The Villages Medicare Advantage Plan

[jensul619]

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

[jensul619]

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

[eremite06]

That's why I'm staying with regular Medicare and a supplement.

[Bogie Shooter]

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

https://www.talkofthevillages.com/forums/villages-florida-general-discussion-73/question-residents-who-have-lived-tv-least-2-5-years-214514/index12.html#post1321280

[Mudder]

I had/have a very different experience with VHC. I have what is considered a rare disorder which started a bout three years ago. My primary care doctor at VHC knew I needed to see a very special specialist. I got permission from United Health to go to Shands where I was correctly diagnosed, started treatment. About a year ago I was beyond their scope of knowledge, did a bit of research, found a doctor at Massachusetts General in Boston who is a worldwide known expert. She is now my doctor for this issue all covered by United Health Care using the Passport option. For a $15 copay I have the best care available and it all started with The Villages Health System and my primary care doctor employed there. That's the other side of the story!
Seek and ye shall find.

[JoMar]

As I read the OP, it seems the issue was a personal choice and had little to do with the plan. Her rant seems to be about her satisfaction (or lack of) with the surgeon. That is her option, and her plan gives her more options. But just because it doesn't serve her individual needs doesn't mean it won't work well for others. We all have choices, and not sure why the OP believes she can try and slant those choices. It might be a revalation, but we are all aduilts and are capable of making our own choices. Do your thing, and let the rest of us do ours.

[Happinow]

It is important to hear everyone's experiences with doctors and insurance she so that we can be as informed as possible, weather we agree or disagree. Please don't knock the OP's information. Someone may find it valuable when making their healthcare and/or Dr. decision.

[Mrs. Robinson]

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

[Miles42]

Ours is one big horror story. Run away don't look back. It would take pages for me to tell you how much run around this system has given us on our first year. Will be changing.

[Villageswimmer]

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


Thank you for sharing your story with us. I hope you are doing well now.

[jarm450@aol.com]

Our story has a different twist to it. Our friends are snowbirds and spend roughly half their time in Michigan and half time in TV. He is a retired educator and is insured through a BCBS Advantage PPO. They have had this insurance for years and it has always served their needs well wherever they have sought care. Recently he had emergency triple bypass surgery. He started in TV hospital and than was transferred to Leesburg for the surgery. He received good care in both hospitals. Where everything broke down was when he needed a skilled care facility for physical therapy when he was being transferred from the hospital. None of the facilities in TV would take him because of his insurance. The absolute worst was Freedom Pointe. My wife and I went there to speak with one of their coordinators and were treated in a rude and condescending manner. We were told that while they have a contract with BCBS they essentially do not accept anyone with the insurance. The Club was the same. The Villages Facility on 466 were very nice but than we learned that they have 100 beds for medicare but only 15 for insurance. The interesting part of this story is our friend was readily accepted in a Leesburg facility that ironically is also owned by Brookdale which owns Freedom Pointe. We also learned that the Club which will not accept BCBS is owned by the same company that owns the Lady Lake facility which does accept BCBS. It causes us to question whether TV has some type of agreement with facilities on their property that force the use of United Health. The whole thing stinks.

[784caroline]

With all the changes occurring in the Village Health Care (VHC) system, I predict there will be more changes to come ...... most likely a buy-out by some large group that will take over the VHC patient workload......who will then again change the paramaters under which it will work. Anyone here in TV long enough to see what happened starting with the Moffet Center Relationship will understand VHC does not have a good track record.

[NYGUY]

With all the changes occurring in the Village Health Care (VHC) system, I predict there will be more changes to come ...... most likely a buy-out by some large group that will take over the VHC patient workload......who will then again change the paramaters under which it will work. Anyone here in TV long enough to see what happened starting with the Moffet Center Relationship will understand VHC does not have a good track record.

And I have speculated that the buyer might be United Healthcare (they may already have a partial ownership interest).

[JoMar]

It is important to hear everyone's experiences with doctors and insurance she so that we can be as informed as possible, weather we agree or disagree. Please don't knock the OP's information. Someone may find it valuable when making their healthcare and/or Dr. decision.

Many of the experiences are rants based on specific situation and we have no view of the other sides opinion or any other facts to support any poster. Who would make a decision just based on some persons personal opinion....on something as serious as health care? Many have left for fear of change, many have left because it just isn't what I had up north and some have left because they love to live here but hate the fact that the Developer is making money or that decisions are economically based. No one is forcing anyone to use the healthcare system but it seems there is a core that finds it important to take the negative side whenever someone doesn't agree with what they believe to be "what it should be". End of rant.

