"Traditional Medicare" vs Medicare Advantage

[GreggC69]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?

[villagetinker]

Traditional Medicare here, we ran into too many problems with an advantage plan could not get access to desired specialists and the ones available were several weeks to months for appointments.
No idea on the compensation.

[retiredguy123]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?
Personally, I think that The Villages health care facilities do not accept original Medicare because they want to make them more accessible to Villagers. If they accepted original Medicare, they would be required by law to accept all original Medicare patients from the surrounding areas, and they would soon become overcrowded with non-Villagers. These facilities were constructed within The Villages to be convenient to Villagers, not non-Villagers. Otherwise, what is the point of using Villages property to operate health care facilities within The Villages? My opinion.

[Aces4]

Personally, I think that The Villages health care facilities do not accept original Medicare because they want to make them more accessible to Villagers. If they accepted original Medicare, they would be required by law to accept all original Medicare patients from the surrounding areas, and they would soon become overcrowded with non-Villagers. These facilities were constructed within The Villages to be convenient to Villagers, not non-Villagers. Otherwise, what is the point of using Villages property to operate health care facilities within The Villages? My opinion.

I don't believe that has anything to do with it. It's about the money, IMHO. Long read but worth the information provided.. Tap on "just a moment".

Just a moment... (https://www.cbpp.org/research/health/growth-in-medicare-advantage-raises-concerns)

[retiredguy123]

I don't believe that has anything to do with it. It's about the money, IMHO. Long read but worth the information provided.. Tap on "just a moment".

Just a moment... (https://www.cbpp.org/research/health/growth-in-medicare-advantage-raises-concerns)
I understand your opinion. But, if a Villager cannot get an appointment at a Villages health care facility because of overcrowding, what is the point of building health care facilities on Villages property? The developer is trying to create a convenient environment for people who want to buy houses and get convenient health care.

[Aces4]

I understand your opinion. But, if a Villager cannot get an appointment at a Villages health care facility because of overcrowding, what is the point of building health care facilities on Villages property? The developer is trying to create a convenient environment for people who want to buy houses and get convenient health care.

Read the attached information regarding Medicare Advantage please. I believe The Villages is looking out for The Villages and it is not a benefactor for the citizenry's medical care.

[retiredguy123]

Read the attached information regarding Medicare Advantage please. I believe The Villages is looking out for The Villages and it is not a benefactor for the citizenry's medical care.
I have read it, but I tend to view the developer's plan as primarily to create a good lifestyle for residents and to attract homebuyers, not to sell health care services.

[Rainger99]

I understand your opinion. But, if a Villager cannot get an appointment at a Villages health care facility because of overcrowding, what is the point of building health care facilities on Villages property? The developer is trying to create a convenient environment for people who want to buy houses and get convenient health care.

Kind of like building the school. The parents have to work for the villages in order for the kids to go there.

[Stu from NYC]

I have read it, but I tend to view the developer's plan as primarily to create a good lifestyle for residents and to attract homebuyers, not to sell health care services.

Agreed

[mtdjed]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?

Regarding your first question, when I became eligible, I chose original Medicare knowing that is was more expensive. However, I also knew that the Advantage programs have a network of providers and my current providers at the time were not included. Also, at the time several of the Major Cancer treatment centers were not on the list of providers. I was also advised that the Advantage program was required to approve certain actions.

With the Original Medicare you don't have a limited provider network and Medicare determines whether treatment is covered by a code provided by providers giving the reason for required treatment. That code itself is the Approval so there is no wait and no restriction to your source of treatment. Doctor wants MRI, chooses source, provides a referral with proper code and you can get MRI. In my situation, my former employer pays the first $1,000 of my supplement cost (slightly less than half,) I pay about $1,200 for my supplement and it includes yearly cost to Genesis Fitness center.

Everyone has a different need. I am happy with my decision.

[tophcfa]

I understand your opinion. But, if a Villager cannot get an appointment at a Villages health care facility because of overcrowding, what is the point of building health care facilities on Villages property? The developer is trying to create a convenient environment for people who want to buy houses and get convenient health care.

If that’s the case then the rapid pace of development isn’t doing Villager's who already own homes a solid. How about limiting the pace of growth so it doesn’t suffocate the available health care infrastructure? Perhaps I’m missing something, but in my opinion it totally doesn’t make sense to not accept original Medicare in the largest 55+ retirement community in the world!

