Medicare Advantage Plans in Florida and The Villages?

[JWish]

We just moved to The Villages from another state, and I just started in Medicare in December. All was set up for the other state as original Medicare, as I had researched Medicare extensively and heard lots of negatives about Advantage plans.

We are now working with a local Medicare insurance broker in The Villages, who is telling us that Advantage plans are totally different in Florida than the rest of the country, and that Villages Health is a different and amazing care system than normal care providers.

Sounds too good to be true as we would save a significant amount of money on a Florida Advantage plan, but I don’t want to fall for a sales pitch and regret it later.

Is this a different animal in Florida? Any challenges finding providers around The Villages for Advantage Plans? Any challenges finding providers accepting new patients? Does the UHC Advantage Plan travel provision really work? I’m hesitant to voluntarily join an HMO, but maybe the PPO version would be a better fit for a skeptic.

Looking for real-world experiences with it, especially from those who have been on it awhile.

Thanks for any feedback!

[BrianL99]

We just moved to The Villages from another state, and I just started in Medicare in December. All was set up for the other state as original Medicare, as I had researched Medicare extensively and heard lots of negatives about Advantage plans.

We are now working with a local Medicare insurance broker in The Villages, who is telling us that Advantage plans are totally different in Florida than the rest of the country, and that Villages Health is a different and amazing care system than normal care providers.

Sounds too good to be true as we would save a significant amount of money on a Florida Advantage plan, but I don’t want to fall for a sales pitch and regret it later.

Is this a different animal in Florida? Any challenges finding providers around The Villages for Advantage Plans? Any challenges finding providers accepting new patients? Does the UHC Advantage Plan travel provision really work? I’m hesitant to voluntarily join an HMO, but maybe the PPO version would be a better fit for a skeptic.

Looking for real-world experiences with it, especially from those who have been on it awhile.

Thanks for any feedback!

Advantage plans are regulated by the government, just like every health care plan. They're the same all over the USA.

There are 1000's of posts on the subject, here on TOTV. Use the Search Tool and the keyword "Advantage" .... you'll be reading posts until early 2027.

[rjm1cc]

The advantage plans do different, just listen to the TV adv.
Look at this site and you can get free help in learning about the plans. SHINE - Home (https://www.floridashine.org/)

[Dotneko]

I recommend chatting with SHINE.
We have been here 5 years and had Medicare Advantage with absolutely no issues.
I have a wonderful PCP at Lake Deaton, get into specialists quickly, have every 8 week infusions at zero cost to me (they are billed at 13,000 dollars to MA). I am quite happy so
far. Interestingly, I have FloridaBlue MA and my husband has United Health MA - we wanted to do real life comparisons of them. His is a bit better for dental and quarterly things like aspirin and bandaids, but his health is luckily good so we havent tested big ticket stuff with them.

[villagetinker]

Second vote for SHINE, they helped us avoid a very costly mistake, and their information is UNBIASED.
One of the big problems we had was that the specialist we wanted to see did NOT accept the advantage plans that The Villages Health System required, now this was several years ago, some there may have been some changes.
Remember, advantage plans are MANAGED care they decide for you, traditional Medicare you have a lot more say in your care.

[Sabella]

Second vote for SHINE, they helped us avoid a very costly mistake, and their information is UNBIASED.
One of the big problems we had was that the specialist we wanted to see did NOT accept the advantage plans that The Villages Health System required, now this was several years ago, some there may have been some changes.
Remember, advantage plans are MANAGED care they decide for you, traditional Medicare you have a lot more say in your care.

I recently left an Aetna advantage plan PPO which was absolutely wonderful. There were no co-pays and It usually cost nothing. I went back to original Medicare because after doing research its not so wonderful - as you get older and you get sicker an advantage plan is gonna be limited as to what they will cover when compared to original Medicare. All the advantage plans are run by medical insurance companies with one objective to be extremely profitable and make more money.

[Blueblaze]

We tried Villages Health the first year. Not impressed. Severe doctor shortage and we needed months of notice to see a real doctor. Then they refused to admit me when their parking lot testing discovered that what I thought was allergies was actually Covid (for the 2nd time, after being vaccinated), and then refused to prescribe an antibiotic for the inevitable sinus infection (after I recovered from Covid a week later but took a month to test negative).

Our original doctor isn't even there anymore, anyway. But if you want to use them, no choice -- you have to get your insurance from United, which I also discovered when I switched to Humana the 2nd year, after both Humana and Villages told me they would be available, and then discovered that the greatly restricted HMO plan they accepted wasn't the PPO I'd chosen.

So the next year, we switched back to United and then couldn't find a real doctor in Villages Health who was taking new patients anywhere within a 45 minute drive from my home (even though there's a Villages Health clinic just outside my "village").

This year, I discovered Humana's "Give back" plans, which return $150/mo per patient of our Social Security check's medicare payments. The specialist copay is higher ($45), but for $300/month, I can afford to see a lot of specialists. However, the real reason I switched was that Moffit Cancer Center in Tampa is in-network, unlike any other advantage plan I looked at. Not that either of us have Cancer, but I had a scare a couple of years ago, and Moffit is one of the best in the country.

Whatever you do, be sure to select a PPO, not an HMO. If something goes wrong and you need to hire the best, you don't want to be stuck paying the whole thing out of your own pocket.

[rjm1cc]

I think the PPO suggestion is good. The question is what coverage do you have when you travel around the US.

[lpkruege1]

We just moved to The Villages from another state, and I just started in Medicare in December. All was set up for the other state as original Medicare, as I had researched Medicare extensively and heard lots of negatives about Advantage plans.

We are now working with a local Medicare insurance broker in The Villages, who is telling us that Advantage plans are totally different in Florida than the rest of the country, and that Villages Health is a different and amazing care system than normal care providers.