[golfing eagles]

Many of the experiences are rants based on specific situation and we have no view of the other sides opinion or any other facts to support any poster. Who would make a decision just based on some persons personal opinion....on something as serious as health care? Many have left for fear of change, many have left because it just isn't what I had up north and some have left because they love to live here but hate the fact that the Developer is making money or that decisions are economically based. No one is forcing anyone to use the healthcare system but it seems there is a core that finds it important to take the negative side whenever someone doesn't agree with what they believe to be "what it should be". End of rant.

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

[CFrance]

Agree with rant. My best advice is to either talk with SHINE or the UHC rep at the health centers. TOTV has nothing but anecdotal horror stories that MAY or MAY NOT have been different elsewhere. Also, about 2/3 of the perceptions of the Advantage plan is just plain wrong. People are worried about restricting their choice of specialists/hospitals. For example, it is true, if you have traditional medicare with a supp, you can go to 99.9% of the providers in Central Florida. With the Advantage plan you can only go to 98% of them---but if you have an unusual situation you can get covered for the other 1.9%. So get the facts from a reliable source before hunting for greener grass.
But I don't want 98% of the providers in Central Florida. I want the ability to access providers anywhere in the country. That's why we have a supplement as opposed to an advantage plan. If I get a rare disease, I want to go where the knowledge is and not have to jump through hoops to get there. I know how you feel about research/teaching centers, GE, but we feel differently for various reasons I won't go into for fear of being accused of giving opinion based on just anecdotal information!

[villagerjack]

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

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

[golfing eagles]

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

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

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

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

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

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

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

[Avista]

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

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

[raynan]

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

[Villageswimmer]

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


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

[arickis]

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

[Leisha2]

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

[2BNTV]

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

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

MA plans are geared toward people who are basically healthy.

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

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

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

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

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

[Nucky]

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

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

MA plans are geared toward people who are basically healthy.

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

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

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

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

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

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

[rivaridger1]

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

[villagetinker]

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

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

[JoMar]

But changes are acoming...lol

[2BNTV]

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

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

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

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

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

[Villages Kahuna]

I posted a thread yesterday about my experience with the Villages health but it doesn't seem to be showing anywhere I can find it
My husband and I are two of the 15,000 residents whose health insurance will be cancelled on 1/1/17 unless we switch to a UHC Medicare advantage plan, preferably the one the Villages is advertising everywhere.
We have original Medicare and a supplement which work very well for us. The VHC is much less expensive and provides good care, IF AND ONLY IF YOU ARE HEALTHY, which we were. We both had no serious health issues but because of our ages mid seventies), we should stay with Medicare and the supplement we had. We found a new primary care doctor outside of the Villages in early September.
THANK GOD WE DID. In mid October I was diagnosed with invasive breast cancer and saw a surgeon here in the Villages who I was not at all impressed with. I ended up having the surgery at Moffitt Cancer Center in Tampa where the care was absolutely wonderful. If I had stayed with the VHC, Moffitt is considered "out of network" and my surgery would not have been covered. So, thank you for dropping us. When I see the full page newspaper ads and receive flyers in the mailbox saying how wonderful the insurance is, I get so angry and want to tell the world that no, it is only wonderful if you have NO health issues. My advice is to please please choose very carefully.
I hope this helps anyone who is trying to decide what to do.My wife and I were also dropped by Villages Health. My consideration of their Medicare Advantage Plan was a non-starter. I have multiple artificial joints and non of the orthopedic surgeons in their network would do "revisions" to existing artificial joints. I would have had to find a surgeon, probably in Orlando, and then pay 100% of the cost of the suirgery myself!

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

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

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

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

[Boomer]

For those who already have Plan F as a supplement to traditional Medicare, you are probably aware that as of January 2020, Plan F is going away -- except for those who are already enrolled who will be grandfathered. (But who knows really, considering the political climate with more and more talk of privatizing Medicare.)

If Medicare ends up being privatized, that would mean that insurance companies will then be holding allllllllll the cards in this game. Insurance companies and Big Pharma are powerful DC lobbies so nothing would surprise me.

As I read about The Villages "My Way Or Highway Plan" (that big surprise to many, including those who had been told they were grandfathered) I have to wonder if this situation is a bit of a hint of what total privatization would feel like. Choices gone. Insurance companies in total control of what to do with all us aging, often expensive people. Yep. Insurance companies holding all the cards in the game..........Seeya on the ice floes.

Oh, and, btw, UNH is the symbol for United Healthcare stock. During 2016 UNH has gone up more than 35%, closing yesterday at very near its 52-week high.

Why doesn't anybody ever talk about the stockholder and CEO who own a piece of us and get paid before our doctors do?

Now, before somebody comes in here and calls me a commie pinko, let me make clear that I most certainly have absolutely no problem with opportunities offered by investing in stocks.........Telecom........Toothpaste.......... Tape.........and others, but............about that 35% leap UNH took this year? I am glad I do not own a piece of healthcare stocks..........because I do not want to own a piece of you.

