Traditional Medicare w/plan F vs Advantage

[quinnpd]

My wife and I have been on traditional medicare plus United Health Care supplemental plan F for the past 8 years with no problems with health and/or seeing doctors whether here in Florida or "up north". Each year we visit SHINE and they tell us to stay were we are, that we have best plan as long as we are comfortable with the monthly premium that we pay (and we are). For the past 3 years we have visited with United Health Care sales reps in The Villages and each year they tell us that we have best plan and they cannot recommend that we change?? The last time we talked with them was last November during the signup period for 2016. So here we are, being told not to switch to an Advantage Plan and then being told that we had to switch if we wanted to stay with VHC?? What to do, what to do.

[champion6]

It's time to begin your search for a new Primary Care Physician here in Florida. There are many to choose from.

[billethkid]

Easy. Do what you have heard many times...keep what you have if you are happy with it.

What we like is the covereage is not restricted to any specific doctors or specialists or hospitals.

We looked at the "Marcus Welby" approach when it was first offered here in TV...too restrictive for us and no added value to change.

To each his own. If you like what you have....no need to switch!

[golfing eagles]

There are a lot of posts complaining about how "restrictive" the UHC advantage plan is. I went to their website an pulled the list of participating providers----it is 135 pages long. Perhaps it's not all that restrictive

[gerryann]

Stick with what you have. The Villages health plan is way too restrictive. Just look for another Dr.
Villages health is nothing more than a HMO. If the insurance payments that you have been paying are doable for you.....don't change.

[CritterLover]

There are a lot of posts complaining about how "restrictive" the UHC advantage plan is. I went to their website an pulled the list of participating providers----it is 135 pages long. Perhaps it's not all that restrictive

YES!! Why is it so hard for folks to just get all the facts rather than run with bits and pieces of very managed news? The list is HUGE!

[Fredster]

YES!! Why is it so hard for folks to just get all the facts rather than run with bits and pieces of very managed news? The list is HUGE!

Question....the list may be long, but is it a requirement of VHC to have to go through a gate keeper doctor to see a specialist?

[CritterLover]

Question....the list may be long, but is it a requirement of VHC to have to go through a gate keeper doctor to see a specialist?

In my experience, it depended on the type of specialist. Saw a dermatologist on my own, but needed a referral from my doctor for cardiology. Seemed sensible enough to me.

[Fredster]

In my experience, it depended on the type of specialist. Saw a dermatologist on my own, but needed a referral from my doctor for cardiology. Seemed sensible enough to me.

Thank you!

[2BNTV]

OP should stay with the plan that best works for them.

If it ain't broke, don't fix it.

Everyone has to decide what plan best suits their needs based on facts. The only variable is, if one has a MA plan, trying to project one future needs, if they think they are going to start being unhealthy, may want to switch to original Medicare with a supplemental plan.

Someone mentioned to me that if I have had an MA plan for several years, switching to original Medicare with a supplement will be denied. Hmmmmmmmmmmm....... need to check the info out more closely going forward.

[Sonny39]

The Villages advantage HMO and PPO plans do not require a referral from your PC;P.

[NYGUY]

Question....the list may be long, but is it a requirement of VHC to have to go through a gate keeper doctor to see a specialist?

It depends on the type of United Healthcare Medicare Advantage plan you have. If it's the HMO, you need a referral. If you have the PPO, you don't need a referral.

[spuds51]

My wife and I have been on traditional medicare plus United Health Care supplemental plan F for the past 8 years with no problems with health and/or seeing doctors whether here in Florida or "up north". Each year we visit SHINE and they tell us to stay were we are, that we have best plan as long as we are comfortable with the monthly premium that we pay (and we are). For the past 3 years we have visited with United Health Care sales reps in The Villages and each year they tell us that we have best plan and they cannot recommend that we change?? The last time we talked with them was last November during the signup period for 2016. So here we are, being told not to switch to an Advantage Plan and then being told that we had to switch if we wanted to stay with VHC?? What to do, what to do.