Sounds too good to be true as we would save a significant amount of money on a Florida Advantage plan, but I don’t want to fall for a sales pitch and regret it later.

Is this a different animal in Florida? Any challenges finding providers around The Villages for Advantage Plans? Any challenges finding providers accepting new patients? Does the UHC Advantage Plan travel provision really work? I’m hesitant to voluntarily join an HMO, but maybe the PPO version would be a better fit for a skeptic.

Looking for real-world experiences with it, especially from those who have been on it awhile.

Thanks for any feedback!

Watch the travel side of it. What's covered, where, at what percentage. Is international travel covered? Do you snow bird? I found most of my seasonal doctors were not on the plan. I went with a medigap policy. It cost me more a month but I get quality care from anyone excepting medicare. Just saying.

[Rzepecki]

SHINE - Home (https://www.floridashine.org/)
SHINE can help you find the plan that will work best for your needs. Unbiased information; they are not insurance agents.

[elle123]

I think the PPO suggestion is good. The question is what coverage do you have when you travel around the US.
To be precise it's Medicare "Disadvantage" not Advantage.🤑

[rsmurano]

Advantage plans are not governed by Medicare, far from it. Advantage plans suck, ran by insurance companies, and these companies will do anything they can to save money for themselves rather than give you care your dr prescribed.

Don’t believe me, then why doesn’t Medicare require authorization for a procedure but an advantage plan does? Because, close to 70% of the time an advantage plan will refuse doing the service your dr prescribed whereas Medicare doesn’t require authorization? Because when the insurance company refuses service they save money. Don’t believe me, google it and you will see Congress has been working on this fraudulent practice for many years. The insurance companies hope that the patient will get tired of fighting the insurance company and give up.

Google why hospitals are refusing patients with advantage plans. More and more hospitals are adding themselves to the list.

Go out and get a good supplement plan and you will get the work your dr requested without any headaches

[Ptmcbriz]

We have our Advantage plan through my husband’s retirement union in California. It’s Anthem Blue Cross Blue Shield Medicare Advantage. Even though it’s a California based plan it’s nationwide. The Villages Health bills Florida Anthem BCBS and they in turn bill California Anthem BCBS. We love it. We have never been turned down for anything and they have covered everything except very minimal copays ($5 office visit). So you can have Advantage plans from anywhere if they are Nationwide.

[Janie123]

We just moved to The Villages from another state, and I just started in Medicare in December. All was set up for the other state as original Medicare, as I had researched Medicare extensively and heard lots of negatives about Advantage plans.

We are now working with a local Medicare insurance broker in The Villages, who is telling us that Advantage plans are totally different in Florida than the rest of the country, and that Villages Health is a different and amazing care system than normal care providers.

Sounds too good to be true as we would save a significant amount of money on a Florida Advantage plan, but I don’t want to fall for a sales pitch and regret it later.

Is this a different animal in Florida? Any challenges finding providers around The Villages for Advantage Plans? Any challenges finding providers accepting new patients? Does the UHC Advantage Plan travel provision really work? I’m hesitant to voluntarily join an HMO, but maybe the PPO version would be a better fit for a skeptic.

Looking for real-world experiences with it, especially from those who have been on it awhile.

Thanks for any feedback!
I have not heard of any doctor or hospital no longer accepting a supplemental plan, but it seems like every year, hospitals and practices are dropping Advantage plans left and right. Currently the Mayo Clinic in Jax is not accepting any advantage plans and Moffitt in Tampa is not accepting certain advantage plans. We have a pancreatic cancer survivor via the Mayo Clinic. Treatment went from August thru April. I can’t imagine what we would have done when they stopped mid treatment.

The survivor was exceptionally healthy and one day, she got very bad indigestion, two days later, a tumor was found in her pancreas. Two weeks later chemo was started.

I will never roll the dice on healthcare. Today we both have a Cigna Supplemental G plan that is accepted everywhere.

[coleprice]

When turning 65 and signing up for Medicare, consider a Medicare SUPPLEMENT Plan G or Plan F rather than an Advantage Plan. Medicare Supplement plans cost more, but they are far more comprehensive. Plus, more Doctors accept Supplement Plans and they can save you money if you're hospitalized. For more information, check out medicare school.com or call them at 833-833-3661.

[biker1]

Plan F has an eligibility requirement date of Jan 1, 2020. Someone turning 65 now, will not be eligible.

When turning 65 and signing up for Medicare, consider a Medicare SUPPLEMENT Plan G or Plan F rather than an Advantage Plan. Medicare Supplement plans cost more, but they are far more comprehensive. Plus, more Doctors accept Supplement Plans and they can save you money if you're hospitalized. For more information, check out medicare school.com or call them at 833-833-3661.

[lawgolfer]

We just moved to The Villages from another state, and I just started in Medicare in December. All was set up for the other state as original Medicare, as I had researched Medicare extensively and heard lots of negatives about Advantage plans.

We are now working with a local Medicare insurance broker in The Villages, who is telling us that Advantage plans are totally different in Florida than the rest of the country, and that Villages Health is a different and amazing care system than normal care providers.

Sounds too good to be true as we would save a significant amount of money on a Florida Advantage plan, but I don’t want to fall for a sales pitch and regret it later.

Is this a different animal in Florida? Any challenges finding providers around The Villages for Advantage Plans? Any challenges finding providers accepting new patients? Does the UHC Advantage Plan travel provision really work? I’m hesitant to voluntarily join an HMO, but maybe the PPO version would be a better fit for a skeptic.

Looking for real-world experiences with it, especially from those who have been on it awhile.

Thanks for any feedback!