A long time ago I heard a quote but I don't know who said it. I have seen it come true too many times in our economic history.........

"Unrestrained greed is not only bad morals, it's bad economics."

The word "unrestrained" says it all.

Boomer Cassandra

[golfing eagles]

For those who already have Plan F as a supplement to traditional Medicare, you are probably aware that as of January 2020, Plan F is going away -- except for those who are already enrolled who will be grandfathered. (But who knows really, considering the political climate with more and more talk of privatizing Medicare.)

If Medicare ends up being privatized, that would mean that insurance companies will then be holding allllllllll the cards in this game. Insurance companies and Big Pharma are powerful DC lobbies so nothing would surprise me.

As I read about The Villages "My Way Or Highway Plan" (that big surprise to many, including those who had been told they were grandfathered) I have to wonder if this situation is a bit of a hint of what total privatization would feel like. Choices gone. Insurance companies in charge of what to do with all us aging, often expensive people. Yep. Insurance companies holding all the cards in the game..........Seeya on the ice floes.

Oh, and, btw, UNH is the symbol for United Healthcare stock. During 2016 UNH has gone up more than 35%, closing yesterday at very near its 52-week high.

Why doesn't anybody ever talk about the stockholder and CEO who own a piece of us and get paid before our doctors do?

Now, before somebody comes in here and calls me a commie pinko, let me make clear that I most certainly have absolutely no problem with opportunities offered by investing in stocks.........Telecom........Toothpaste.......... Tape.........and others, but............about that 35% leap UNH took this year? I am glad I do not own a piece of healthcare stocks..........because I do not want to own a piece of you.

A long time ago I heard a quote but I don't know who said it. I have seen it come true too many times in our economic history.........

"Unrestarained greed is not only bad morals, it's bad economics."

The word "unrestrained" says it all.

Boomer Cassandra

Not sure what your point is----hundreds upon hundreds of stocks from all different sectors have gone up 35+% to 52 week highs this year. I hope you
don't think their stock price has anything to do with what happened at TVH.

I said most of my musings in posts #16 and #19----but I want to repeat that people should get their info FROM THE SOURCE--speak with SHINE or the UHC rep, do not rely on this thread which is sorry to say way off the mark.

One post from a gentleman whose comments I have come to respect greatly was way off target. He implied TV UHC MA plan is restricted to a very small number of local doctors---when there are 20,000 Florida physicians in network. Also, while Shands and Moffit are not in network, MD Anderson in Orlando most certainly is. Anyone can just go to the UHC website and check it out. There are orthopaedists in network that do joint replacement revisions, there are quality urologists, and again, if there is a demonstrated NEED (NOT WANT) for an out of network physician, it will generally be approved---in 30 years I never had that request denied for a patient.

[Boomer]

For those who already have Plan F as a supplement to traditional Medicare, you are probably aware that as of January 2020, Plan F is going away -- except for those who are already enrolled who will be grandfathered. (But who knows really, considering the political climate with more and more talk of privatizing Medicare.)

If Medicare ends up being privatized, that would mean that insurance companies will then be holding allllllllll the cards in this game. Insurance companies and Big Pharma are powerful DC lobbies so nothing would surprise me.

As I read about The Villages "My Way Or Highway Plan" (that big surprise to many, including those who had been told they were grandfathered) I have to wonder if this situation is a bit of a hint of what total privatization would feel like. Choices gone. Insurance companies in total control of what to do with all us aging, often expensive people. Yep. Insurance companies holding all the cards in the game..........Seeya on the ice floes.

Oh, and, btw, UNH is the symbol for United Healthcare stock. During 2016 UNH has gone up more than 35%, closing yesterday at very near its 52-week high.

Why doesn't anybody ever talk about the stockholder and CEO who own a piece of us and get paid before our doctors do?

Now, before somebody comes in here and calls me a commie pinko, let me make clear that I most certainly have absolutely no problem with opportunities offered by investing in stocks.........Telecom........Toothpaste.......... Tape.........and others, but............about that 35% leap UNH took this year? I am glad I do not own a piece of healthcare stocks..........because I do not want to own a piece of you.

A long time ago I heard a quote but I don't know who said it. I have seen it come true too many times in our economic history.........

"Unrestrained greed is not only bad morals, it's bad economics."

The word "unrestrained" says it all.

Boomer Cassandra
- - - - -
Not sure what your point is----hundreds upon hundreds of stocks from all different sectors have gone up 35+% to 52 week highs this year. I hope you
don't think their stock price has anything to do with what happened at TVH.

I said most of my musings in posts #16 and #19----but I want to repeat that people should get their info FROM THE SOURCE--speak with SHINE or the UHC rep, do not rely on this thread which is sorry to say way off the mark.

