Villages Health Care-Advantage plans

[quinnpd]

I've been with Villages Health Care (Colony Cottage) since its inception. I have traditional medicare with United Health Care supplemental plan F. Since the very start I could not tell any difference between the care I received with my current plan(s) or if the care would improve if I switched to advantage. Since I view the care from the Villages Health Care well below what I received from my primary care physician in the Midwest, I could not justify making the change to an advantage plane. I have felt for some time that I would move along and find another General Practitioner and now will being doing just that. This has never been about "better health care", it is all about the money. VHC is way over staffed and they have wonderful facilities, very large, bright and clean but you need big profit margins to continue to operate in this manner.
I've heard two different "rumors" that United Advantage pays VHS either $5000 per year and/or $800 per month per patient regardless if they are seen by physician or not (I suspect the truth lies somewhere in between) whereas traditional medicare only pays per visit??? So follow the money folks, that's what its all about. VHS will have to continue to tweek their "model" often to keep up the cost of doing business.

[wendyquat]

I'm not sure we'll find the care we were used to in other places. I've been looking a couple of days and most of the doctors here appear to have been educated in foreign countries. Not saying that is bad, just don't know! I guess they are the only ones that will see us peons who stoop so low as to be covered by Medicare and Supplement!

[Jayhawk]

I've been with Villages Health Care (Colony Cottage) since its inception. I have traditional medicare with United Health Care supplemental plan F. Since the very start I could not tell any difference between the care I received with my current plan(s) or if the care would improve if I switched to advantage. Since I view the care from the Villages Health Care well below what I received from my primary care physician in the Midwest, I could not justify making the change to an advantage plane. I have felt for some time that I would move along and find another General Practitioner and now will being doing just that. This has never been about "better health care", it is all about the money. VHC is way over staffed and they have wonderful facilities, very large, bright and clean but you need big profit margins to continue to operate in this manner.
I've heard two different "rumors" that United Advantage pays VHS either $5000 per year and/or $800 per month per patient regardless if they are seen by physician or not (I suspect the truth lies somewhere in between) whereas traditional medicare only pays per visit??? So follow the money folks, that's what its all about. VHS will have to continue to tweek their "model" often to keep up the cost of doing business.



You make some interesting observations.

Since you have been with the system for about 4 years and view the care as "well below" what you had before, why have you waited to change?

How do you know it's "just about the money"? Obviously, that matters to any business, but could there be other factors? There has to be a maximum number of patients they can serve with the present infrastructure. Over time, Advantage patients could be denied access if there are insufficient openings due to acceptance of all Medicare plans. Sort of like TV schools- if those in now don't follow guidelines for attendance and are allowed to remain, that penalizes those waiting to get in who would comply.

As for tweaking their business model based on results, that is what all good businesses do. Those that don't often fail.

I guess since you aren't that thrilled with the care, and were planning to move on anyway, you probably are not upset with this decision on the part of VHS.

For all who stay in (and everyone can stay in by participating in the accepted plans, similar to many business models), this should be a good thing for long term stability. I know I am counting on it.

Choice is a good thing, and everyone gets to make their own decision about whether to remain in the system. Just hope folks make their decision on facts and not RUMORS as you mentioned.

No one is being booted out, and that is a great thing.

Have a great day.

[wendyquat]

You make some interesting observations.

Since you have been with the system for about 4 years and view the care as "well below" what you had before, why have you waited to change?

How do you know it's "just about the money"? Obviously, that matters to any business, but could there be other factors? There has to be a maximum number of patients they can serve with the present infrastructure. Over time, Advantage patients could be denied access if there are insufficient openings due to acceptance of all Medicare plans. Sort of like TV schools- if those in now don't follow guidelines for attendance and are allowed to remain, that penalizes those waiting to get in who would comply.

As for tweaking their business model based on results, that is what all good businesses do. Those that don't often fail.

I guess since you aren't that thrilled with the care, and were planning to move on anyway, you probably are not upset with this decision on the part of VHS.

For all who stay in (and everyone can stay in by participating in the accepted plans, similar to many business models), this should be a good thing for long term stability. I know I am counting on it.

Choice is a good thing, and everyone gets to make their own decision about whether to remain in the system. Just hope folks make their decision on facts and not RUMORS as you mentioned.

No one is being booted out, and that is a great thing.

Have a great day.

You obviously have Medicare Advantage and the disappointment in the system does not affect you personally so I doubt you'd be the one to comment and gloat to those of us who were sold property and promised this EXCELLENT healthcare in Americas FRIENDLIEST hometown. It is understandable that one might not have been happy with our choice of physicians. After two years with the same Doctor I determined he was not the one for me so I asked for and got a new doctor that I liked very much! We understand that the bottom line is what it's all about but that does little to excuse their promises and method of notification. It is a great inconvenience for most of us and it would have made it a bit easier to stomach if only they had made a little effort to tack one little paragraph in their letter saying they were sorry!

Because of my background in health insurance it is my opinion that the Advantage plan is great for the healthy but not so good if you have health problems and your trusted doctors do not participate. Although I have reason to believe that not everyone is getting top care at TVs health centers, there are those of us who value good health care and don't want to settle for second best!

[rockyisle]

You make some interesting observations.

Since you have been with the system for about 4 years and view the care as "well below" what you had before, why have you waited to change?

How do you know it's "just about the money"? Obviously, that matters to any business, but could there be other factors? There has to be a maximum number of patients they can serve with the present infrastructure. Over time, Advantage patients could be denied access if there are insufficient openings due to acceptance of all Medicare plans. Sort of like TV schools- if those in now don't follow guidelines for attendance and are allowed to remain, that penalizes those waiting to get in who would comply.

As for tweaking their business model based on results, that is what all good businesses do. Those that don't often fail.

I guess since you aren't that thrilled with the care, and were planning to move on anyway, you probably are not upset with this decision on the part of VHS.

For all who stay in (and everyone can stay in by participating in the accepted plans, similar to many business models), this should be a good thing for long term stability. I know I am counting on it.

Choice is a good thing, and everyone gets to make their own decision about whether to remain in the system. Just hope folks make their decision on facts and not RUMORS as you mentioned.

No one is being booted out, and that is a great thing.

Have a great day.

Jay Hawk - I'm happy you feel that you've made a good decision on your healthcare plan. Just wish we felt the same way.
We've been with VHS from the start - coming with the doctors at Family Doctors at Belleview. We were very happy that they were bringing a great health care model to TV. And they were the single largest reason we made the decision to purchase a home here vs other larger communities in Florida. Up until we bought our home, finding a good PCP was not easy.