[retiredguy123]

If that’s the case then the rapid pace of development isn’t doing Villager's who already own homes a solid. How about limiting the pace of growth so it doesn’t suffocate the available health care infrastructure? Perhaps I’m missing something, but in my opinion it totally doesn’t make sense to not accept original Medicare in the largest 55+ retirement community in the world!
There are plenty of Medicare providers close by who do accept original Medicare. The developer builds, owns, and operates health care facilities on Villages property that are designed to be convenient to Villagers who want to use a Villages operated facility. Restricting these facilities to a few Medicare Advantage plan members makes it easier to use these facilities. If they could limit access to Villagers only, they probably would accept original Medicare. But they cannot because Medicare is a Federal program and they are not allowed to descriminate against non-Villagers. If they had to accept original Medicare, I think the developer would close the facilities. This is just my opinion and you don't need to agree.

[Aces4]

If that’s the case then the rapid pace of development isn’t doing Villager's who already own homes a solid. How about limiting the pace of growth so it doesn’t suffocate the available health care infrastructure? Perhaps I’m missing something, but in my opinion it totally doesn’t make sense to not accept original Medicare in the largest 55+ retirement community in the world!

Yes, you hit the nail on the head. One has to choose a plan with fewer coverages/options for medical care to use The Villages facilities at this point. It appears they are unable to build the infrastructure or attract top notch care for everyone. Some system, from my point of view.

[CybrSage]

If that’s the case then the rapid pace of development isn’t doing Villager's who already own homes a solid. How about limiting the pace of growth so it doesn’t suffocate the available health care infrastructure? Perhaps I’m missing something, but in my opinion it totally doesn’t make sense to not accept original Medicare in the largest 55+ retirement community in the world!

The developer is building new facilities in the south.

[Tomptomp]

I think Medicare advantage would put me in a network of doctors. Since I am a snowbird I need doctors in two locations that Medicare will cover. I don’t think that works for snowbirds.

[Indydealmaker]

Read the attached information regarding Medicare Advantage please. I believe The Villages is looking out for The Villages and it is not a benefactor for the citizenry's medical care.

OMG! A business operating for profit!

[Rwirish]

Surprised, shocked, why?

Medicare Advantage hands down IMO. Never had a issue, don’t need referrals and access to providers has been great.

[elle123]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?
In "Newspeak" the term "Advantage" actually means "Disadvantage. :)

[bobeaston]

Personally, I think that The Villages health care facilities do not accept original Medicare because they want to make them more accessible to Villagers. If they accepted original Medicare, they would be required by law to accept all original Medicare patients from the surrounding areas, and they would soon become overcrowded with non-Villagers. These facilities were constructed within The Villages to be convenient to Villagers, not non-Villagers. Otherwise, what is the point of using Villages property to operate health care facilities within The Villages? My opinion.

Wrong! It is not discrimination for / against The Villages residents. Some time ago, I learned from one of The Villages Health leaders, who was part of the original planning, that it was ALL ABOUT the cost structures of what practitioners are paid for Medicare Advantage patients. That cost structure was a key component of recruiting the professionals needed to make the business successful.

[rsmurano]

The advantage plans are terrible, ran by insurance companies, and almost 70% of the time will refuse medical procedures that your Dr wants to do. Don’t believe me, call an advantage plan provider and ask them if they can deny service. I have, they all say yes, and then google advantage plans denial rates, why congress has been looking into this. Medicare will never refuse a Dr for doing a procedure, but insurance companies do this 70% of the time because this is how they make money. While you are googling about the advantage plans, query why hospitals are refusing admitting advantage plan clients. Hundreds of hospitals have done this so far and more every month.

Take Medicare and get a supplement plan, a plan g, plan n, plan right when you retire because after this don’t have to accept you. Little known fact: if you go initially with an advantage plan then find out you don’t like it, a supplement plan doesn’t have to accept you, whereas if you initially go with a supplement plan and want to go to advantage plan, no problem.

[Susan1717]

I’ve been on an advantage and love it! Never been turned down for a procedure and I’ve had the same great service here and up north as I’m a snowbird. I also belong to 2 fitness centers in both locations that they pay for from the silver sneakers.

[jimdecastro]

I am an agent for Florida Blue and can explain the various options and can explain TBH policy as well. Look me up on Facebook, when you search my name, you'll see I'm an agent in my profile picture.

[USNA87]

For the TV veterans who have Parts A and B and TriCare for Life, what are your experiences?

[HJBeck]

We are sold on “traditional Medicare” because we can select the top rated specialists for whatever medical issue we may have. Do not like being restricted to specialists in a particular network. We want the freedom to choose.

[sdeikenberry]

Medicare Advantage Plans work because they are supposed to keep patients healthy. In reality, the plan receives a certain amount of money for each person in the plan and it's in the plan's best interest to not spend money on patient's if they avoid it...because the less spent the more profit they make. That said, they are still obligated to provide the necessary health care to a patient, but they aren't obligated to go beyond what is strictly necessary. The main problem with Advantage Plans is you CANNOT choose to go to any facility or doctor you wish UNLESS they are inside the plans network.
We have traditional medicare with an AARP supplemental plan that covers all of our expenses the traditional medicare won't pay. We've had this plan for over 10 years now. So beyond our monthly premiums we pay zero dollars for healthcare. This works for us...we can go anwhere we choose and have any doctor we choose and it's completely covered...no issues.
I am a former healthcare provider and I would never recommend anyone get an Advantage Plan unless they simply cannot afford regular medicare with a supplemental plan attached. You lose too much control of your healthcare...and you are your best advocate...not someone else.