One post from a gentleman whose comments I have come to respect greatly was way off target. He implied TV UHC MA plan is restricted to a very small number of local doctors---when there are 20,000 Florida physicians in network. Also, while Shands and Moffit are not in network, MD Anderson in Orlando most certainly is. Anyone can just go to the UHC website and check it out. There are orthopaedists in network that do joint replacement revisions, there are quality urologists, and again, if there is a demonstrated NEED (NOT WANT) for an out of network physician, it will generally be approved---in 30 years I never had that request denied for a patient.

----
Oh my! GE, have I been dismissed? (I can't find that little thingy that rolls on the floor laughing or I would put it in this spot.)

It might surprise you to know that this woman knows very well what the stock market has been doing. geez I just happen to believe in picking and choosing for various reasons. Mine.

As far as your not understanding my point..........I have great concerns over the potential we are facing for total privatization of Medicare. And I think what has happened in TV is a bit of a taste of total privatization. UNH is making lots of money and if Medicare is privatized, profits will know no limits. And who will pay for that. (rhetorical question) Thus, my opinion piece above.

I was involved in contract talks for many years and saw what happened to our benefits costs. For instance, the drug card was a Trojan Horse. As soon as everybody was out there clutching plastic instead of collecting receipts to send eventually to the insurance company for reimbursement, drug prices skyrocketed because nobody was watching. All they could see was the convenience of that card. Ironically, when my people were clamoring for the card, in the early 90s, I told them we would be sorry, but they did not believe me. I do not think it is a good plan for the sheep to welcome the wolf to guard them, to be completely in charge of the flocking.

GE, I would love to have a real life discussion with you about all this. Seriously. I am not back there behind Door Number 2 yet but when this abominable snowbird gets there, maybe I will show up at Crispers or something. -- Do not take offense that I am not put in my place. When I say I would welcome a real discussion, I mean that. I think it would be fun and each of us could learn something. But, for now, I better go Christmas shopping.

I remain, Boomer Cassandra

[golfing eagles]

- - - - -


----
Oh my! GE, have I been dismissed? (I can't find that little thingy that rolls on the floor laughing or I would put it in this spot.)

It might surprise you to know that this woman knows very well what the stock market has been doing. geez I just happen to believe in picking and choosing for various reasons. Mine.

As far as your not understanding my point..........I have great concerns over the potential we are facing for total privatization of Medicare. And I think what has happened in TV is a bit of a taste of total privatization. UNH is making lots of money and if Medicare is privatized, profits will know no limits. And who will pay for that. (rhetorical question) Thus, my opinion piece above.

I was involved in contract talks for many years and saw what happened to our benefits costs. For instance, the drug card was a Trojan Horse. As soon as everybody was out there clutching plastic instead of collecting receipts to send eventually to the insurance company for reimbursement, drug prices skyrocketed because nobody was watching. All they could see was the convenience of that card. Ironically, when my people were clamoring for the card, in the early 90s, I told them we would be sorry, but they did not believe me. I do not think it is a good plan for the sheep to welcome the wolf to guard them, to be completely in charge of the flocking.

GE, I would love to have a real life discussion with you about all this. Seriously. I am not back there behind Door Number 2 yet but when this abominable snowbird gets there, maybe I will show up at Crispers or something. -- Do not take offense that I am not put in my place. When I say I would welcome a real discussion, I mean that. I think it would be fun and each of us could learn something. But, for now, I better go Christmas shopping.

I remain, Boomer Cassandra

Wasn't trying to "dis" you at all, and I'm certainly not trying to put anyone "in their place". I thought you had very valid points on privatization. And you may very well know more about the stock market than I do. I poorly worded the concept that a stock price and company policy often does not correlate. Sorry.
My main point was really that people need to get first hand info---the ideas about the UHC MA plan floating around on this thread range from incorrect to bizarre.

[NYGUY]

....Also, while Shands and Moffit are not in network, MD Anderson in Orlando most certainly is.

I believe Orlando Health replaced MD Anderson with UF Health awhile back.

[golfing eagles]

I believe Orlando Health replaced MD Anderson with UF Health awhile back.

I don't know. All I can say is I ran MD Anderson thru the UHC MA website under "Am I covered" a few hours ago and it came up yes.

[NYGUY]

I don't know. All I can say is I ran MD Anderson thru the UHC MA website under "Am I covered" a few hours ago and it came up yes.

Well lets see....does anyone know if MD Anderson is still in Orlando?

[golfing eagles]

Well lets see....does anyone know if MD Anderson is still in Orlando?

You never know---sometimes websites have out of date info, seen it before, will see it again.......