The "freebies" from an Advantage Plan are not worth the hassle and danger of not being able to easily go to a doctor outside the Plan. We have a friend who was diagnosed with an aggressive cancer. The next day she flew to Houston, checked into M D Anderson, and has been there for two months with Medicare and United Health paying the bills. She could never have done that in an Advantage Plan.

[TVTVTV]

We just moved to The Villages from another state, and I just started in Medicare in December. All was set up for the other state as original Medicare, as I had researched Medicare extensively and heard lots of negatives about Advantage plans.

We are now working with a local Medicare insurance broker in The Villages, who is telling us that Advantage plans are totally different in Florida than the rest of the country, and that Villages Health is a different and amazing care system than normal care providers.

Sounds too good to be true as we would save a significant amount of money on a Florida Advantage plan, but I don’t want to fall for a sales pitch and regret it later.

Is this a different animal in Florida? Any challenges finding providers around The Villages for Advantage Plans? Any challenges finding providers accepting new patients? Does the UHC Advantage Plan travel provision really work? I’m hesitant to voluntarily join an HMO, but maybe the PPO version would be a better fit for a skeptic.

Looking for real-world experiences with it, especially from those who have been on it awhile.

Thanks for any feedback!

Don't fall for it. You can always change later, but stay with original Medicare now. It is too good to be true. Lots of interpretation between the lines.

[MX rider]

We've been on UHC Advantage since we retired and are happy with it. We use all the wellness benefits they offer, as well as the vision and dental.
Yes, UHC Advantage plans differ by state and even by county, although not a lot.

We were on it in Indiana but switched to The Villages UHC Advantage when we moved here last year. We like The Villages Health system and had no problem getting a PCP. Appointments are easy to get since they limit how many patients a doctor can have, and only take MA plans. So we never sit in the waiting room more than 15 minutes before we get called back. Take a tour of their facility. They have them all throughout The Villages.

MA plans are a good option, over 50% of new enrollees choose them. But it's not a one size fits all as some like to make you think. For some, regular Medicare is the best way to go.

Not all MA plans are the same, some are better than others. Do your research, check the ratings and as others have said, talk to SHINE.
SHINE told us Medicare Advantage was a very good option for us.

No, not every single hospital or doctor takes UHC MA. But we did our research, and many excellent hospitals do take it, including UF Shands and Advent Health in Orlando.

[MX rider]

The "freebies" from an Advantage Plan are not worth the hassle and danger of not being able to easily go to a doctor outside the Plan. We have a friend who was diagnosed with an aggressive cancer. The next day she flew to Houston, checked into M D Anderson, and has been there for two months with Medicare and United Health paying the bills. She could never have done that in an Advantage Plan.

Thats not true!
With UHC MA we can go to any hospital that takes UHC Advantage anywhere in the country. But there are some that don't take it.

We did our research, and even though we're healthy we checked around and found many highly rated cancer centers in Florida and Indiana (our home state) that take UHC MA.

[RoboVil]

We just moved to The Villages from another state, and I just started in Medicare in December. All was set up for the other state as original Medicare, as I had researched Medicare extensively and heard lots of negatives about Advantage plans.

We are now working with a local Medicare insurance broker in The Villages, who is telling us that Advantage plans are totally different in Florida than the rest of the country, and that Villages Health is a different and amazing care system than normal care providers.

Sounds too good to be true as we would save a significant amount of money on a Florida Advantage plan, but I don’t want to fall for a sales pitch and regret it later.

Is this a different animal in Florida? Any challenges finding providers around The Villages for Advantage Plans? Any challenges finding providers accepting new patients? Does the UHC Advantage Plan travel provision really work? I’m hesitant to voluntarily join an HMO, but maybe the PPO version would be a better fit for a skeptic.

Looking for real-world experiences with it, especially from those who have been on it awhile.

Thanks for any feedback!

A lot of discussion on this. And while I cannot speak of any specific Medicare Advantage plan, I can tell you that at MD Anderson they really like it when you have regular Medicare. No prior authorizations, just get started on therapy ASAP. Similarly, I met a woman with a Medicare Advantage plan from Arkansas who was in the middle of chemo and received a notification that her Medicare Advantage plan was dropping MD Anderson and she had no idea what she was going to do. It is probably just a negotiating tactic, but it was causing her real stress. If you travel regularly back and forth across the US you may be out of network from an Advantage plan. The benefit of an Advantage plan they are less expensive up front, the risk of an Advantage plan is that it is an insurance company whose main goal is to make a profit. Also, one important point. If you go with an Advantage plan, it is almost impossible to go back to Regular Medicare.

[mraines]

We have our Advantage plan through my husband’s retirement union in California. It’s Anthem Blue Cross Blue Shield Medicare Advantage. Even though it’s a California based plan it’s nationwide. The Villages Health bills Florida Anthem BCBS and they in turn bill California Anthem BCBS. We love it. We have never been turned down for anything and they have covered everything except very minimal copays ($5 office visit). So you can have Advantage plans from anywhere if they are Nationwide.
I have this plan as well and have not had any problems. Just curious, I have mine through MPIP (IATSE). What union was your husband in?

[biker1]

The short version is you can switch during the one year trial period when you first become eligible for Medicare. After that, you can switch but will typically have to go through underwriting for a Supplemental Plan. If you have health issues, you may not be able to obtain a Supplemental Plan.

A lot of discussion on this. And while I cannot speak of any specific Medicare Advantage plan, I can tell you that at MD Anderson they really like it when you have regular Medicare. No prior authorizations, just get started on therapy ASAP. Similarly, I met a woman with a Medicare Advantage plan from Arkansas who was in the middle of chemo and received a notification that her Medicare Advantage plan was dropping MD Anderson and she had no idea what she was going to do. It is probably just a negotiating tactic, but it was causing her real stress. If you travel regularly back and forth across the US you may be out of network from an Advantage plan. The benefit of an Advantage plan they are less expensive up front, the risk of an Advantage plan is that it is an insurance company whose main goal is to make a profit. Also, one important point. If you go with an Advantage plan, it is almost impossible to go back to Regular Medicare.