I, personally, participated with the USF focus group in 2011 on what type of medical concerns were keeping couples like us from purchasing a home. It was an interesting and rewarding experience. Not long after, VHS began their program and promotion of the Dr. Welby philosophy. There were able to bring good doctors and support personnel along with them (who by the way have one year, 50 mile radius non-compete clauses in their work contracts.. including the NP's).

We saw the writing on the wall last year when friends who were turning 65 were being told to sign up for Advantage or get out. I began to look at who is who at the top of the VHS system now - none other than Kaiser Permantente followers and practitioners.

I guess that most people have forgotten what happened 20 years ago when HMO's were all the rage - lousy health care, big requirements for referrals and stalling tactics...

So, we will return to FL this fall already signed on with a new PCP... we took care of that before we left for the summer months in NH... By the way, for those of you who travel outside of TV, you need to check to see if your state and county are in the plan.. For us, only 3 counties in NH are considered... we would be SOL should something happen to us while up north.

And, last and most important, you all really need to investigate what your out of pocket expenses are going to look like with the "zero" cost premium. When I looked at it a couple of years ago, you have an out of pocket charge of $$$$ for the first 5 days of hospitalization - and that is not a one time charge.. It's for each incident. It would only take once to eat up the costs of an UH Plan F plan (that's what we have) to get you to realize you've probably made a mistake.

I wish all of you the very best on the new plan. In my parting letter to VHS I reminded them that they were putting thousands of patients at risk should this new venture fail - as it is almost impossible to get supplemental coverage like we have now after going for the low ball program.

[Jayhawk]

Those who assume I have the Advantage program today are making a bad assumption. I don't, but I will.

Why?

Because I value the service and care I receive from VHS. I understand how business works. If I want their service / care, I need to comply with the requirements of the business.

There are currently 37 PCP's listed on the various VHS web pages (not counting the Aisenstat's who are still shown but not really there).

Now, using the MAXIMUM number of patients (1,250) that each doctor can accept, that equates to 46,250 available patient slots.

Many folks who have complained about the new requirements state they are concerned about being away from TV for long periods of time, like during summers, and therefore limited in coverage.

There are now about 120,000 residents in TV, so wouldn't it make sense that with limited capacity, the business would make decisions that would positively impact the most residents as well as the business's ability to remain strong?

I get it that this is disappointing to some, but 50 years of having health insurance confirms to me that plans and providers change darn near every year. That's just the way it works.

Best of luck as you choose to stay in the system or withdraw for other choices.

[kaseydog]

I moved to tv in 2013. The villages accepted original medicare & my nys insurance. Now they are telling me that to stay with tv health i have to join
medicare advantange. My nys insurance says they they will drop me if i do this. This will result in loss of benefits & a $2,500 reimbursement from my former employer. The villages runs ads saying "new" villagers can join tv health & pick a medicare advantage plan. This ad also states royalties will be paid to the villages. Best of all you don't have to reside in the villages to use tv health as long as you have medicare advantage.
The phone number for info rang 30 times with no answer or recording to leave a message. Call administrative ofc. 352-674-1700. They are taking names & have a team looking at the responses to this decision. Please call & voice your opinion. I spoke to barbara oliver she did not want to give me her name but i insisted. Fight for your rights.

[jojo]

Jay Hawk - I'm happy you feel that you've made a good decision on your healthcare plan. Just wish we felt the same way.
We've been with VHS from the start - coming with the doctors at Family Doctors at Belleview. We were very happy that they were bringing a great health care model to TV. And they were the single largest reason we made the decision to purchase a home here vs other larger communities in Florida. Up until we bought our home, finding a good PCP was not easy.

I, personally, participated with the USF focus group in 2011 on what type of medical concerns were keeping couples like us from purchasing a home. It was an interesting and rewarding experience. Not long after, VHS began their program and promotion of the Dr. Welby philosophy. There were able to bring good doctors and support personnel along with them (who by the way have one year, 50 mile radius non-compete clauses in their work contracts.. including the NP's).

We saw the writing on the wall last year when friends who were turning 65 were being told to sign up for Advantage or get out. I began to look at who is who at the top of the VHS system now - none other than Kaiser Permantente followers and practitioners.

I guess that most people have forgotten what happened 20 years ago when HMO's were all the rage - lousy health care, big requirements for referrals and stalling tactics...

So, we will return to FL this fall already signed on with a new PCP... we took care of that before we left for the summer months in NH... By the way, for those of you who travel outside of TV, you need to check to see if your state and county are in the plan.. For us, only 3 counties in NH are considered... we would be SOL should something happen to us while up north.

And, last and most important, you all really need to investigate what your out of pocket expenses are going to look like with the "zero" cost premium. When I looked at it a couple of years ago, you have an out of pocket charge of $$$$ for the first 5 days of hospitalization - and that is not a one time charge.. It's for each incident. It would only take once to eat up the costs of an UH Plan F plan (that's what we have) to get you to realize you've probably made a mistake.

I wish all of you the very best on the new plan. In my parting letter to VHS I reminded them that they were putting thousands of patients at risk should this new venture fail - as it is almost impossible to get supplemental coverage like we have now after going for the low ball program.

Rockyside, As we debate our options after receiving the VHS letter, besides the option to go anywhere for health care services, the second major factor for us is that we are guaranteed continuation of the supplement plan and that is not the case with Medicare Advantage.

[ColdNoMore]

Jay Hawk - I'm happy you feel that you've made a good decision on your healthcare plan. Just wish we felt the same way.
We've been with VHS from the start - coming with the doctors at Family Doctors at Belleview. We were very happy that they were bringing a great health care model to TV. And they were the single largest reason we made the decision to purchase a home here vs other larger communities in Florida. Up until we bought our home, finding a good PCP was not easy.

I, personally, participated with the USF focus group in 2011 on what type of medical concerns were keeping couples like us from purchasing a home. It was an interesting and rewarding experience. Not long after, VHS began their program and promotion of the Dr. Welby philosophy. There were able to bring good doctors and support personnel along with them (who by the way have one year, 50 mile radius non-compete clauses in their work contracts.. including the NP's).

We saw the writing on the wall last year when friends who were turning 65 were being told to sign up for Advantage or get out. I began to look at who is who at the top of the VHS system now - none other than Kaiser Permantente followers and practitioners.