[bowlingal]

Villages healthcare does accept traditional Medicare for it's specialists. It does not accept traditional Medicare for Primary Care docs.

[crash]

I understand your opinion. But, if a Villager cannot get an appointment at a Villages health care facility because of overcrowding, what is the point of building health care facilities on Villages property? The developer is trying to create a convenient environment for people who want to buy houses and get convenient health care.

The developer is interested in who will pay the rent and in The Villages that is medical. He just rents the buildings.

The new hospital that was planned south of. 44 got cancelled because they have staffing issues not enough doctors. Instead they are building free standing emergency rooms. There will be a day when we have a medical crisis because too many people for the number of medical facilities.

[TomPerry]

The advantage plans are terrible, ran by insurance companies, and almost 70% of the time will refuse medical procedures that your Dr wants to do. Don’t believe me, call an advantage plan provider and ask them if they can deny service. I have, they all say yes, and then google advantage plans denial rates, why congress has been looking into this. Medicare will never refuse a Dr for doing a procedure, but insurance companies do this 70% of the time because this is how they make money. While you are googling about the advantage plans, query why hospitals are refusing admitting advantage plan clients. Hundreds of hospitals have done this so far and more every month.

Take Medicare and get a supplement plan, a plan g, plan n, plan right when you retire because after this don’t have to accept you. Little known fact: if you go initially with an advantage plan then find out you don’t like it, a supplement plan doesn’t have to accept you, whereas if you initially go with a supplement plan and want to go to advantage plan, no problem.
People complain about The Villages Advantage Plan and Advantage Plans in general, but we have had great experiences after switching when we moved to TV! I had heartburn while on my morning walking, went to my PCP at Colony and ended up with a triple bypass. Got an EKG, stress test, heart Catherization then a triple bypass. From initial PCP visit to triple bypass, 17 days! After giving myself 15,000 - 20,000 injections over my life, now down to ONE injection per week, off insulin and A1C is 5.7 - 6.0! My wife has had severe back issues, received back surgery and has NO back issues since! We travel back to Massachusetts every summer and have no issues seeing out former doctors if and when needed. Complain all you want, but you can’t prove it by us!

[Ptmcbriz]

It’s about attracting top talent. Medicare payments won’t make a doctor enough money to want to live here for very long. Private Medicare insurance (Advanrage) does pay a lot more. I have Anthem and have loved it. I was in the hospital for 5 days and I paid out of pocket $100 for the entire stay. Medicare is known for not paying much.

[rustyp]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?

In 2024, 32.8 million people are enrolled in a Medicare Advantage plan, accounting for more than half, or 54 percent of Medicare eligible participants.

[RoseyRed]

Wrong! It is not discrimination for / against The Villages residents. Some time ago, I learned from one of The Villages Health leaders, who was part of the original planning, that it was ALL ABOUT the cost structures of what practitioners are paid for Medicare Advantage patients. That cost structure was a key component of recruiting the professionals needed to make the business successful.

The Villages Health said they could not accept me as a new patient due to not being on Medicare. They accepted my husband who is on an Advantage plan. I am not an expert but sounds like age discrimination in reverse :). I am over 55 so thought I would be accepted.

[talonip]

For the TV veterans who have Parts A and B and TriCare for Life, what are your experiences?

It works well. If I remember we were grandfathered in when the villages changed their policy. We have been treated very well.

Only issue I don’t like is that when you are selected to use the villages health you cannot select a location near where you live or doctor.

[Mluzinas]

A must read article!!! Take the time to read, excellent, accurate summary. Thanks for sharing!

[LoisR]

The Villages Med Plan doesn't have access to the Moffitt Cancer Center.

[Andyb]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?
Ever wonder why the push and advertise the Advantage plans so much? That should set off red flags. More money for them. Advantage gives less doctor options and very limited across state lines.

[MX rider]

People complain about The Villages Advantage Plan and Advantage Plans in general, but we have had great experiences after switching when we moved to TV! I had heartburn while on my morning walking, went to my PCP at Colony and ended up with a triple bypass. Got an EKG, stress test, heart Catherization then a triple bypass. From initial PCP visit to triple bypass, 17 days! After giving myself 15,000 - 20,000 injections over my life, now down to ONE injection per week, off insulin and A1C is 5.7 - 6.0! My wife has had severe back issues, received back surgery and has NO back issues since! We travel back to Massachusetts every summer and have no issues seeing out former doctors if and when needed. Complain all you want, but you can’t prove it by us!