[gwenhwalker@yahoo.com]

I have had UHC since I moved here 10 yrs ago. Wonderful doctor. Always seen by someone same day if medical issue comes up in between 6 month visits. No copay unless specialist. No complaints

[Birdrm]

You can switch back from and Advantage plan to a Supplement plan you just have to go through underwriting. Yes, if you have an existing health issue they can reject your switch but if fairly healthy and no major issues you can switch to a Supplement plan!

[Whoaboy]

We just moved to The Villages from another state, and I just started in Medicare in December. All was set up for the other state as original Medicare, as I had researched Medicare extensively and heard lots of negatives about Advantage plans.

We are now working with a local Medicare insurance broker in The Villages, who is telling us that Advantage plans are totally different in Florida than the rest of the country, and that Villages Health is a different and amazing care system than normal care providers.

Sounds too good to be true as we would save a significant amount of money on a Florida Advantage plan, but I don’t want to fall for a sales pitch and regret it later.

Is this a different animal in Florida? Any challenges finding providers around The Villages for Advantage Plans? Any challenges finding providers accepting new patients? Does the UHC Advantage Plan travel provision really work? I’m hesitant to voluntarily join an HMO, but maybe the PPO version would be a better fit for a skeptic.

Looking for real-world experiences with it, especially from those who have been on it awhile.

Thanks for any feedback!
I cant speak as to the advantage plans here but I stuck with regular and a supplement. What I wanted to tell you though is that though is that since you are now in Florida, you have to get a different drug plan or perhaps keep same but it costs more ( at least for me because my previous state was less) BUT you can keep your supplement and that price stays the same as your home state. Again cheaper in my home state than here. If you change supplement plans then yes you have to pay Florida prices . I will probably never change as I paying lots less . Found this out purely by accident but I glad I did!

[OrangeBlossomBaby]

You can switch back from and Advantage plan to a Supplement plan you just have to go through underwriting. Yes, if you have an existing health issue they can reject your switch but if fairly healthy and no major issues you can switch to a Supplement plan!

Most people over 65 have a "pre-existing condition." That's why it's a risk to start with Advantage with the presumption that you can always just switch to regular Medicare. If they decide some day that YOUR pre-existing condition is a disqualifying one, then they'll deny you.

[mtdjed]

You can switch back from and Advantage plan to a Supplement plan you just have to go through underwriting. Yes, if you have an existing health issue they can reject your switch but if fairly healthy and no major issues you can switch to a Supplement plan!

The true test is which plan is best without considering cost. Sure, no problem
with Medicare Advantage if you are healthy. You will save money and it may continue that way.

But, when you some serious care, you may be excluded from some of the best care resources. May never happen, but if need cancer care, does your plan cover Moffit, Shands or Mayo. I understand that UHC Advantage may now cover but several years ago it didn't. What about other Advantage programs?

I am fortunate that my pension pays $1000/year toward my Medicare supplement plan. I am also fortunate enough that I can afford Medicare Supplement Plan. I would rather have the assurance that I can get the best medical care. I will give up my need to have a new Tesla, Geneses, or Lexus every year.

[biker1]

Not exactly. There is no issue with switching back to traditional Medicare. The only issue might be if you also want to add a Supplemental Plan. There is no requirement to have a Supplemental Plan although most people do enroll in one. Exactly which preexisting conditions would cause a rejection during underwriting for a Supplemental Plan will vary. I had asked my broker this and she could only speak in general terms.

Most people over 65 have a "pre-existing condition." That's why it's a risk to start with Advantage with the presumption that you can always just switch to regular Medicare. If they decide some day that YOUR pre-existing condition is a disqualifying one, then they'll deny you.

[Keninches]

Stay away from Advantage Plans. If you have any medical issues or you may never know when an issue will happen.
What sounds too good to be true is Bad. Someone said earlier, “It’s Medicare DisAdvantage, instead of Advantage.

[rustyp]

If you take the advice posted on this subject in this thread I have a bridge to sell you. This has got to be a record of how much misinformation has been published per post.

I'll make a bet 75% of the Medicare / Supplement supporters of whom the overwhelming majority never had an advantage plan can not tell you the difference between a HMO and a PPO. Do yourself a huge favor - GO TO SHINE.

[BrianL99]

You can switch back from and Advantage plan to a Supplement plan you just have to go through underwriting. Yes, if you have an existing health issue they can reject your switch but if fairly healthy and no major issues you can switch to a Supplement plan!

Not exactly. There is no issue with switching back to traditional Medicare. The only issue might be if you also want to add a Supplemental Plan. There is no requirement to have a Supplemental Plan although most people do enroll in one. Exactly which preexisting conditions would cause a rejection during underwriting for a Supplemental Plan will vary. I had asked my broker this and she could only speak in general terms.

If's unfortunate that Florida isn't as flexible as many other states, that give you an almost unlimited right to switch back to a Medicare Supplement. Given the insurance climate in FL, I guess I shouldn't be surprised.

[Rainger99]

For those of you with supplemental plans, what is the approximate cost of your plan per month?

And does it go up every year?

[MX rider]

If you take the advice posted on this subject in this thread I have a bridge to sell you. This has got to be a record of how much misinformation has been published per post.

I'll make a bet 75% of the Medicare / Supplement supporters of whom the overwhelming majority never had an advantage plan can not tell you the difference between a HMO and a PPO. Do yourself a huge favor - GO TO SHINE.