I guess that most people have forgotten what happened 20 years ago when HMO's were all the rage - lousy health care, big requirements for referrals and stalling tactics...

So, we will return to FL this fall already signed on with a new PCP... we took care of that before we left for the summer months in NH... By the way, for those of you who travel outside of TV, you need to check to see if your state and county are in the plan.. For us, only 3 counties in NH are considered... we would be SOL should something happen to us while up north.

And, last and most important, you all really need to investigate what your out of pocket expenses are going to look like with the "zero" cost premium. When I looked at it a couple of years ago, you have an out of pocket charge of $$$$ for the first 5 days of hospitalization - and that is not a one time charge.. It's for each incident. It would only take once to eat up the costs of an UH Plan F plan (that's what we have) to get you to realize you've probably made a mistake.

I wish all of you the very best on the new plan. In my parting letter to VHS I reminded them that they were putting thousands of patients at risk should this new venture fail - as it is almost impossible to get supplemental coverage like we have now after going for the low ball program.

Thank you for a very well written and balanced post. :thumbup:

It's especially compelling, considering that you were actually involved with the whole process from the beginning.

[cableb08]

I am new to TV, 2015, and joined the VHS because I talked to a rep from United and he told me I should keep what I had because it was better than what they would offer.
PLUS, I could keep my heath plan, retiree Medicare and supplemental, BC/BS of MD.
I have never had any problem w/ my current health plan coverage. As a matter of fact, I just had a knee replacement by the top Ortho in the area, and my out-of-pocket expense was <$200 vs. original cost of $ 85K.
Now I am being told change to VHS plans or go find another PCP- damned this is not easy to do, where do you find who is good or not so good???

[gomsiepop]

I received my letter on Saturday telling me that unless my husband and I choose United Healthcare Medicare Advantage we would no longer be seen by The Villages Healthcare at Pinellas where our primary doctor is located. Although I am very happy with my primary doctor I was more concerned with the specialists that we see. I called my cardiologist this morning and was told the only thing affected by the "new rules" of medical coverage was our primary doctor. All of our specialists will still see us with our conventional Medicare and United Healthcare. Well, bye bye Villages Health. Your loss, not mine.

[Lynne2387]

My husband and I are leaving the Villages health care after 3 years. We have good coverage and will not switch to an Advantage plan. We agree with everything you said. We were, in fact, told one of the reps at Colony to keep what we had because it was better than anything they could offer!

[CritterLover]

I moved to tv in 2013. The villages accepted original medicare & my nys insurance. Now they are telling me that to stay with tv health i have to join
medicare advantange. My nys insurance says they they will drop me if i do this. This will result in loss of benefits & a $2,500 reimbursement from my former employer. The villages runs ads saying "new" villagers can join tv health & pick a medicare advantage plan. This ad also states royalties will be paid to the villages. Best of all you don't have to reside in the villages to use tv health as long as you have medicare advantage.
The phone number for info rang 30 times with no answer or recording to leave a message. Call administrative ofc. 352-674-1700. They are taking names & have a team looking at the responses to this decision. Please call & voice your opinion. I spoke to barbara oliver she did not want to give me her name but i insisted. Fight for your rights.
Blicata, someone doing their job should not be held responsible for the decision of the group. I seriously doubt that Ms. Oliver means any ill-will toward anyone, especially their patients and I can only imagine how hectic their jobs must be now! This is not the messenger's fault and I certainly hope in "fighting for their rights", nobody would take anything out on an individual.

[spuds51]

Those who assume I have the Advantage program today are making a bad assumption. I don't, but I will.

Why?

Because I value the service and care I receive from VHS. I understand how business works. If I want their service / care, I need to comply with the requirements of the business.

There are currently 37 PCP's listed on the various VHS web pages (not counting the Aisenstat's who are still shown but not really there).

Now, using the MAXIMUM number of patients (1,250) that each doctor can accept, that equates to 46,250 available patient slots.

Many folks who have complained about the new requirements state they are concerned about being away from TV for long periods of time, like during summers, and therefore limited in coverage.

There are now about 120,000 residents in TV, so wouldn't it make sense that with limited capacity, the business would make decisions that would positively impact the most residents as well as the business's ability to remain strong?

I get it that this is disappointing to some, but 50 years of having health insurance confirms to me that plans and providers change darn near every year. That's just the way it works.

Best of luck as you choose to stay in the system or withdraw for other choices.

My wife and I were both in the VHS. We both liked our doctors and really liked how well everything was run. We would have loved to stay but to me it would be taking a chance with our health care. The worst thing about the advantage plan is an insurance company is going to decide if you need treatment..not your doctor. The term is medically necessary. Ask someone at SHINE if my doctor orders an MRI for instance, will I get it or will it have to be cleared by the insurance co?
I would suggest that you, and anyone else considering an advantage plan, talk to a SHINE rep and ask them about who decides what is necessary between the two plans.

[bachfan]

Many people here have also worked their whole life and have been able to retire with benifits for life. They will all have to leave TVH if they want to keep the insurance they worked for. The entire thing seems shady to force ins down your throat if you wish to remain in TVH . I am not of Medicare age so my letter stated that I'm still allowed to remain but I will be looking for a new dr also .

[rubicon]

I am not a fan of TVHCS preferring from the beginning to utilize Munroe. However in fairness to all the health care system and insurance are dealing with the enormous upheaval ACA has had. ACA is reported to be going down in flames. Is it so ?????

It is sad to see The Villages Healthcare System boot residents out because they do not belong to the right health insurance club. Does not have that "Friendliest Home Town" sound to it.

[outlaw]

Just remember it's only health care. We still get free nightly live entertainment in the squares. Just exercise, stay in shape, eat healthy, and maybe you won't need health care.

[ColdNoMore]

Just remember it's only health care. We still get free nightly live entertainment in the squares. Just exercise, stay in shape, eat healthy, and maybe you won't need health care.

OK, that was funny. :1rotfl:

[wendyquat]

To solve the big mystery, it is all about CONTROL! The Advantage plan will be telling YOU and your doctors what can be done for you! They do not intend to spend more for your care than they allot for your care! If you are not happy with your Advantage plan, I'm not sure you can return to your old supplement without qualifying questions. I could find no one who would tell me that I could "go back" without penalty! I'm sure it's a business decision for TV and THANKS BUT NO THANKS!

[Polar Bear]

...The Advantage plan will be telling YOU and your doctors what can be done for you...

