access to specialty doctors / hospitals like the Mayo clinic. Assuming this is true that personally does not bother me for reasons that could start another thread. So if that's all the difference is I'm staying - I like riding my golf cart to the center right around the corner. I like not waiting a long time to be seen. I like the attention to detail I receive from my doctor and staff. I like electronic access to all my records. I like getting my labs done in the same building. I like the beauty of facilities. I like the clientele I see in the facility. I like how they work with me over the phone and do what they say in a timely fashion. I like how they call my other doctors (even my eye doctor) to get my records from them and review the results with me. Yep - I'm staying based upon the info I've read here.

[graciegirl]

Ever wonder why "the developer" raised rents for competing primary care providers in all their commercial rental properties, thus forcing many of them to relocate? Wasn't this just laying the groundwork for the current announcement?

My PCP says that is not true. He is an honest man, a Christian from Nigeria. I like him and his medical knowledge.

[Avista]

The only negative I read here about United Health Care Medical Advantage is not having access to specialty doctors / hospitals like the Mayo clinic. Assuming this is true that personally does not bother me for reasons that could start another thread. So if that's all the difference is I'm staying - I like riding my golf cart to the center right around the corner. I like not waiting a long time to be seen. I like the attention to detail I receive from my doctor and staff. I like electronic access to all my records. I like getting my labs done in the same building. I like the beauty of facilities. I like the clientele I see in the facility. I like how they work with me over the phone and do what they say in a timely fashion. I like how they call my other doctors (even my eye doctor) to get my records from them and review the results with me. Yep - I'm staying based upon the info I've read here.

Amen! Great post!

[Yorio]

My only complaint re the current situation is that VHS should have told me that eventually UHC Medicare Advantage will be the only insurance they will accept. Now that years passed and gotten used to this system and becoming friendly with the Doctor, we won't be 'grandfathered' at the end of the year. We took supplemental insurance because we were snowbirds. We still use some doctors up north even if we are full time here now. We travel overseas and we have supplement that covers emergency outside of U.S. We are currently in limbo. 😔

[Bonnevie]

I agree in that I feel I was told they would accept my insurance knowing they intended to change that--hoping that people would be so enamored of Villages Health that they would want to switch. I can't and I will tell you they sent a referral once to a neurosurgeon for a herniated disc who never called me. They sent it again, same thing. They finally called me and asked if I wanted referral to one in Ocala. Or they said, "you have BC/BS so you could call the office the neurosurgeon's office yourself and they'd give you an appt." It may be cheaper to use Villages Health, but that's why you buy insurance--just in case you need it for something major.

[rustyp]

I agree in that I feel I was told they would accept my insurance knowing they intended to change that--hoping that people would be so enamored of Villages Health that they would want to switch. I can't and I will tell you they sent a referral once to a neurosurgeon for a herniated disc who never called me. They sent it again, same thing. They finally called me and asked if I wanted referral to one in Ocala. Or they said, "you have BC/BS so you could call the office the neurosurgeon's office yourself and they'd give you an appt." It may be cheaper to use Villages Health, but that's why you buy insurance--just in case you need it for something major.

How much cheaper would it be for you?

[justjim]

My only complaint re the current situation is that VHS should have told me that eventually UHC Medicare Advantage will be the only insurance they will accept. Now that years passed and gotten used to this system and becoming friendly with the Doctor, we won't be 'grandfathered' at the end of the year. We took supplemental insurance because we were snowbirds. We still use some doctors up north even if we are full time here now. We travel overseas and we have supplement that covers emergency outside of U.S. We are currently in limbo. 😔

We have friends in the same boat. They too are in a "pickle" and I feel bad for them. Just as they got comfortable with the "Dr Welby concept" ---he too retired. Life is just not fair sometimes.

[Bonnevie]

I talked at length with the doctor in charge of Villages Health who was trying to convince me Villages Health was better than what I had as a Federal retiree and he said I'd save a lot. Not sure what the cost of the Advantage Plan is but I pay about $200 for BC/BS and then medicare part B $122 a month.

[rustyp]

I talked at length with the doctor in charge of Villages Health who was trying to convince me Villages Health was better than what I had as a Federal retiree and he said I'd save a lot. Not sure what the cost of the Advantage Plan is but I pay about $200 for BC/BS and then medicare part B $122 a month.

So if you are enrolled in The Villages health system and like it why wouldn't you research how much savings you could reap by switching for the same services provided ? Wouldn't that be a win win for you ?

[rhood]

Jayhawk,
Well said. I am working on a list of questions (up to 22 so far from reading the various comments and concerns) that I will be taking with us when we go to talk to SHINE and Villages Health.