Well said!
Pretty much what I said too. Most of the people bad mouthing MA plans really know very little about them except "what I heard is".

Not all MA plans are the same and some are better than others. That's why people need to actually research the plans.
SHINE said The Villages UHC MA plan was a very good option for us.

Having a choice is a good thing imo.

[Blueblaze]

I have not heard of any doctor or hospital no longer accepting a supplemental plan, but it seems like every year, hospitals and practices are dropping Advantage plans left and right. Currently the Mayo Clinic in Jax is not accepting any advantage plans and Moffitt in Tampa is not accepting certain advantage plans. We have a pancreatic cancer survivor via the Mayo Clinic. Treatment went from August thru April. I can’t imagine what we would have done when they stopped mid treatment.

The survivor was exceptionally healthy and one day, she got very bad indigestion, two days later, a tumor was found in her pancreas. Two weeks later chemo was started.

I will never roll the dice on healthcare. Today we both have a Cigna Supplemental G plan that is accepted everywhere.

Well. I guess is depends on your situation, but a typical supplemental plan costs about $150/mo per person, plus the $185/mo medicare payment. That works out to $8,400/year per married couple, just to be able to see any doctor you want.

Personally, I think it's a better deal to spend $840/yr for PPO insurance that pays everything except the co-pay to stay in-network for routine stuff -- or 80% of any doctor or treatment I want up to $6700 total out of pocket (and then all of it) -- if I have a medical disaster. And Moffit being in-network even saves the $6700 if I get cancer.

So far, neither Humana nor United have ever refused me anything, unless you consider staying in-network for primary care and the typical specialists old folks have to see every year. United covered almost everything a couple of years ago when I had to go to Orlando to have a super-duper specialist make sure a pancreatic cyst wasn't cancer. And Humana covered almost everything when my wife spent a week in the hospital last year from a (thankfully minor) stroke. But I guess its possible some out-of-network doctor or hospital could refuse to take Humana's money for some reason some day.

I guess I'll never know until something really bad happens. Then I guess I'd have to spend our savings or sell the house. Life's a gamble. I guess I'm willing to bet a multi-billion-dollar company isn't lying to me in any serious way that millions of customers haven't have already discovered.

[biker1]

My Plan N runs $170 per month and it does go up each year.

For those of you with supplemental plans, what is the approximate cost of your plan per month?

And does it go up every year?

[biker1]

I believe it is only 4 states. I grew up in one and wouldn't consider moving back there or to the other 3. I guess that qualifies as "many" ;-)

If's unfortunate that Florida isn't as flexible as many other states, that give you an almost unlimited right to switch back to a Medicare Supplement. Given the insurance climate in FL, I guess I shouldn't be surprised.

[MaryMS]

We’ve had great service and care through the Villages Health United Advantage plan. No trouble seeing specialists or Marion West Hospital. We tried Premier Medical, but was unhappy with service and facilities.

[Lottoguy]

We have nothing but positive things to say about our Plan. Our United Healthcare plan includes $5,000 for dental. Max out of pocket is $2,400 per person.

[Happydaz]

If's unfortunate that Florida isn't as flexible as many other states, that give you an almost unlimited right to switch back to a Medicare Supplement. Given the insurance climate in FL, I guess I shouldn't be surprised.

Don’t single out Florida. This happens in any other state.

[Aces4]

Well. I guess is depends on your situation, but a typical supplemental plan costs about $150/mo per person, plus the $185/mo medicare payment. That works out to $8,400/year per married couple, just to be able to see any doctor you want.

Personally, I think it's a better deal to spend $840/yr for PPO insurance that pays everything except the co-pay to stay in-network for routine stuff -- or 80% of any doctor or treatment I want up to $6700 total out of pocket (and then all of it) -- if I have a medical disaster. And Moffit being in-network even saves the $6700 if I get cancer.

So far, neither Humana nor United have ever refused me anything, unless you consider staying in-network for primary care and the typical specialists old folks have to see every year. United covered almost everything a couple of years ago when I had to go to Orlando to have a super-duper specialist make sure a pancreatic cyst wasn't cancer. And Humana covered almost everything when my wife spent a week in the hospital last year from a (thankfully minor) stroke. But I guess its possible some out-of-network doctor or hospital could refuse to take Humana's money for some reason some day.

I guess I'll never know until something really bad happens. Then I guess I'd have to spend our savings or sell the house. Life's a gamble. I guess I'm willing to bet a multi-billion-dollar company isn't lying to me in any serious way that millions of customers haven't have already discovered.

As long as you remember that your medicare advantage plan does not have fixed rates for the rest of your lives. The more people on the plan, the more restricted care and higher rates to pay for the aging population. You're looking through a magnifying glass at your current situation and missing the complete view.

Why did Humana only cover most of the charges when your spouse had a stroke? IMHO, that should be totally covered unless she was ordering steak for dinner every night.

People can elect advantage medicare if they want. My irritation is how there is such a concerted effort to get all senior citizens on a limited care, private insurance plan. There is an effort to close out original Medicare, which is arguably the gold standard of health care for all senior citizens struggling with health care issues.

[JohnN]

We have been living in The Villages for 17 years now and using UHC The VIllages Advantage Plan.
In 2024, I had FOUR serious cardiovascular surgeries with a total of 9 stents. Plus all of the other hospital time, MRI, CT, rehab, etc. UHC preauthorized quickly whenever needed with no trouble. Total 2024 provider billing was in excess of $250K, my share of which was $1,500. The docs literally saved my life and UHC did what they were supposed to do.

Prior to that adventure, in the other years, again no problems with UHC. We did have o learn our way around The Villages Health System and other providers, but that's likely the same anywhere these days. A lot of people knock the advantage plan and say "wait til you have something serious happen." Well, I did and it worked out great. Best wishes.