Through several years in an Advantage plan and a couple major medical procedures, I've yet to experience anything like this.

[wendyquat]

[QUOTE=Polar Bear;1257777]Through several years in an Advantage plan and a couple major medical procedures, I've yet to experience anything like this

That's good to hear! I've had friends that had problems.

[pbkmaine]

My husband and I are most concerned with major medical issues, not day-to-day care. What happens if we develop a rare cancer, need an organ transplant, or have a difficult-to-diagnose problem? We want the freedom to go to the best place to get treatment and not have our options limited. That's why we use Medigap F rather than an Advantage plan.

[raisingJB]

My wife and I are currently considering purchasing a home in the Villages. We are both on Medicare and have BCBS of Illinois as supplemental. We have had BCBS for 40 years and are not going to change. Is this going to be an issue if we decide to buy a home?

[golfing eagles]

My wife and I are currently considering purchasing a home in the Villages. We are both on Medicare and have BCBS of Illinois as supplemental. We have had BCBS for 40 years and are not going to change. Is this going to be an issue if we decide to buy a home?


No more so than if you were moving to Dallas or Oshkosh. You would have to find a new doctor, and would probably look for someone who accepted your existing insurance after getting recommendations from your neighbors or friends. No different here.

The controversy is rooted in the concept that some people feel that they were "promised" they could stay in TVH system "forever", regardless of any changes in insurances or national health care policy. They feel they were "lied" to, although no one has submitted proof of any such promise, and probably never will, since it would be a rather unique position. Therefore there are a large number of TVH patients that will either have to change their doctor, or change their insurance. The complainers don't want to do either. They feel they are taking a risk by changing insurance, although after reviewing the plans, the risk is, in my opinion, minimal. It's sort of like stating you don't want to get shot by a terrorist in France. So don't go to France. But they want to go to France anyway, but get a guarantee they won't get shot. Not an option that is offered.

[2BNTV]

No more so than if you were moving to Dallas or Oshkosh. You would have to find a new doctor, and would probably look for someone who accepted your existing insurance after getting recommendations from your neighbors or friends. No different here.

The controversy is rooted in the concept that some people feel that they were "promised" they could stay in TVH system "forever", regardless of any changes in insurances or national health care policy. They feel they were "lied" to, although no one has submitted proof of any such promise, and probably never will, since it would be a rather unique position. Therefore there are a large number of TVH patients that will either have to change their doctor, or change their insurance. The complainers don't want to do either. They feel they are taking a risk by changing insurance, although after reviewing the plans, the risk is, in my opinion, minimal. It's sort of like stating you don't want to get shot by a terrorist in France. So don't go to France. But they want to go to France anyway, but get a guarantee they won't get shot. Not an option that is offered.

Excellent post!!!! :bigapplause:

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

[JoMar]

No more so than if you were moving to Dallas or Oshkosh. You would have to find a new doctor, and would probably look for someone who accepted your existing insurance after getting recommendations from your neighbors or friends. No different here.

The controversy is rooted in the concept that some people feel that they were "promised" they could stay in TVH system "forever", regardless of any changes in insurances or national health care policy. They feel they were "lied" to, although no one has submitted proof of any such promise, and probably never will, since it would be a rather unique position. Therefore there are a large number of TVH patients that will either have to change their doctor, or change their insurance. The complainers don't want to do either. They feel they are taking a risk by changing insurance, although after reviewing the plans, the risk is, in my opinion, minimal. It's sort of like stating you don't want to get shot by a terrorist in France. So don't go to France. But they want to go to France anyway, but get a guarantee they won't get shot. Not an option that is offered.

Oshkosh, interesting choice of location...lol.

[golfing eagles]

Oshkosh, interesting choice of location...lol.

B'gosh, I guess it was:1rotfl::1rotfl::1rotfl:

[2BNTV]

Oshkosh, interesting choice of location...lol.

Oskosh is in Wisconsin, USA :D

BTW - Isn't Google great?

[spuds51]

Medicare Advantage video




No Premium "FREE" Medicare Plans | You Get What You Pay For - YouTube (https://www.youtube.com/watch?v=REYZuAHbNb0)

[villagetinker]

Anyone have a copy of the 2016 UHC plan F and plan N enrollment guides that I could borrow for 1-2 days? My wife and I have these plans, and I have the "accepted" plan books for this year. I want to do a detailed comparison to see what we might be giving up if we stay. I know the new books will be out in October, but I am trying to plan ahead (assuming there will not be significant changes except for costs).

Thank you in advance.

PS I called UHC to get copies, the minion said oh we can send you those electronically, guess what I got LINKS to the website, and NO documents. I could not find the documents on the site, and a google search turned up nothing useful. We tossed ours out after we signed up, who knew???

[hillncea]

Excellent post!!!! :bigapplause:

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

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

[ValSetz]

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

[Jpicchi]

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

[Carla B]

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

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

[Marciastef]

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

[LynnWM158]

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

[champion6]

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

A critical element of health care is confidence. If you have lost confidence in the system (as we have because of the way this recent decision was made and communicated), it's time to go. Who's to say The Villages won't close the entire system three or four years from now because it's not making enough money for them then (and with the number of people walking because of this recent decision, that's not such a far-fetched scenario). Where will be people who stick with the system now be then?Sadly, you might find the same situation when you change to another individual doctor or another group. You never know ... it's a jungle out there.

[golfing eagles]

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



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

[golfing eagles]

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

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

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

[gerryann]

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

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

[Carla B]

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

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

[jpforster]

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

[Happydaz]

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

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

[shmoo1]

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

[Johnd]

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

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

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

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

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

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

[Rgstarnes]

I have chosen to not have any association with The VHS, as a result of the level of service received at the hospital for both me and my wife. Without getting into specifics, let me just say the diagnosis from the Villages Hospital were far from accurate for us.
I do agree one hospital stay on an advantage plan will help you understand why the supplemental plan is far better for seniors. That is why we have chosen the supplemental plan.