Hope im not in line behind you.

[villagetinker]

Hope im not in line behind you.

Up to 23 now, I will give you a warning....:D:D:D

Or should I bring scotch?

[Bonnevie]

So if you are enrolled in The Villages health system and like it why wouldn't you research how much savings you could reap by switching for the same services provided ? Wouldn't that be a win win for you ?

I could save a lot of money as long as I stay healthy. As I pointed out, one of the Villages Health specialists did not even answer two referral requests from them--why do you think that is? I have hearing aids and my insurance covered the entire cost of them and they can be replaced every 3 years if needed, the Villages plan certainly won't do that.
For me insurance is there in the event you need it--like deductibles on your car. I hope I won't need it but if I do, I'll be covered much better than the advantage plan.

[rustyp]

Is there anyone here on this blog that actually has United Health Care Advantage or has earnestly researched it that can share their real life experience / recommendation ?

[Polar Bear]

Is there anyone here on this blog that actually has United Health Care Advantage or has earnestly researched it that can share their real life experience / recommendation ?

I'm one of those that has had UHC Advantage even before it was required. I've been happy with the doctors, my care, and my coverage, which has included one major surgery and other fairly typical health issues. Cost has been reasonable IMO also.

[Dan9871]

We have the Villages Health Advantage Plan and are very satisfied with everything including the quality of care and the convenience.

We've had one major medical event that involved a stay in Villages Hospital and later to Munroe. All was covered very well with the providers in the network. The way care is managed at Villages Hospital if you are in the Villages Advantage Plan is especially nice... your stay is managed by Villages Health doctors, not the hospital's Hospitalist doctors.

Lot's of other smaller things too, but no problem getting them taken care of with in-network providers.

We also had no problem getting permission and coverage to go to an out-of-network provider one time simply because the in-network providers were not conveniently located.

Before we came to The Villages we were in an HMO with limited providers to choose from and references needed and all that. We had a number of major medical events... but never had a problem getting quality services from inside that network either.

So for the past 35 years or so we've only had a limited network of providers and referral requirements. Yes, all that time we've had some worry that this would limit the availability and quality of our health care. But it has never been a issue.



Is there anyone here on this blog that actually has United Health Care Advantage or has earnestly researched it that can share their real life experience / recommendation ?

[rustyp]

We have the Villages Health Advantage Plan and are very satisfied with everything including the quality of care and the convenience.

We've had one major medical event that involved a stay in Villages Hospital and later to Munroe. All was covered very well with the providers in the network. The way care is managed at Villages Hospital if you are in the Villages Advantage Plan is especially nice... your stay is managed by Villages Health doctors, not the hospital's Hospitalist doctors.

Lot's of other smaller things too, but no problem getting them taken care of with in-network providers.

We also had no problem getting permission and coverage to go to an out-of-network provider one time simply because the in-network providers were not conveniently located.

Before we came to The Villages we were in an HMO with limited providers to choose from and references needed and all that. We had a number of major medical events... but never had a problem getting quality services from inside that network either.

So for the past 35 years or so we've only had a limited network of providers and referral requirements. Yes, all that time we've had some worry that this would limit the availability and quality of our health care. But it has never been a issue.

Thank you. It is refreshing to get the facts Vs emotional roller coaster.

[goodtimesintv]

It's in here, but you don't want to see it.......

"

.....Impossible Burden For The Elderly And The Disabled

About half the cost of the ACA (Affordable Care Act) is paid for by cuts in Medicare spending and the only practical way those cuts can be made is by reduced fees to providers.

The Medicare actuaries have noted with alarm that Medicare fees to doctors will drop below Medicaid levels in the near future and the combined effect of lower Medicare and Medicaid hospital spending will drive one in seven hospitals from the market in the next five years.

Although the administration talks about making Medicare more efficient, three separate reports by the Congressional Budget Office (CBO) have concluded that the pilot programs and demonstration projects that are supposed to find these efficiencies are not working.

In fact, the only place in Medicare that shows any promise at all is in the Medicare Advantage (MA) program. But the administration is determined to proceed with cuts in MA subsides and appears to be paying no attention whatever to the efficiencies MA entrepreneurs are discovering.

Because no serious budget analyst believes the Medicare spending cuts can withstand the inevitable political backlash and because they don’t believe the pilot programs will work either, both the CBO and the Medicare Trustees are annually publishing “alternative forecasts” in an effort to predict how Congress will cave. But if Congress does cave and restores the previous Medicare spending path, that means that the ACA isn’t paid for; and that, in turn, means large unfunded liabilities stretching out indefinitely into the future and increasing federal debt......"