[paulascorpio]

My husband and I were on UHA through The Villages starting January of last year. Great not having to pay anything. We were originally on Medicare with a plan F supplement but switched to the UA plan. Then in July last year he developed Multiple Myeloma. Within 4 weeks, we incurred $16,500 additional cost of co-pay bills. We immediately switched back to Medicare and a Plan F supplement as we were allowed to switch back within the year. The only bills incurred with his cancer from that point on, were those while on United.
I am so grateful that we were able to switch back.

[rivaridger1]

Wasn't trying to "dis" you at all, and I'm certainly not trying to put anyone "in their place". I thought you had very valid points on privatization. And you may very well know more about the stock market than I do. I poorly worded the concept that a stock price and company policy often does not correlate. Sorry.
My main point was really that people need to get first hand info---the ideas about the UHC MA plan floating around on this thread range from incorrect to bizarre.

1. The Villages United Healthcare Advantage Plan is best for younger healthy seniors. The docs associated with The Village Healthcare system want to practice preventive medicine. Just read the material in the local paper every Sunday and that will tell what they are emphasizing.
2. Once you are in an Advantage plan the insurance company has the opportunity once a year to change the provider network and thus exclude access to expensive specialized care. The decisions to do this will be governed by the overall profits being generated under the plan.
3. If you get seriously ill and need very specialized services outside the Advantage provider network and as a result need to change back to Medicare and a Supplement policy, coverage can be denied and/or re-priced. If re-priced, the premium is whatever the for-profit insurer decides to charge. Whether you can afford it or not is not an issue.
4.No one in The Villages is getting any younger. All of us our going to pass on to join our ancestors. When we do from a medical perspective it will probably be something quite medically expensive to deal with that kills us.
5. The Villages Healthcare Advantage Plan is provided by the largest for-profit insurance company in the United States. The people that run it are not dumb and will do whatever is necessary in the future to assure its continued profitability including restrictions to network access if it such a change is needed.
6.Your red, white and blue Medicare Card and a Supplement policy to go with it are equal in value to a vault filled with gold bars when you are seriously ill. Some day, no matter what you do from a preventative standpoint, you are going to be seriously ill.
7. A lot of people are risk takers and prefer to put every available savings in their pockets when available. That is fine, but the old adage of penny wise and pound foolish might have some application when evaluating Medicare Advantage Plans.

[golfing eagles]

My husband and I were on UHA through The Villages starting January of last year. Great not having to pay anything. We were originally on Medicare with a plan F supplement but switched to the UA plan. Then in July last year he developed Multiple Myeloma. Within 4 weeks, we incurred $16,500 additional cost of co-pay bills. We immediately switched back to Medicare and a Plan F supplement as we were allowed to switch back within the year. The only bills incurred with his cancer from that point on, were those while on United.
I am so grateful that we were able to switch back.

Having just switched to UHC MA from Plan F, could you please elaborate on just how this happens? The max out of pocket expense on option 1 is $4400/yr. and $1900/yr. on option 2, exclusive of drug cost, which is identical to plan F. There are co-pays on MA, but they are $15 and $30 in general, so $16,500 in 4 weeks is unlikely in co-pays. Did you include the cost of very expensive tier 5 drugs that you received in the first 4 weeks, in which case the cost would have been the same on plan F? Did the cost of drugs push you into the catastrophic phase and therefore the main cost fell on the MA plan? Was there a bone marrow transplant in the first 4 weeks? And finally, did you choose to utilize an out of network provider without prior approval? Since the formulary and terms of coverage are virtually identical in the 2 plans, the main difference is the network restriction.

[golfing eagles]

1. The Villages United Healthcare Advantage Plan is best for younger healthy seniors. The docs associated with The Village Healthcare system want to practice preventive medicine. Just read the material in the local paper every Sunday and that will tell what they are emphasizing.
2. Once you are in an Advantage plan the insurance company has the opportunity once a year to change the provider network and thus exclude access to expensive specialized care. The decisions to do this will be governed by the overall profits being generated under the plan.
3. If you get seriously ill and need very specialized services outside the Advantage provider network and as a result need to change back to Medicare and a Supplement policy, coverage can be denied and/or re-priced. If re-priced, the premium is whatever the for-profit insurer decides to charge. Whether you can afford it or not is not an issue.
4.No one in The Villages is getting any younger. All of us our going to pass on to join our ancestors. When we do from a medical perspective it will probably be something quite medically expensive to deal with that kills us.
5. The Villages Healthcare Advantage Plan is provided by the largest for-profit insurance company in the United States. The people that run it are not dumb and will do whatever is necessary in the future to assure its continued profitability including restrictions to network access if it such a change is needed.
6.Your red, white and blue Medicare Card and a Supplement policy to go with it are equal in value to a vault filled with gold bars when you are seriously ill. Some day, no matter what you do from a preventative standpoint, you are going to be seriously ill.
7. A lot of people are risk takers and prefer to put every available savings in their pockets when available. That is fine, but the old adage of penny wise and pound foolish might have some application when evaluating Medicare Advantage Plans.