[Happydaz]

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

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

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

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

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

The information you refer to here concerns switching from a Medicare Advantage Plan back to traditional Medicare insurance. When a person originally switches to a Medicare Advantage plan they no longer are in traditional Medicare, that is why they need to renew their application when they switch back. Medicare Part A covers hospitals and comes with deductibles, etc..The Medicare B part pays 80% of your outpatient care, you are responsible for the other 20%. That can be a lot of money! That is why people who have traditional Medicare usually purchase a MediGap policy from a private insurance company. OK, here comes the problem, when you want to apply for private MediGap insurance after coming off a Medicare Advantage plan they will require you to fill out a health questionnaire. If you have any serious pre existing health problems they can refuse to cover you. This shows that choosing a Medicare Advantage plan when you are relatively healthy and enjoying the low premiums may not turn out so good if you get a serious disease. (Which most of us get sooner or later.) You may think you could switch to the traditional Medicare and then go out and get a MediGap policy, but you may find out that the insurance companies won't sell you a policy. So the choices left to you are to stay with the Medicare Advantage plan or go with just Medicare and get stuck paying high deductibles, etc..

[Carla B]

You're right, Happydaz. If you don't follow strict guidelines, it's not automatic that you'll be able to buy a Medigap supplement. I know, 'cause I've done it and had to qualify health-wise. A person may also be subject to a higher monthly premium based on age at time of enrollment.

[golfing eagles]

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

Well, it's not quite as monolithic as you stated it. TVH has only been around for about 4 years, therefore the population of TV prior to 2012 had doctors not in TVH. I doubt huge numbers of these people dumped their physician of 5, 10, 15 or even 20 years just because a new option opened up---there were plenty of options before TVH. So a large part of TVH patient base is made up of those that came here in the last 4 years, and there are a large number of those people who are under age 65. TVH's decision does not affect the insurances of those under 65.

In growing, non-retirement areas, such as Research Triangle, practices are about 15-20% Medicare. Our NY practice was 41% Medicare. I would guess TVH is about 70% Medicare, maybe higher. With the exception of Tricare, almost all these people either have traditional Medicare with a supplement or already have a MA policy. So essentially they are dropping one Medicare insurance plan in favor of the other, and the people will choose what's best for them.

To use our NY practice as an example, we only dropped one insurance completely in the last 30 years, because it became absolutely ridiculous to accept it. This was an insurance that was offered by several large employers, and most patients picked it because it deducted the least amount from their paycheck (which is generally how most employees choose). We lost about 70% of those patients, but over the ensuing years about half returned due to changing their insurance for whatever reason. Any other insurance we dropped we only stopped accepting NEW patients with that insurance and "grandfathered" the rest---we thought that was the higher moral ground, but many practices will just drop all that have a given insurance.

I doubt the remaining partners would introduce a drastic change to 41% of the practice. But for argument's sake lets say that such a decision would cost the practice 2 million/year. So it wouldn't even be a consideration. Now for the wild card---say UHC came along and said they wanted to use the name of our practice on their MA plans, and for that right they would pay $20 million in royalties. Now the whole decision process changes dramatically, doesn't it? It would be a financial no-brainer, the only consideration would be ethical. But they would probably rationalize that they aren't dumping anyone, the patients have the option of changing Medicare plans. This is essentially the same situation that TVH was in.

[Dan9871]

golfing eagles: I’m trying to figure out what conclusion to draw from the numbers you present here.

Are you saying the 20M royalties make it possible lose a large number of patients in the transition to MA only but still run a system with 30 minute appointments, same day appointments, and doc’s that support no more than 1250 patients, and TVH doc’s managing Villages Hospital patients until enough TV residents see the value/quality of this system so that it is viable without the royalties?

I ask because I, as a patient, I see TVH as way, way better than any other medical service, including simple medical events, specialists and hospital stays, than any other I’ve experienced. My only worry is that the transition to MA puts TVH out of business.

BTW your explanation about picking the “best” specialist clarified something I’ve thought for decades. I’m not in the medical field but could never figure out how I could pick the “best” specialist/surgeon.. I’ve run into and had some friends run into some of the points you mentioned. I’ve also run into what seemed to me as doc’s doing a good job of marketing themselves as “best”.

But on the other hand in one case though TVH I feel I did end up with the “best” in field….

Well, it's not quite as monolithic as you stated it. TVH has only been around for about 4 years, therefore the population of TV prior to 2012 had doctors not in TVH. I doubt huge numbers of these people dumped their physician of 5, 10, 15 or even 20 years just because a new option opened up---there were plenty of options before TVH. So a large part of TVH patient base is made up of those that came here in the last 4 years, and there are a large number of those people who are under age 65. TVH's decision does not affect the insurances of those under 65.

In growing, non-retirement areas, such as Research Triangle, practices are about 15-20% Medicare. Our NY practice was 41% Medicare. I would guess TVH is about 70% Medicare, maybe higher. With the exception of Tricare, almost all these people either have traditional Medicare with a supplement or already have a MA policy. So essentially they are dropping one Medicare insurance plan in favor of the other, and the people will choose what's best for them.

To use our NY practice as an example, we only dropped one insurance completely in the last 30 years, because it became absolutely ridiculous to accept it. This was an insurance that was offered by several large employers, and most patients picked it because it deducted the least amount from their paycheck (which is generally how most employees choose). We lost about 70% of those patients, but over the ensuing years about half returned due to changing their insurance for whatever reason. Any other insurance we dropped we only stopped accepting NEW patients with that insurance and "grandfathered" the rest---we thought that was the higher moral ground, but many practices will just drop all that have a given insurance.

I doubt the remaining partners would introduce a drastic change to 41% of the practice. But for argument's sake lets say that such a decision would cost the practice 2 million/year. So it wouldn't even be a consideration. Now for the wild card---say UHC came along and said they wanted to use the name of our practice on their MA plans, and for that right they would pay $20 million in royalties. Now the whole decision process changes dramatically, doesn't it? It would be a financial no-brainer, the only consideration would be ethical. But they would probably rationalize that they aren't dumping anyone, the patients have the option of changing Medicare plans. This is essentially the same situation that TVH was in.

[golfing eagles]

golfing eagles: I’m trying to figure out what conclusion to draw from the numbers you present here.
Are you saying the 20M royalties make it possible lose a large number of patients in the transition to MA only but still run a system with 30 minute appointments, same day appointments, and doc’s that support no more than 1250 patients, and TVH doc’s managing Villages Hospital patients until enough TV residents see the value/quality of this system so that it is viable without the royalties?


BTW your explanation about picking the “best” specialist clarified something I’ve thought for decades. I’m not in the medical field but could never figure out how I could pick the “best” specialist/surgeon.. I’ve run into and had some friends run into some of the points you mentioned. I ask because I, as a patient, I see TVH as way, way better than any other medical service, including simple medical events, specialists and hospital stays, than any other I’ve experienced. My only worry is that the transition to MA puts TVH out of business.