[Arlington2]

We have been living in The Villages for 17 years now and using UHC The VIllages Advantage Plan.
In 2024, I had FOUR serious cardiovascular surgeries with a total of 9 stents. Plus all of the other hospital time, MRI, CT, rehab, etc. UHC preauthorized quickly whenever needed with no trouble. Total 2024 provider billing was in excess of $250K, my share of which was $1,500. The docs literally saved my life and UHC did what they were supposed to do.

Prior to that adventure, in the other years, again no problems with UHC. We did have o learn our way around The Villages Health System and other providers, but that's likely the same anywhere these days. A lot of people knock the advantage plan and say "wait til you have something serious happen." Well, I did and it worked out great. Best wishes.

But,but,but you didn't go to Mayo Clinic or Cleveland Clinic or some other nationally high rated hospital. No way you could have survived (sarcasm)

[Rainger99]

We have been living in The Villages for 17 years now and using UHC The VIllages Advantage Plan.
In 2024, I had FOUR serious cardiovascular surgeries with a total of 9 stents. Plus all of the other hospital time, MRI, CT, rehab, etc. UHC preauthorized quickly whenever needed with no trouble. Total 2024 provider billing was in excess of $250K, my share of which was $1,500. The docs literally saved my life and UHC did what they were supposed to do.

Prior to that adventure, in the other years, again no problems with UHC. We did have o learn our way around The Villages Health System and other providers, but that's likely the same anywhere these days. A lot of people knock the advantage plan and say "wait til you have something serious happen." Well, I did and it worked out great. Best wishes.

What hospital did you go to?

[Aces4]

We have been living in The Villages for 17 years now and using UHC The VIllages Advantage Plan.
In 2024, I had FOUR serious cardiovascular surgeries with a total of 9 stents. Plus all of the other hospital time, MRI, CT, rehab, etc. UHC preauthorized quickly whenever needed with no trouble. Total 2024 provider billing was in excess of $250K, my share of which was $1,500. The docs literally saved my life and UHC did what they were supposed to do.

Prior to that adventure, in the other years, again no problems with UHC. We did have o learn our way around The Villages Health System and other providers, but that's likely the same anywhere these days. A lot of people knock the advantage plan and say "wait til you have something serious happen." Well, I did and it worked out great. Best wishes.

Great? How about 8 surgeries in four years, 6 of them major, rehab and no pre-auth and NO money out of pocket and none of the surgeries in The Villages.

[rustyp]

We have been living in The Villages for 17 years now and using UHC The VIllages Advantage Plan.
In 2024, I had FOUR serious cardiovascular surgeries with a total of 9 stents. Plus all of the other hospital time, MRI, CT, rehab, etc. UHC preauthorized quickly whenever needed with no trouble. Total 2024 provider billing was in excess of $250K, my share of which was $1,500. The docs literally saved my life and UHC did what they were supposed to do.

Prior to that adventure, in the other years, again no problems with UHC. We did have o learn our way around The Villages Health System and other providers, but that's likely the same anywhere these days. A lot of people knock the advantage plan and say "wait til you have something serious happen." Well, I did and it worked out great. Best wishes.

Great? How about 8 surgeries in four years, 6 of them major, rehab and no pre-auth and NO money out of pocket and none of the surgeries in The Villages.

I don't get lt. John N spent $1500 for major issues. You spent $0 except for approx $200/month supplemental for 4 years = $9600. Bonus - both of you are still on the top side of the grass.

[JohnN]

What hospital did you go to?



Leesburg Regional Hospital, my cardiologist was top-tier and associated with Orlando Health. The hospital wasn't at all "fun" but they did their job pretty well.

I have been to the Villlages Hospital ER some years back, not a good experience but that was a long time ago. If given a choice, I'd pick Leesburg.

[JohnN]

Great? How about 8 surgeries in four years, 6 of them major, rehab and no pre-auth and NO money out of pocket and none of the surgeries in The Villages.

Nope, I don't want any more surgeries! LOL I'm glad we're both here though.

[Aces4]

I don't get lt. John N spent $1500 for major issues. You spent $0 except for approx $200/month supplemental for 4 years = $9600. Bonus - both of you are still on the top side of the grass.

We got to chose top notch facilities, providers, therapists and didn't have to jump through approval hoops from private insurance companies. Perhaps you missed an early thread from another poster in which a surgeon indicated his patient was refused TKR care even though the x-ray showed bone on bone.

Why do you think Drs and medical centers are beginning to drop patients with advantage medicare? Private insurance companies on the back side controlling expenses to enhance their profits are the answer. If original Medicare is eliminated and everyone is pushed into the private insurance companies advantage program, you'll really see Drs dropping advantage Medicare patients.

[Rainger99]

I believe it is only 4 states. I grew up in one and wouldn't consider moving back there or to the other 3. I guess that qualifies as "many" ;-)

Four states (CT, MA, ME, NY) require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries ages 65 and older, regardless of medical history.

[BrianL99]

Four states (CT, MA, ME, NY) require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries ages 65 and older, regardless of medical history.

Are you forgetting about California, Idaho, Illinois, Nevada, and Oregon ?

[MX rider]

Great? How about 8 surgeries in four years, 6 of them major, rehab and no pre-auth and NO money out of pocket and none of the surgeries in The Villages.

You paid plenty out of pocket. How much have you spent over the years on a supplimatal plan? You may want to add it up so you know the true cost.

Nothing is totally free! Advantage plans have their place, but aren't for everyone. As I said earlier, choice is a good thing.

[Aces4]

You paid plenty out of pocket. How much have you spent over the years on a supplimatal plan? You may want to add it up so you know the true cost.