No offense, but I'd really like to know the basis upon which you came up with these 7 "talking points"

1. Don't you think "preventative medicine" benefits older seniors as well? Even the government concurs with this, hence all their chronic care management, Optum QA criteria and PQRI initiatives. Like most physicians, the doctors of TVH are well trained in treating chronic and serious illness, in fact, it is the preventative medicine issues that in general are newer to us.

2. The provider network can, and frequently does change somewhat every year in ALL insurance plans. The insurance company can decide to drop certain providers, and the providers can opt out of participation in an insurance plan, just as patients have the option to change insurers. So what. Most of the insurers changes are QA driven, profit being a secondary motive in that decision.

3. True, AFTER the first year it is harder to change back to supplemental policy, there may be underwriting criteria and there may be a premium increase--but it's not "whatever they want to charge". But why would someone really need to change back? If you get "seriously ill" , there are more than enough in network physicians to treat you. If you have a NEED for care that cannot be provided in network, 99.5% of the time the insurer will approve the out of network provider. The main problem is when someone WANTS, not NEEDS out of network care, with exception of certain states such as California

4. Yes, we will all die, and yes the bill can be expensive. What is your point---it is the coverage that counts, not the raw bill, and your exposure is limited under either plan

5. Aha! Now we come to the crux of your philosophy---you used that most vulgar word to the far left---PROFIT. Of course, when it comes to health care administration, insurers "profits" are far, far less than government waste. As far as single payer government health insurance goes, I'll take a pass on VA medicine for all.

6. Actually, your Medicare card and supplement will probably COST the average patient about $2000/yr. MORE than the MA plan. If you are seriously ill, it may save you a few thousand. IF you CHOOSE to go out of network without approval, then it will save you a fortune, but then that would be on you, not the insurer.

7. I agree with that adage, but if you look at the plans it detail, you will find it does not apply here.

[OCsun]

1. The Villages United Healthcare Advantage Plan is best for younger healthy seniors. The docs associated with The Village Healthcare system want to practice preventive medicine. Just read the material in the local paper every Sunday and that will tell what they are emphasizing.
2. Once you are in an Advantage plan the insurance company has the opportunity once a year to change the provider network and thus exclude access to expensive specialized care. The decisions to do this will be governed by the overall profits being generated under the plan.
3. If you get seriously ill and need very specialized services outside the Advantage provider network and as a result need to change back to Medicare and a Supplement policy, coverage can be denied and/or re-priced. If re-priced, the premium is whatever the for-profit insurer decides to charge. Whether you can afford it or not is not an issue.
4.No one in The Villages is getting any younger. All of us our going to pass on to join our ancestors. When we do from a medical perspective it will probably be something quite medically expensive to deal with that kills us.
5. The Villages Healthcare Advantage Plan is provided by the largest for-profit insurance company in the United States. The people that run it are not dumb and will do whatever is necessary in the future to assure its continued profitability including restrictions to network access if it such a change is needed.
6.Your red, white and blue Medicare Card and a Supplement policy to go with it are equal in value to a vault filled with gold bars when you are seriously ill. Some day, no matter what you do from a preventative standpoint, you are going to be seriously ill.
7. A lot of people are risk takers and prefer to put every available savings in their pockets when available. That is fine, but the old adage of penny wise and pound foolish might have some application when evaluating Medicare Advantage Plans.

I agree!

[golfing eagles]

I agree!

Question remains---On what basis do you "agree".... I disagree, but have plenty of facts and experience for my opinion. You are certainly entitled to yours, but all I can suggest is to get the FACTS directly from a source---UHC or SHINE, after all, I could be wrong.......

[OCsun]

Question remains---On what basis do you "agree".... I disagree, but have plenty of facts and experience for my opinion. You are certainly entitled to yours, but all I can suggest is to get the FACTS directly from a source---UHC or SHINE, after all, I could be wrong.......

My opinion is right for me based on my personal experience and of course, as you pointed out, your opinion is right for you based on your experience. Shine is an excellent point to start a search for health insurance details if, you have no health insurance knowledge. UHC representatives will only help you to understand how their product can work for you.

Please don't take my opinion personally. It is just my opinion.

[collie1228]

I have a Medicare Advantage plan through Care Plus, and I'm very satisfied with it. I told my primary care physician that I was pleased with the plan, and he said "You should be pleased with it, you're very healthy." He told me that people with serious health issues would find major restrictions on their healthcare choices in any Medicare Advantage plan. His advice to me was to continue with Care Plus, but if any health issues should arise, change to original Medicare with a supplement plan at the next annual enrollment period. For me, I think that was good advice.