I’ve also run into what seemed to me as doc’s doing a good job of marketing themselves as “best”.

But on the other hand in one case though TVH I feel I did end up with the “best” in field….

The short answer is yes. The number I gave is theoretical, but there will be an amount that offsets the loss while maintaining the premise of TVH. Whether this actually occurred or not is anyone's guess, I just don't think UHC gets to use a trademarked name for free.

[spuds51]

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

No problem ..glad it helped

[villagerjack]

My husband and I are most concerned with major medical issues, not day-to-day care. What happens if we develop a rare cancer, need an organ transplant, or have a difficult-to-diagnose problem? We want the freedom to go to the best place to get treatment and not have our options limited. That's why we use Medigap F rather than an Advantage plan.

Not every " good" doctor accepts Medicare. They don't have to

[villagerjack]

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

The video is by an insurance salesman selling supplemental plans so read between the lines. After viewing 50% I shut it down since he sounded like a carnival barker to me.

[spuds51]

The video is by an insurance salesman selling supplemental plans so read between the lines. After viewing 50% I shut it down since he sounded like a carnival barker to me.

He is an independent agent that sales medicare advantage as well as supplemental insurance. The agents also get more money for selling Advantage plans. It's just one of many information videos out there. Go to youtube and type in Medicare Advantage videos and see what comes up. I have watched several and they all seem to be in line with what he says.

Here is another independent agent..Matthew Claassen 1-800-847-9680 ext -2..He also will sell you an Advantage Plan if you want one. He will let you know how they work before doing so tho.

[NYGUY]

....It would be a financial no-brainer, the only consideration would be ethical. But they would probably rationalize that they aren't dumping anyone, the patients have the option of changing Medicare plans. This is essentially the same situation that TVH was in.

Doc, are you saying that TVH, in choosing the financial no-brainer, may have been unethical?

[sabinfl]

The one thing I can say is: Marcus Welby has left the building. Maybe I saw that someplace, but it is worth repeating.

[golfing eagles]

Doc, are you saying that TVH, in choosing the financial no-brainer, may have been unethical?

more like all ethics are created equal only some ethics are more equal than others

[GSchamm]

Sounds like socialism to me. Where have we heard "If you like your Doctor, you can keep your Doctor", before. We were also told by a UHC salesperson to keep our plan because it was better than what UHC had to offer. We all want to make the right choice, the one that is best for us. I never need a 30 minute appointment, usually end up just visiting with my DR about politics or whatever. They don't like this either.

[spiritels]

Jay Hawk - I'm happy you feel that you've made a good decision on your healthcare plan. Just wish we felt the same way.
We've been with VHS from the start - coming with the doctors at Family Doctors at Belleview. We were very happy that they were bringing a great health care model to TV. And they were the single largest reason we made the decision to purchase a home here vs other larger communities in Florida. Up until we bought our home, finding a good PCP was not easy.

I, personally, participated with the USF focus group in 2011 on what type of medical concerns were keeping couples like us from purchasing a home. It was an interesting and rewarding experience. Not long after, VHS began their program and promotion of the Dr. Welby philosophy. There were able to bring good doctors and support personnel along with them (who by the way have one year, 50 mile radius non-compete clauses in their work contracts.. including the NP's).

We saw the writing on the wall last year when friends who were turning 65 were being told to sign up for Advantage or get out. I began to look at who is who at the top of the VHS system now - none other than Kaiser Permantente followers and practitioners.

I guess that most people have forgotten what happened 20 years ago when HMO's were all the rage - lousy health care, big requirements for referrals and stalling tactics...

So, we will return to FL this fall already signed on with a new PCP... we took care of that before we left for the summer months in NH... By the way, for those of you who travel outside of TV, you need to check to see if your state and county are in the plan.. For us, only 3 counties in NH are considered... we would be SOL should something happen to us while up north.

And, last and most important, you all really need to investigate what your out of pocket expenses are going to look like with the "zero" cost premium. When I looked at it a couple of years ago, you have an out of pocket charge of $$$$ for the first 5 days of hospitalization - and that is not a one time charge.. It's for each incident. It would only take once to eat up the costs of an UH Plan F plan (that's what we have) to get you to realize you've probably made a mistake.

I wish all of you the very best on the new plan. In my parting letter to VHS I reminded them that they were putting thousands of patients at risk should this new venture fail - as it is almost impossible to get supplemental coverage like we have now after going for the low ball program.
My husband spoke today to the "Retirement Benefits Consultant" in the Santa Barbara ofc. He also got the bad news that 1st 5 hospital days will be min $260 ea day, every ofc visit $25 copayment, they will NOT take secondary insurance like BCBS! He left before being told about other out of pocket expenses like tests & lab work, scans, etc. cuz he was so upset. This IS about money people! The Villages Health wants to be paid more money plus do u know that WE help pay them a 13% to 17% govt payment? People, we shouldn't JUST be looking for new doctors! WE need advocates in this issue! What if ALL Drs in the Villages do this? Is this a proper thing to do to long standing elderly patients? What about the news stations? What about our politicians who need us??? What about AARP? Do we have to take this just because The Villages Health Care wants more money? And if this insurance isn't accepted in other locations nearby, what then???

[spiritels]

You obviously have Medicare Advantage and the disappointment in the system does not affect you personally so I doubt you'd be the one to comment and gloat to those of us who were sold property and promised this EXCELLENT healthcare in Americas FRIENDLIEST hometown. It is understandable that one might not have been happy with our choice of physicians. After two years with the same Doctor I determined he was not the one for me so I asked for and got a new doctor that I liked very much! We understand that the bottom line is what it's all about but that does little to excuse their promises and method of notification. It is a great inconvenience for most of us and it would have made it a bit easier to stomach if only they had made a little effort to tack one little paragraph in their letter saying they were sorry!

Because of my background in health insurance it is my opinion that the Advantage plan is great for the healthy but not so good if you have health problems and your trusted doctors do not participate. Although I have reason to believe that not everyone is getting top care at TVs health centers, there are those of us who value good health care and don't want to settle for second best!
I replied to your post and had a lot of negative things to say about this change plus more details since we just spoke today to a Santa Barbara rep. My reply will need to be approved by a moderator, hope they allow it thru.