Six Problems With The ACA That Aren’t Going Away (http://healthaffairs.org/blog/2015/06/25/six-problems-with-the-aca-that-arent-going-away/)

.

[larcha]

Is UHC Medicare Advantage guaranteed issue if you switch?

[Jimmydoodlebug]

Could someone who uses this Medicare Advantage plan tell me how you get care when you're traveling to another state?

My wife is interested but we travel the country a lot and need to know if we'd be better staying with Medicare and a secondary provider.

Thanks

[ColdNoMore]

It's in here, but you don't want to see it.......


"

.....Impossible Burden For The Elderly And The Disabled

About half the cost of the ACA (Affordable Care Act) is paid for by cuts in Medicare spending and the only practical way those cuts can be made is by reduced fees to providers.

The Medicare actuaries have noted with alarm that Medicare fees to doctors will drop below Medicaid levels in the near future and the combined effect of lower Medicare and Medicaid hospital spending will drive one in seven hospitals from the market in the next five years.

Although the administration talks about making Medicare more efficient, three separate reports by the Congressional Budget Office (CBO) have concluded that the pilot programs and demonstration projects that are supposed to find these efficiencies are not working.

In fact, the only place in Medicare that shows any promise at all is in the Medicare Advantage (MA) program. But the administration is determined to proceed with cuts in MA subsides and appears to be paying no attention whatever to the efficiencies MA entrepreneurs are discovering.

Because no serious budget analyst believes the Medicare spending cuts can withstand the inevitable political backlash and because they don’t believe the pilot programs will work either, both the CBO and the Medicare Trustees are annually publishing “alternative forecasts” in an effort to predict how Congress will cave. But if Congress does cave and restores the previous Medicare spending path, that means that the ACA isn’t paid for; and that, in turn, means large unfunded liabilities stretching out indefinitely into the future and increasing federal debt......"

Six Problems With The ACA That Aren’t Going Away


Interestingly enough, if you look at the letters to your Opinion Article (written by someone who obviously wants to repeal ACA) you find this.......


6.) Impossible burden for the elderly and disabled: This section is purely speculative and the problems with Medicare financing are largely independent of the ACA.

The ACA does not cut coverage or provider reimbursement to Medicare. These budget pressures were coming with, or without the ACA.

I also don’t understand your argument for MA. First of all, this is essentially a national Medicare version of the state exchanges, which you seem vehemently against. The government was explicitly overpaying MA plans since its induction and the ACA eliminates this clause. If these plans are finding efficiencies as you claim, they should be able to cope with these cuts just fine. Also, one or two years of data on ACOs, which represent quite a radical change in the way organizations must think about health care financing (moving from fee-for-service, where billing more is encouraged, to a budgeted scheme where the goal is to control costs will take time and experience, trial and error), and we should not abandon them, but continue to monitor what is successful and make adjustments as we go.

I appreciate your commentary, but find it confusing and contradictory. If you are against everything the ACA stands for, stand up for yourself and call for its repeal. Outline your alternative that avoids these “problems” with the ACA yet still manages to extend health insurance to more people at a reasonable cost. I recognize and appreciate your budgetary concerns with health care in the US, but I don’t blame the ACA at all, nor do I think the ACA does anything to notably better or worsen the situation.

I see our staggering high number of uninsured as an even more critical failing, particularly among the developed world where our high rate of uninsurance is unique (and shameful).

Rather than address cost, the ACA is essentially a budget neutral policy that seeks to broaden insurance coverage in the US, and it does just that.

[donbettyr]

All things are relative. I was paying $2000 per month, with each of us having to pay the first $1000 each year, so $4000 a year is cheap. I go directly to my specialists, and can go to the best of them in this area. As a someone in practice for 34 years, Who you see matters. Spent a lot of time when moved here, asking M.D.'s, RN's, and others from this area who we should see(and they also offered opinions on who NOT to see.

[Avista]

Could someone who uses this Medicare Advantage plan tell me how you get care when you're traveling to another state?

My wife is interested but we travel the country a lot and need to know if we'd be better staying with Medicare and a secondary provider.

Thanks

The best thing to do is pose your questions to the folks at the Medicare Store. We've used the one in Sumter. They are great. Present as many "what if" scenarios you can think of.

You are covered at any hospital or urgent care in an emergency. If you are going to stay in a place for awhile you can get what is called a Passport. They can explain this much better than I can.

[2BNTV]

The best thing to do is pose your questions to the folks at the Medicare Store. We've used the one in Sumter. They are great. Present as many "what if" scenarios you can think of.