Nothing is totally free! Advantage plans have their place, but aren't for everyone. As I said earlier, choice is a good thing.

Unfortunately, we've had far more expenses than we have ever paid in. We're good with our original Medicare and our supplemental plan.

[MX rider]

Unfortunately, we've had far more expenses than we have ever paid in. We're good with our original Medicare and our supplemental plan.

My point remains, you paid a lot out of pocket over they years. Saying you paid nothing simply isn't true.

MA plans are a great option for many of us, as is medicare for others. There's no right or wrong.

[Aces4]

My point remains, you paid a lot out of pocket over they years. Saying you paid nothing simply isn't true.

MA plans are a great option for many of us, as is medicare for others. There's no right or wrong.

One of the surgeries I listed was an 8 hour, complicated, new surgical procedure. A study was developed and the surgery created great success for an ongoing problem. It also provided needed information for others undergoing such an extensive surgery.

Try to fly that past advantage Medicare coverage.

[Blueblaze]

One of the surgeries I listed was an 8 hour, complicated, new surgical procedure. A study was developed and the surgery created great success for an ongoing problem. It also provided needed information for others undergoing such an extensive surgery.

Try to fly that past advantage Medicare coverage.

Why would any hospital or doctor refuse a dollar just because it comes from an Advantage PPO?

Yes, an out-of-network doctor might charge more than the plan is willing to pay, and you might get stuck with the balance. But that could happen with ANY insurance plan, including a medigap policy. At least with my MA plan, I'm saving $8000/year in premiums. I happen to think it's worth the bet that if the worst happens and I wind up stuck with a 6-figure medical bill some day, at least I'll have the $160K I saved over 20 years to use before I have to dip into my savings. But on the other hand, there's at least an even chance that will never happen -- and I pocket $160K.

Insurance is a bet, anyway you look at it. I don't disparage anyone for seeing the odds differently or having a different risk tolerance than I do. I think the only reason someone would do that is because they're insecure about the choice they've made.

[Aces4]

Why would any hospital or doctor refuse a dollar just because it comes from an Advantage PPO?

Yes, an out-of-network doctor might charge more than the plan is willing to pay, and you might get stuck with the balance. But that could happen with ANY insurance plan, including a medigap policy. At least with my MA plan, I'm saving $8000/year in premiums. I happen to think it's worth the bet that if the worst happens and I wind up stuck with a 6-figure medical bill some day, at least I'll have the $160K I saved over 20 years to use before I have to dip into my savings. But on the other hand, there's at least an even chance that will never happen -- and I pocket $160K.

Insurance is a bet, anyway you look at it. I don't disparage anyone for seeing the odds differently or having a different risk tolerance than I do. I think the only reason someone would do that is because they're insecure about the choice they've made.

As I said earlier, I believe one's view of the advantage medicare plan is myopic. One is only guaranteed their advantage medicare coverage and costs today, once they convert every senior to private insurance who's only goal is high profits and low care, one will understand what they have in 20 years.

I believe there is no way advantage medicare would have approved and totally paid for the advanced surgical services I mentioned earlier.

[MX rider]

As I said earlier, I believe one's view of the advantage medicare plan is myopic. One is only guaranteed their advantage medicare coverage and costs today, once they convert every senior to private insurance who's only goal is high profits and low care, one will understand what they have in 20 years.



I believe there is no way advantage medicare would have approved and totally paid for the advanced surgical services I mentioned earlier.

Key phrase in your statement: "I believe". In truth you're just guessing.

Inferring people on MA plans aren't making a smart decision, didn't do their research, and only are looking at cost is insulting, and for many people you couldn't be more wrong!
You seem to have a really hard time accepting that many of us like our MA plans.

We chose UHC MA because we think its the best fit for us.
Whats best for you isn't whats best for everyone, even though you think so..

[BigDawgInLakeDenham]

There is so much false information and opions on this issue presened here that it proves there are many people that don't know what they are talking about but will remain passionate about their opinion based on their limited experiences. Everyone needs to educate themselves through researching all of their opinions THEMSELVES!!! It's about you and your personal needs. No one here knows your personal health information and no one knows your travel plans...etc. Maybe you are 80 and maybe you are 45 on SSDI with Medicare but mostly healthy.....nobody here knows and that is why you need to choose the best you can afford. Should you pay for an insurance company that will send you to your cancer center of choice but you have no cancer history and no risk factors....only you can decide that. Just Please don't base your needs on everything you've read here and talk to your Doctors and Insurance advisors. As a retired RN I have a greater understanding of how it all works. If I like my current Doctors and I am changing insurance I call my doctors' offices and ask to talk to the billing person. I tell them my situation and I ask what insurances they accept and which one is the best payor to assist in my informed decision.....in addition to talking to my Doctor, insurance advisors, and my own research. I know it's much harder for folks that haven't worked in the health industry and everything seems like a different language...but it's not hard to do your own research. One thing is for sure, after a career in the ER, I've never ever seen someone denied a life saving procedure....insurance or not. Oh....Medigap insurance is from the same insurance companies that offer Advantage plans. And stop saying MA instead of Medicare Advantage because every Healthcare practitioner knows MA means Medicaid. Do you qualify for Medical Assistance? If you do then how can you afford your bills here in the Villages. Stop confusing the issue with MA please

[MX rider]