[villagetinker]

I have a Medicare Advantage plan through Care Plus, and I'm very satisfied with it. I told my primary care physician that I was pleased with the plan, and he said "You should be pleased with it, you're very healthy." He told me that people with serious health issues would find major restrictions on their healthcare choices in any Medicare Advantage plan. His advice to me was to continue with Care Plus, but if any health issues should arise, change to original Medicare with a supplement plan at the next annual enrollment period. For me, I think that was good advice.

Having gone through the process (MA back to Medicare and supplement), you may be in for a shock. We got lucky and were able to change back during the first year with no penalty, however this is what was told to me: (if you want to go back to Medicare)
1. You may/will be subjected to health questions.
2. Based on your answers to the above questions, you may/will be denied coverage for a period of time for specific health issues, or subjected to higher premiums (both Medicare and supplemental).
3. I do not recall if you could be completely denied getting back to Medicare based on the above questions.

If you are considering this, I would call Medicare ( and or SHINE) and get info specific for your situation.

Also, ALL of this is subject to major changes with the new administration after January 20th.......

The above information is over 1 year old, and things may have changed.

[rivaridger1]

No offense, but I'd really like to know the basis upon which you came up with these 7 "talking points"

1. Don't you think "preventative medicine" benefits older seniors as well? Even the government concurs with this, hence all their chronic care management, Optum QA criteria and PQRI initiatives. Like most physicians, the doctors of TVH are well trained in treating chronic and serious illness, in fact, it is the preventative medicine issues that in general are newer to us.

2. The provider network can, and frequently does change somewhat every year in ALL insurance plans. The insurance company can decide to drop certain providers, and the providers can opt out of participation in an insurance plan, just as patients have the option to change insurers. So what. Most of the insurers changes are QA driven, profit being a secondary motive in that decision.

3. True, AFTER the first year it is harder to change back to supplemental policy, there may be underwriting criteria and there may be a premium increase--but it's not "whatever they want to charge". But why would someone really need to change back? If you get "seriously ill" , there are more than enough in network physicians to treat you. If you have a NEED for care that cannot be provided in network, 99.5% of the time the insurer will approve the out of network provider. The main problem is when someone WANTS, not NEEDS out of network care, with exception of certain states such as California

4. Yes, we will all die, and yes the bill can be expensive. What is your point---it is the coverage that counts, not the raw bill, and your exposure is limited under either plan

5. Aha! Now we come to the crux of your philosophy---you used that most vulgar word to the far left---PROFIT. Of course, when it comes to health care administration, insurers "profits" are far, far less than government waste. As far as single payer government health insurance goes, I'll take a pass on VA medicine for all.

6. Actually, your Medicare card and supplement will probably COST the average patient about $2000/yr. MORE than the MA plan. If you are seriously ill, it may save you a few thousand. IF you CHOOSE to go out of network without approval, then it will save you a fortune, but then that would be on you, not the insurer.

7. I agree with that adage, but if you look at the plans it detail, you will find it does not apply here.

I really do not understand the thrust of the question. They are talking points and relate to the subject at hand. What does " basis " have to do with it ? They either are factual representations or falsehoods. If falsehoods, go on record and correct them. I will not be offended.

1. I think preventative medicine has a prominent place in healthcare and do not think I intimated otherwise. I merely offered an opinion to the effect The Villages Healthcare system is emphasizing same in conjunction with its efforts to attract young healthy seniors to sign up for its Advantage product. This statement was intended as an opening for the rest of my post. Everything you added was absolutely correct but I saw no need to provider a " primer " to define " preventative medicine ".

2. Here I do think you are incorrect. The provider network provided by Medicare is all encompassing and probably includes 99 % of all physicians practicing clinical medicine in the United States and pretty much with few exceptions most medical institutions of note. The institutions opting out can agree however to except the Medicare reimbursement scheme voluntarily and many do so. Physicians can opt out but most that do are mental healthcare specialists. It is estimated that 42% of them have done so. Furthermore, any insurance company which provides Medicare Supplement policies must honor the claims of any medical service provider if Medicare has first paid the claim.

Medicare Advantage insurers on the other hand can as you indicated change their provider networks once each year. Medicare Supplement insurers have no say in the matter. The " so what " comment minimizes the importance in some cases of maintaining a trusted doctor patient relationship.

3. Okay you got me. I obviously misspoke and any re-pricing does have to be approved buy the state insurance departments. I am still under the impression however that once you opt out of Medicare Supplement insurance the insurance company can refuse to take you back if they feel you are medically not insurable. Welcome to the world of paying 20% of your medical expenses just at the point in time you are hard pressed to afford them. There are a couple of other posts dealing with why you might want to go back on this thread and I think they stand for themselves. Do you really believe all medical care is equal ? Personally I want the best for both my loved ones and myself.