[spiritels]

I am new to TV, 2015, and joined the VHS because I talked to a rep from United and he told me I should keep what I had because it was better than what they would offer.
PLUS, I could keep my heath plan, retiree Medicare and supplemental, BC/BS of MD.
I have never had any problem w/ my current health plan coverage. As a matter of fact, I just had a knee replacement by the top Ortho in the area, and my out-of-pocket expense was <$200 vs. original cost of $ 85K.
Now I am being told change to VHS plans or go find another PCP- damned this is not easy to do, where do you find who is good or not so good???
We also have secondary BCBS from MD. If we change to what the Villages Health wants we were told that they would NOT accept secondary ins like BCBS specifically! I can't believe that they would prey on the elderly in this way! We need to get advocates! I hope Villages Health lose a ton of patients

[spiritels]

I moved to tv in 2013. The villages accepted original medicare & my nys insurance. Now they are telling me that to stay with tv health i have to join
medicare advantange. My nys insurance says they they will drop me if i do this. This will result in loss of benefits & a $2,500 reimbursement from my former employer. The villages runs ads saying "new" villagers can join tv health & pick a medicare advantage plan. This ad also states royalties will be paid to the villages. Best of all you don't have to reside in the villages to use tv health as long as you have medicare advantage.
The phone number for info rang 30 times with no answer or recording to leave a message. Call administrative ofc. 352-674-1700. They are taking names & have a team looking at the responses to this decision. Please call & voice your opinion. I spoke to barbara oliver she did not want to give me her name but i insisted. Fight for your rights.
We have to make this a HUGE issue!!! We, who feel that we are getting forced to accept what we believe is more out of pocket expenses and lower quality health care(and if you think that not being able to find good doctors/specialists or other locations to choose from isn't lower quality health care, then you're absolutely wrong) we need to stand up and fight this! Don't be silent, people!!! Let others with more power and authority know what's going on here! Because if you don't think the Villages isn't somehow involved you're also wrong. This is after all a real estate company owned city. Including the hospital! And a specialist of mine told me this

[spiritels]

Many people here have also worked their whole life and have been able to retire with benifits for life. They will all have to leave TVH if they want to keep the insurance they worked for. The entire thing seems shady to force ins down your throat if you wish to remain in TVH . I am not of Medicare age so my letter stated that I'm still allowed to remain but I will be looking for a new dr also .
I also am not of Medicare age but my husband is and we have BCBS secondary. They will no longer even be accepting the secondary insurance! This is legal, doctors can choose what insurance they will accept but I also think there is something shady going on behind the scenes. There is definitely money, and more money involved. Would like to see this blow up in their faces. And what about the ethics of the doctors who know what's happening to their patients? SAD

[Lauramore]

I wish to alert Villagers of a recent problem I faced with a new physician. I was told I must have tests not covered by any insurance or Medicare. These tests were to be paid by me and would total thousands of dollars. Since I am in excellent health, I refused these tests saying I could not afford them and only wanted those covered by Medicare. I continued to be pressured and politely left the office. Medicare ,my insurance, and I received bills. Prior to their arrival, I received a call from the doctor's office telling me to either come back for ALL the tests or find another doctor. I had already chosen the later. The secretary warned me my insurance would not pay for another visit for one year. I knew this was incorrect.

My message is to watch for unscrupulous activities everywhere. They"re also present in the professional group too.

[Lauramore]

I wish to alert Villagers of a recent problem I faced with a new physician. I was told I must have tests not covered by any insurance or Medicare. These tests were to be paid by me and would total thousands of dollars. Since I am in excellent health, I refused these tests saying I could not afford them and only wanted those covered by Medicare. I continued to be pressured and politely left the office. Medicare ,my insurance, and I received bills. Prior to their arrival, I received a call from the doctor's office telling me to either come back for ALL the tests or find another doctor. I had already chosen the later. The secretary warned me my insurance would not pay for another visit for one year. I knew this was incorrect.

My message is to watch for unscrupulous activities everywhere. They"re also present in the professional group too.

[spiritels]

OK, that was funny. :1rotfl:
No, that was minimalizing the serious issues and worries that some of our families and neighbors have.

[Villageswimmer]

I wish to alert Villagers of a recent problem I faced with a new physician. I was told I must have tests not covered by any insurance or Medicare. These tests were to be paid by me and would total thousands of dollars. Since I am in excellent health, I refused these tests saying I could not afford them and only wanted those covered by Medicare. I continued to be pressured and politely left the office. Medicare ,my insurance, and I received bills. Prior to their arrival, I received a call from the doctor's office telling me to either come back for ALL the tests or find another doctor. I had already chosen the later. The secretary warned me my insurance would not pay for another visit for one year. I knew this was incorrect.

My message is to watch for unscrupulous activities everywhere. They"re also present in the professional group too.


Could you please tell us the name of the Doctor/group? Many among us are looking for a new dr. Thanks,

[spiritels]

We were told today they would also not be accepting secondary insurances like BCBS. The rep at Santa Barbara only found one positive thing to changing to Med Advantage w/TVHC no longer accepting secondary insurance: get rid of BCBS and save the extra couple hundred dollars a month to cover all the extra copays and out of pocket expences. Some Advantage, huh???

[spiritels]

Could you please tell us the name of the Doctor/group? Many among us are looking for a new dr. Thanks,
We're thinking of definitely looking OUTSIDE the Villages for a new primary care phys. You don't know if ultimately every group in the Villages will follow the lead of VHC. And changing to Med Advan is going to be bad for the long term. You will not be able to change back!

[spiritels]

Contacted Marco Rubio's ofc about VHC. Cannot count on anything but we have alot of voters here. Maybe they could just help w/advocacy for folks having to leave VHC.

[Wandatime]

Medicare Advantage video




No Premium "FREE" Medicare Plans | You Get What You Pay For - YouTube (https://www.youtube.com/watch?v=REYZuAHbNb0)

EXCELLENT VIDEO! Thanks so much for posting. Great explanation of the differences between a Medicare supplement plan and a Medicare advantage plan. Education is vital, folks!

:bigbow:

[John_W]

We're thinking of definitely looking OUTSIDE the Villages for a new primary care phys. You don't know if ultimately every group in the Villages will follow the lead of VHC. And changing to Med Advan is going to be bad for the long term. You will not be able to change back!