There is so much false information and opions on this issue presened here that it proves there are many people that don't know what they are talking about but will remain passionate about their opinion based on their limited experiences. Everyone needs to educate themselves through researching all of their opinions THEMSELVES!!! It's about you and your personal needs. No one here knows your personal health information and no one knows your travel plans...etc. Maybe you are 80 and maybe you are 45 on SSDI with Medicare but mostly healthy.....nobody here knows and that is why you need to choose the best you can afford. Should you pay for an insurance company that will send you to your cancer center of choice but you have no cancer history and no risk factors....only you can decide that. Just Please don't base your needs on everything you've read here and talk to your Doctors and Insurance advisors. As a retired RN I have a greater understanding of how it all works. If I like my current Doctors and I am changing insurance I call my doctors' offices and ask to talk to the billing person. I tell them my situation and I ask what insurances they accept and which one is the best payor to assist in my informed decision.....in addition to talking to my Doctor, insurance advisors, and my own research. I know it's much harder for folks that haven't worked in the health industry and everything seems like a different language...but it's not hard to do your own research. One thing is for sure, after a career in the ER, I've never ever seen someone denied a life saving procedure....insurance or not. Oh....Medigap insurance is from the same insurance companies that offer Advantage plans. And stop saying MA instead of Medicare Advantage because every Healthcare practitioner knows MA means Medicaid. Do you qualify for Medical Assistance? If you do then how can you afford your bills here in the Villages. Stop confusing the issue with MA please

Thats what I've been saying as well. Do your research, talk to SHINE, check the ratings and providers, and make an educated decision. We even talked to people on UHC. Having more than one option is a good thing.

But I disagree on this, if you're responding to a post titled "Medicare Advantage plans", and using MA plans as an abbreviation, it isn't confusing anyone. imo

[BigDawgInLakeDenham]

Thats what I've been saying as well. Do your research, talk to SHINE, check the ratings and providers, and make an educated decision. We even talked to people on UHC. Having more than one option is a good thing.

But I disagree on this, if you're responding to a post titled "Medicare Advantage plans", and using MA plans as an abbreviation, it isn't confusing anyone. imo

Everyone in Healthcare and the Insurance industry hearing MA automatically thinks Medicaid aka Medical Assistance. Feel free to disagree with established Insurance acronyms. Medicare Advantage plans are commonly referred to as Advantage plans....just stating facts I know from over 30 years working as a Registered Nurse in a world class hospital....I for one will never be able to say I have MA because my retirement income precludes me from being poor enough to qualify for MA. If you have MA then say it

[Aces4]

There is so much false information and opions on this issue presened here that it proves there are many people that don't know what they are talking about but will remain passionate about their opinion based on their limited experiences. Everyone needs to educate themselves through researching all of their opinions THEMSELVES!!! It's about you and your personal needs. No one here knows your personal health information and no one knows your travel plans...etc. Maybe you are 80 and maybe you are 45 on SSDI with Medicare but mostly healthy.....nobody here knows and that is why you need to choose the best you can afford. Should you pay for an insurance company that will send you to your cancer center of choice but you have no cancer history and no risk factors....only you can decide that. Just Please don't base your needs on everything you've read here and talk to your Doctors and Insurance advisors. As a retired RN I have a greater understanding of how it all works. If I like my current Doctors and I am changing insurance I call my doctors' offices and ask to talk to the billing person. I tell them my situation and I ask what insurances they accept and which one is the best payor to assist in my informed decision.....in addition to talking to my Doctor, insurance advisors, and my own research. I know it's much harder for folks that haven't worked in the health industry and everything seems like a different language...but it's not hard to do your own research. One thing is for sure, after a career in the ER, I've never ever seen someone denied a life saving procedure....insurance or not. Oh....Medigap insurance is from the same insurance companies that offer Advantage plans. And stop saying MA instead of Medicare Advantage because every Healthcare practitioner knows MA means Medicaid. Do you qualify for Medical Assistance? If you do then how can you afford your bills here in the Villages. Stop confusing the issue with MA please

Thank you, after having worked in the health insurance industry, I know what you mean about doing your homework. The NIH Science Library in 2021 reported that most advantage Medicare plans are Racial/ethnic minority populations with low incomes are more likely to enter MA, often because MA plans provide more generous or additional benefits such as eyeglasses, etc. There definitely is a market price point for many and that is all well and good. (The MA acronym was used by the NIH...)

My warning is for all those ads being promoted every fall that there is an effort to eliminate Original Medicare. If all seniors are pushed into advantage medicare plans managed by for profit private insurers, the ramifications will be noted quickly.

[MX rider]

Thank you, after having worked in the health insurance industry, I know what you mean about doing your homework. The NIH Science Library in 2021 reported that most advantage Medicare plans are Racial/ethnic minority populations with low incomes are more likely to enter MA, often because MA plans provide more generous or additional benefits such as eyeglasses, etc. There definitely is a market price point for many and that is all well and good. (The MA acronym was used by the NIH...)

My warning is for all those ads being promoted every fall that there is an effort to eliminate Original Medicare. If all seniors are pushed into advantage medicare plans managed by for profit private insurers, the ramifications will be noted quickly.

Blah, blah, blah. 2021 is 4 years ago and the data is from before that. I know quite a few very smart, successful people, which includes my wife and I, that chose MA plans, not due to cost, but because we think they're a better fit.
You continue to insult peoples intelligence thinking you know better.

Many disagree with your "the sky is falling" statements.

[Aces4]

Blah, blah, blah. 2021 is 4 years ago and the data is from before that. I know quite a few very smart, successful people, which includes my wife and I, that chose MA plans, not due to cost, but because we think they're a better fit.
You continue to insult peoples intelligence thinking you know better.

Many disagree with your "the sky is falling" statements.

Blah, blah, blah..If reading comprehension is there, that is a printed statement from the NIH, not my statement. As I said earlier, there is a segment of the population for which advantage medicare works, let's just hope it doesn't push out Original Medicare.

For those who are truly interested in this discussion and why the concern about advantage medicare, I recommend you read this entire piece.. Perform an internet search with this leader: Growth in Medicare Advantage Raises Concerns