You are covered at any hospital or urgent care in an emergency. If you are going to stay in a place for awhile you can get what is called a Passport. They can explain this much better than I can.

:agree:

It's best to check if the area you are traveling to will have adequate coverage. You must call them to activate your passport and call them to deactivate when you return home. It can be used for 9 months in a row.

Emergency care is covered worldwide for all MA plans.

Please check for your self.

[Jimmydoodlebug]

The best thing to do is pose your questions to the folks at the Medicare Store. We've used the one in Sumter. They are great. Present as many "what if" scenarios you can think of.

You are covered at any hospital or urgent care in an emergency. If you are going to stay in a place for awhile you can get what is called a Passport. They can explain this much better than I can.

Thank you for that answer. Where can I find the Medicare Store?

[Jimmydoodlebug]

:agree:

It's best to check if the area you are traveling to will have adequate coverage. You must call them to activate your passport and call them to deactivate when you return home. It can be used for 9 months in a row.

Emergency care is covered worldwide for all MA plans.

Please check for your self.

Thanks, that's very interesting. Not having coverage while traveling is my biggest concern.

[2BNTV]

Thank you for that answer. Where can I find the Medicare Store?

I'm pretty sure they are all in the squares. I know for sure their is one in Lake Sumter Landing and Spanish Springs.

[Avista]

Thank you for that answer. Where can I find the Medicare Store?


We spoke with Cheri at 1049 Lake Sumter Landing 352-391-5262

[LvmyPug2]

The Medicare Store is a United Health Store. To get an unbiased opinion you should speak to a Shine Counselor. They will give you info on all the different plans and companies without trying to sell you a product.

[Joejohnson]

The Medicare Store is a United Health Store. To get an unbiased opinion you should speak to a Shine Counselor. They will give you info on all the different plans and companies without trying to sell you a product.

Yes, do this. UHC Medicare store has their company in mind, and that may or may not be in your best interest. VHC has grandfathered some but not MOST. I am grandfathered, but my wife who has had the same insurances as I all our married life of 47 years, is not grandfathered. She accepts United Health Care or its see ya and goodbye. For some, UHC may be an improvement over their current medical insurance, but for us it would be loss of benefits, choice of Drs and more exspensive even with the loss of benefits. We don't wish to leave Villages Health Care, but we also will not change plans that cost more with less benifits.

[cavalier65]

Yes, do this. UHC Medicare store has their company in mind, and that may or may not be in your best interest. VHC has grandfathered some but not MOST. I am grandfathered, but my wife who has had the same insurances as I all our married life of 47 years, is not grandfathered. She accepts United Health Care or its see ya and goodbye. For some, UHC may be an improvement over their current medical insurance, but for us it would be loss of benefits, choice of Drs and more exspensive even with the loss of benefits. We don't wish to leave Villages Health Care, but we also will not change plans that cost more with less benifits.


You are exactly right! TVH made a business decision to enhance revenue and profits. So be it. But please it should not be disguised as better serving the Villages residents.:BigApplause:

[Bogie Shooter]

I went to the store in LSL. Informative and there was no hard or soft sell. I was given the facts and advised to explore current and future coverage.

[patoonya]

I am being dumped, my only rebuttle is to call TV healthcare center and compain, maybe it will do some good if they new how upset we are

[Jimmydoodlebug]

We spoke with Cheri at 1049 Lake Sumter Landing 352-391-5262

Thank you for your help. :BigApplause:

[Jimmydoodlebug]

The Medicare Store is a United Health Store. To get an unbiased opinion you should speak to a Shine Counselor. They will give you info on all the different plans and companies without trying to sell you a product.

Thank you, I'll call SHINE. They are very helpful and were so good when I was trying to locate a Medicaid-accepting nursing home for my elderly mother.

[RErmer]

Thank you, I'll call SHINE. They are very helpful and were so good when I was trying to locate a Medicaid-accepting nursing home for my elderly mother.

SHINE Counseling session dates, time and locations are in the weekly Recreation News (I am a SHINE volunteer. If you call the Elder Help Line they will just refer you to us at one of the counseling sessions.)

[Avista]

The Medicare Store is a United Health Store. To get an unbiased opinion you should speak to a Shine Counselor. They will give you info on all the different plans and companies without trying to sell you a product.

Both shine AND the Medicare Store would be a good thing to do. Our friend is a shine counselor. He is able to give a generalized comparison but may not know the details of any particular plan. Then again your person may. But I say seeing a Shine person AND Medicare store covers all bases.