It doesn't get much better than what you have. The only drawback is that from what I read they are going to discontinue the plan F in 2020. You'll still be able to keep it but noone else can get on it...which means it probably will start getting expensive.

[gerryh1943]

Went today to see a new Dr.,I also pay for my own insurance which is BCBS, which I have had and also went to TVH since they open. Have a wonderful Dr. that I like but there has to be another one that can suit me. Today went to one which is call Lady lake Family Medicine, they were RollingAcres Rd. and 466 Dr. John Burress. Phone 352-259-7994 they are taking appointments for now you can go check it out with your insurance you an go were you want. I also have plan F.go anywhere you want. Start your search now before October when everyone else starts looking

[gerryh1943]

I Also have Blue Cross Blue Shield plan F today I went to a new A new doctor on rolling acres and 466 made appointment last week, before the rush. Lady Lake Family Medicine Dr Burress phone #352-259-7994. Very clean office which I like about the VH. I like then very much they are all American so know problem understanding anyone. Check them out I am going with them. I would have stayed with the village health but they made their choice. I Am not going to give my freedom up.

[2BNTV]

It depends on the type of United Healthcare Medicare Advantage plan you have. If it's the HMO, you need a referral. If you have the PPO, you don't need a referral.

I have a Medical Advantage UHC HMO 1 Plan and I can see any specialists I want, without a referral. TVH would like to be a gatekeeper but it is not mandatory. Obviously, if I went to a specialists I would send all info back, to my PCP.

This was the main reason I switch from Florida Blue HMO, as I needed a referral from my PCP. It was a PITA to get the authorization through his staff and it should have been a ten minute process. Nuff said about that............

[Avista]

I have a Medical Advantage UHC HMO 1 Plan and I can see any specialists I want, without a referral. TVH would like to be a gatekeeper but it is not mandatory. Obviously, if I went to a specialists I would send all info back, to my PCP.

This was the main reason I switch from Florida Blue HMO, as I needed a referral from my PCP. It was a PITA to get the authorization through his staff and it should have been a ten minute process. Nuff said about that............

You're right. I have Villages HMO and have never needed a referral to see a specialist.

[Steve & Deanna]

What you don't know is that you will pay probably $2,000 for your surgery (if required) and any other thing they do to you while you are in surgery is another $2,000 or $1500 and that adds up. I have heard horror stories about Medicare Advantage. People think oh no premium payment but not so nice when your health fails you. Don't give up a good insurance for an insurance that may not last or decides to charge you a premium after they get you.

[rivaridger1]

I am offering a personal opinion after finding out my Medicare and Plan F insurance was no longer acceptable to the Villages Health organization and also after having had access to it for two years. The VHC model is dedicated to young healthy seniors, e.g., an extended first time appointment, lab draws every six months, access to physician assistants and nurses for the common maladies suffered by healthy seniors. The system does not work very well for specialist referrals since most of the VHC doctors are recent transplants and the internal VHC specialists in house are relatively few. There are many respected primary care physicians outside the VHC model which more then a few of the local specialist physicians consider to be first class. I found four specialists myself prior to selecting VHC as my primary health care provider and other then saying " ok " none of them offered another encouraging word relating to the VHC organization. I have a new primary health care physician and as I visit the specialists and change my records most of them say, " you have a good one. "

[Nucky]

I wonder if I'm missing something? As the new guy in town so far I am very grateful to have the medical care that I have received. Seems like my doctors always make me take an appointment on the 3rd friday of the month in the afternoon....Damn....I pay a reasonable amount towards my Blue Cross insurance, they provide clear instructions how to use my insurance and the doctors I have seen so far are top notch. I will be changing to Medicare in April of 2017 and have learned much from those before me. I don't expect my doctors to be a golf cart ride away and it is nerve wracking setting up all the appointment and the BS that come with getting coverage but once it's done it sure feels great.