After moving to TV from Baltimore in 2011, my wife signed up for a United Health medigap plan. It started out at $185 a month and was over $200 when she changed last open season. She used Premier Medical at Lake Sumter for her doctor. She was never happy with the service, or really lack of service. In her final year her doctor left the firm and she only found out from reading this website, they never told her. In addition she had a drug plan with Humana for $22 a month that required getting all her drugs from Walmart. They didn't have 2 or 3 of her drugs in stock whenever we ordered, and that would delay a day or two and they always were saying we ordered too soon, we would have to wait because of the insurance.

Last January she signed up for The Villages Medicare Advantage Plan at the Pinellas office. Immediately we saved over $220 a month in premiums, and the drug plan was included free. She's had no out pocket expenses this year and gets her drugs at Walgreens and they're always in stock and are cheaper than Walmart. One time VHS did want to send her for a bone density test at Lake Imaginng. She turned it down because if she was found in need of a drug, the drug that is most commonly used is Bisphosphonates, which has very serious side effects and rather not take it. She had no problem with her doctor.

Myself, I had been with the VA Medical system but turned 65 a year ago July, so I also signed up with VHS and I've had great care. I had to pay a co-pay twice to specialist of $30 each. One was a pain management doctor and the other was a pulmonary doctor. I had pneumonia in the spring and had a chest x-ray, a CT scan and a MRI all at Lake Imaginng, my total out of pocket was less than $100. So far, I'm very pleased with the care and it's much more hands on and attentive than that I was receiving from the VA.

[Wandatime]

All I can tell you people is to read the schedule of benefits for both plans! If we had a Medicare Advantage plan when Sheldon was going through his cancer treatments we would be living under a bridge about now. Medicare Advantage may be great when you are relatively healthy but I guarantee it is not so great if you have get seriously or chronically ill.

[golfing eagles]

All I can tell you people is to read the schedule of benefits for both plans! If we had a Medicare Advantage plan when Sheldon was going through his cancer treatments we would be living under a bridge about now. Medicare Advantage may be great when you are relatively healthy but I guarantee it is not so great if you have get seriously or chronically ill.

I'm not an insurance expert. My understanding is that the only way you end up responsible for more than the $4400 out of pocket max under their MA plan is if you go out of network. Even then, if someone needs a service that is not available at all in network, they will approve out of network coverage. I'm sure you are happy with the cancer specialist/hospital Sheldon chose, but would your choice be to go out of network if you had an MA plan?
The reason I ask, is that the biggest criticism of the decision by TVH to take only TV UHC MA plan is the restriction to in-network specialists

[billybye]

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

Why should VHS be a factor in buying a home in The Villages. There are plenty of good physician groups and individual doctors here. Really no need for VHS anyway. We were great here before they got into health care and we will be great here if they get out.

[golfing eagles]

Why should VHS be a factor in buying a home in The Villages. There are plenty of good physician groups and individual doctors here. Really no need for VHS anyway. We were great here before they got into health care and we will be great here if they get out.

I agree 100%. The way that post sounded, there weren't any homes sold here until they started TVH 3-4 years ago. Hmmm....

[Dan9871]

We have The Villages Advantage and earlier this year the in-network my wife needed was just inconvenient to go to, basically a bit over a 3/4 of an hour away. Sent in a request to UHC to go to an out of network provider in the Villages and it was approved in just a few days.

Even then, if someone needs a service that is not available at all in network, they will approve out of network coverage.

[Carla B]

Another unpleasant thought about The Villages Health Medicare Advantage plan is if you become seriously ill, say in October, and you are still ill the following January, you are looking at $4,400 total out of pocket cost twice, or $8,800 in the span of a few months.

[jebartle]

I am new to TV, 2015, and joined the VHS because I talked to a rep from United and he told me I should keep what I had because it was better than what they would offer.
PLUS, I could keep my heath plan, retiree Medicare and supplemental, BC/BS of MD.
I have never had any problem w/ my current health plan coverage. As a matter of fact, I just had a knee replacement by the top Ortho in the area, and my out-of-pocket expense was <$200 vs. original cost of $ 85K.
Now I am being told change to VHS plans or go find another PCP- damned this is not easy to do, where do you find who is good or not so good???

Just had hip replacement surgery, $82,000, our cost $250 with Village advantage plan. Could not be more pleased. Btw, hip is great. Dr Messieh.
I was ready to play golf after 2 weeks, but doc said "cool it",

[pbkmaine]

All I can tell you people is to read the schedule of benefits for both plans! If we had a Medicare Advantage plan when Sheldon was going through his cancer treatments we would be living under a bridge about now. Medicare Advantage may be great when you are relatively healthy but I guarantee it is not so great if you have get seriously or chronically ill.



Could you elaborate?

[gerryann]

All I can tell you people is to read the schedule of benefits for both plans! If we had a Medicare Advantage plan when Sheldon was going through his cancer treatments we would be living under a bridge about now. Medicare Advantage may be great when you are relatively healthy but I guarantee it is not so great if you have get seriously or chronically ill.

I agree with this completely. However, in your (Sheldons) situation.....if you had a Medicare advantage at the time, wouldn't the out of pocket max (which I'm assuming would have been met) been (or equal to) the monthly payments of a secondary (medigap) policy?

I'm trying to make a change and trying to figure out the best way to go.

[BK001]

Medicare Advantage video




No Premium "FREE" Medicare Plans | You Get What You Pay For - YouTube (https://www.youtube.com/watch?v=REYZuAHbNb0)


As someone in the process of learning about the differences between the various options available, I found this video very informative. Thank you for posting it.

[villagetinker]

I agree with this completely. However, in your (Sheldons) situation.....if you had a Medicare advantage at the time, wouldn't the out of pocket max (which I'm assuming would have been met) been (or equal to) the monthly payments of a secondary (medigap) policy?

I'm trying to make a change and trying to figure out the best way to go.

Gerryann, (and others reading these posts):
Contact SHINE, ask them your questions they will provide an UNBIASED review or information on the various plans. There are potential 'gotchas' on both sides. If you go with an ADVANTAGE plan, you may have difficulty getting back to a Supplemental plan. If you go with a supplemental plan, you will have a monthly cost, BUT YOU CAN GO ANYWHERE (except VHS). Way too many other items to list here. SHINE will be a great help. I am not sure if you will get the same UNBIASED info from the villages health care offices.

[spiritels]

I really think we all have to use common sense and ask ourselves does ANY business really make significant business changes in order to benefit their customers financial standing??? And don't fool yourselves, in spite of the VHS being a medical practice, it's a business. They will only make this big change because it's going to benefit THEM financially! If you think this is about benefiting US financially, you're wrong.