4. I thought the point was to continue the post. If you think it superfluous, so be it.

5.Ahem ! I do not think you got me. I was a senior manager of a very specialized commercial insurer ( nothing to do with health insurance ) that for a period of time was the most profitable insurer of its type in the entire world. I, like the people at United Healthcare, was not dumb and did everything in my power to maximize " profits ". I am not going to get into politics with you since this is not the place to do so, but you might be very surprised. The " crux of my philosophy " indeed ! And you did offend me!

6. To quote your post " If you are seriously ill, it may save you a few thousand ". My response is simply a few hundred thousand is the more likely outcome.

7. I'll stand by the adage and its application.

[Boomer]

Never mind. I took it out. (I have got to stop writing posts about insurance.)

But I do think there are lots of things to think about here in this thread. But I need to shut up now. I already said my piece.

[golfing eagles]

I really do not understand the thrust of the question. They are talking points and relate to the subject at hand. What does " basis " have to do with it ? They either are factual representations or falsehoods. If falsehoods, go on record and correct them. I will not be offended.

1. I think preventative medicine has a prominent place in healthcare and do not think I intimated otherwise. I merely offered an opinion to the effect The Villages Healthcare system is emphasizing same in conjunction with its efforts to attract young healthy seniors to sign up for its Advantage product. This statement was intended as an opening for the rest of my post. Everything you added was absolutely correct but I saw no need to provider a " primer " to define " preventative medicine ".

2. Here I do think you are incorrect. The provider network provided by Medicare is all encompassing and probably includes 99 % of all physicians practicing clinical medicine in the United States and pretty much with few exceptions most medical institutions of note. The institutions opting out can agree however to except the Medicare reimbursement scheme voluntarily and many do so. Physicians can opt out but most that do are mental healthcare specialists. It is estimated that 42% of them have done so. Furthermore, any insurance company which provides Medicare Supplement policies must honor the claims of any medical service provider if Medicare has first paid the claim.

Medicare Advantage insurers on the other hand can as you indicated change their provider networks once each year. Medicare Supplement insurers have no say in the matter. The " so what " comment minimizes the importance in some cases of maintaining a trusted doctor patient relationship.

3. Okay you got me. I obviously misspoke and any re-pricing does have to be approved buy the state insurance departments. I am still under the impression however that once you opt out of Medicare Supplement insurance the insurance company can refuse to take you back if they feel you are medically not insurable. Welcome to the world of paying 20% of your medical expenses just at the point in time you are hard pressed to afford them. There are a couple of other posts dealing with why you might want to go back on this thread and I think they stand for themselves. Do you really believe all medical care is equal ? Personally I want the best for both my loved ones and myself.

4. I thought the point was to continue the post. If you think it superfluous, so be it.

5.Ahem ! I do not think you got me. I was a senior manager of a very specialized commercial insurer ( nothing to do with health insurance ) that for a period of time was the most profitable insurer of its type in the entire world. I, like the people at United Healthcare, was not dumb and did everything in my power to maximize " profits ". I am not going to get into politics with you since this is not the place to do so, but you might be very surprised. The " crux of my philosophy " indeed ! And you did offend me!

6. To quote your post " If you are seriously ill, it may save you a few thousand ". My response is simply a few hundred thousand is the more likely outcome.

7. I'll stand by the adage and its application.


Actually, a good debate. I re-read my point 5 and I agree it was offensive. My only excuse is that after a year of campaigning by politicians advocating "free" health care, "free" college tuition, and "free" whatever (and sadly there are voters out there that are stupid enough to believe that anything is "free"), as well as telling us America is bad because of capitalism and corporations are bad because they make a profit I was oversensitive to the issue. My sincere apologies.

I still would like to know how anyone on the UHC MA plan can rack up hundreds of thousands of uncovered bills, UNLESS they CHOOSE to go out of network without prior approval.

[Viperguy]

Interesting thread. I have original Medicare with Tricare as a supplement. You are all correct that it is fantastic IF you can find the correct physicians and their staff can figure out how to bill Tricare. The issue finding medical care points you to the Medicare website which is WORTHLESS often out of date or the doctors no longer take Medicare, incorrect contact information, etc. I have resorted to word of mouth recommendations with various results, some good, some bad. A common thread is over crowding, poor administration and lousy scheduling procedures. One can count on showing up on time, waiting at least 30-45 minutes to be seen and only a few minutes with a physician or PA. We came from Colorado with Kaiser HMO and I was never delayed and billing was always correct to Tricare. Never payed a cent with a major surgery and follow up radiation. All the docs had my complete history and I could email each one or get refills of scripts over the phone. This place is in the dark ages. JMHO Just wondering if The Villages Health will take Tricare secondary and handle the bills??