[gomsiepop]

I watched the following video and made my decision on the information it provided. Each person needs to make a choice based on their own personal needs. My decision to stay with traditional Medicare and my United Healthcare secondary (not Advantage) was based on several factors. First and foremost was my husband has several health issues that require he see several specialists. In good conscience I could not rely on The Villages for their expertise. They flip-flopped on their decision to deny benefits to anyone other than those with the Advantage plan. Watch this video and you can make an informed decision.
No Premium "FREE" Medicare Plans | You Get What You Pay For - YouTube (https://www.youtube.com/watch?v=REYZuAHbNb0&sns=em)

[Northwoods]

I currently go to TVH and have been very impressed with the care. I have a very capable primary care physician, which is extremely important to me.
I've been reading all the comments about the downside of a UH Advantage plan... one of them being that you can't pick specialty care (like Shands or other facilities for cancer or heart-related care). Taking the cancer example, my understanding is that TVH is affiliated with some of the top cancer care institutions... MD Anderson (nationally-known as a leading cancer center) being one of them. I am impressed that they are affiliated with top-rated institutions. Also, many people say "with TVH, "you can't go to out of network physicians/facilities..." But - I know of at least one person who has received an exemption and has been referred to an "out of network" physician ... so... don't assume that you can't be referred to an out-of-network physician/facility if you go with UH-Advantage.
I've also heard people say that if you leave The Villages you won't be covered.... but I know that UH-Advantage offers a Passport plan, which allows members to receive covered services outside of TVH service area when traveling (or if you're a snowbird).
I would recommend, to make an informed decision, visit the Medicare Resource Center, meet with your insurance provider, contact a United Health Care Medicare Advantage advisor which are located in the town squares, meet with SHINE volunteers, and I would also recommend you consider signing up for an educational session at a TVH care center by calling (352) 674-8789.
Again... TVH isn't for everyone. But research your options and talk to the experts. Then make the right decision for you.

[paulascorpio]

We were on it and got nickled and dimed to death.......stay with part F. We went back to F.

[zonerboy]

Several years ago I switched to United Health Care Medical Advantage plan. Before signing up, I checked with the sales people at The Villages Medicare Store. They showed me a big fat book of specialists who were participants in the plan. I looked up the specialists I was already seeing and most of them were in the book, so I signed up in October for the coming year. Little did I know but come January a new book of participating specialists came out and many of the specialists I had seen in the past were no longer listed. The next year I went back to my old Medicare plan F supplement.

[llaran]

Just one example - A woman I know was diagnosed with a rare cancer , only one DR in the US specializes in this cancer, he is on the west coast, with the medicare you now have you could make an appt and see him with no problem. That to me is the advantage or Medicare, you don't have to ask anyone or if the DR or facality is in network. I worked for UnitedHealth 20 yyears, I would never tell anyone to go on to an HMO, ppo maybe, but even if you are very well now , what will tomorrow bring? The last thing you need if you have some sort of condition is problems getting to the Best Dr.

[Avista]

I currently go to TVH and have been very impressed with the care. I have a very capable primary care physician, which is extremely important to me.
I've been reading all the comments about the downside of a UH Advantage plan... one of them being that you can't pick specialty care (like Shands or other facilities for cancer or heart-related care). Taking the cancer example, my understanding is that TVH is affiliated with some of the top cancer care institutions... MD Anderson (nationally-known as a leading cancer center) being one of them. I am impressed that they are affiliated with top-rated institutions. Also, many people say "with TVH, "you can't go to out of network physicians/facilities..." But - I know of at least one person who has received an exemption and has been referred to an "out of network" physician ... so... don't assume that you can't be referred to an out-of-network physician/facility if you go with UH-Advantage.
I've also heard people say that if you leave The Villages you won't be covered.... but I know that UH-Advantage offers a Passport plan, which allows members to receive covered services outside of TVH service area when traveling (or if you're a snowbird).
I would recommend, to make an informed decision, visit the Medicare Resource Center, meet with your insurance provider, contact a United Health Care Medicare Advantage advisor which are located in the town squares, meet with SHINE volunteers, and I would also recommend you consider signing up for an educational session at a TVH care center by calling (352) 674-8789.
Again... TVH isn't for everyone. But research your options and talk to the experts. Then make the right decision for you.

Agree. We've found this to be true.