Well said.
We're on UHC Advantage and are very happy with it, and The Villages Health. No waiting weeks for an appointment and we never wait more than 15 minutes for our PCP. We also use all the wellness benefits from UHC.
Our best friends are on Humana MA and like it. I hear Florida Blue is very good as well.

Contrary to what some will say, there is no real one size fits all.
Do your research and talk to SHINE. They said MA was a great option for us.

Choice is a good thing!

[Professor]

Personally, I think that The Villages health care facilities do not accept original Medicare because they want to make them more accessible to Villagers. If they accepted original Medicare, they would be required by law to accept all original Medicare patients from the surrounding areas, and they would soon become overcrowded with non-Villagers. These facilities were constructed within The Villages to be convenient to Villagers, not non-Villagers. Otherwise, what is the point of using Villages property to operate health care facilities within The Villages? My opinion.

Your response seems to assume that Medicare Advantage is only for Villagers. Hate to break it to you, but Medicare Advantage is all over and everyone can choose it.

[Mulliganguy]

If The Villages wanna treat only villagers then they should probably ask for their resident ID before treatment at sign in. Insurance type shouldn’t even play into it.

[Professor]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?

I chose Original Medicare because I travel some and want to be able to choose my own specialists when needed. Have not been disappointed. I spend some time in Maryland with my kids and grandchild during the summer and have had to have some medical procedures done. As an example, Johns Hopkins does not accept Medicare advantage.

There are those who will respond to this and say they do have options for specialists, but I did check into this and the options are still limited. I want the best care I can find as quickly as I can get it with no runaround from a company telling me who I can see and when.

As a final note, I loved my Villages Health physician Kathie Greene when I was still working and had a corporate plan, which they accepted. Hated to switch but need to do what is best for me.

[retiredguy123]

Ever wonder why the push and advertise the Advantage plans so much? That should set off red flags. More money for them. Advantage gives less doctor options and very limited across state lines.
I agree that it should set off red flags. But, if you think about it, a "for profit" company can increase their profits by screening out waste and fraud. On the other hand, Traditional Medicare claims are processed by the Federal Government by people who don't need to make a profit, and who don't seem to care much about screening out waste and fraud.

[MX rider]

[QUOTE=Andyb;2418681]Ever wonder why the push and advertise the Advantage plans so much? That should set off red flags. More money for them. Advantage gives less doctor options and very limited across state lines.[/QUOT

Omg, they make a profit! You mean like all doctors and most Hospitals?

Btw, over 50% of new medicare enrollees choose Adavntage plans. Many I'm sure did their research and made an eductated decision, like us.

We are happy with our provider list with UHC. And it has a huge nationwide network. We've used it here and in Indiana with zero problems.

Painting with a broad brush is not a good idea when it comes to this. Having options is always a good thing.

[MX rider]

Your response seems to assume that Medicare Advantage is only for Villagers. Hate to break it to you, but Medicare Advantage is all over and everyone can choose it.

I'm not 100% sure on this, but I think The Villages Health accepts anyone on a qualifying MA plan. Not just villagers.
And each PCP can only have a certain number of patients. So the can't overbook.

[Jensor17]

Medicare advantage plans cost more because they are generated by different entities so you have to shop around. Medicare is a federal Govt. entity, so they will receive (example) $1000 Doctor bill and tell the doctor he can only charge $600 - then Medicare will pay 80% of that $600 and you pay remainder. If you choose a supplemental plan through your employer, then Supplemental plans will pay 80% of the 20% that Medicare didn’t pay. That leaves a small balance that you owe a few $dollars.
I don’t have a Medicare advantage plan. It’s much cheaper to go Medicare, then seek a supplemental carrier…(sometimes secondary insurer premium payments may be partially covered by your employer.)

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?

[retiredguy123]

I'm not 100% sure on this, but I think The Villages Health accepts anyone on a qualifying MA plan. Not just villagers.
And each PCP can only have a certain number of patients. So the can't overbook.
You are correct, but the Villages health facilities only accept a small number of selected Advantage plans.

[retiredguy123]

If The Villages wanna treat only villagers then they should probably ask for their resident ID before treatment at sign in. Insurance type shouldn’t even play into it.
This would be illegal if they accept any type of Medicare insurance.

[Kliegls5@gmail.com]

I think Medicare advantage would put me in a network of doctors. Since I am a snowbird I need doctors in two locations that Medicare will cover. I don’t think that works for snowbirds.

We are snowbirds and have Medicare Advantage plans. We have a full set of doctors both in Illinois and here. Have also had to have PT in both places after a broken wrist. We've never had to get prior approval for any of our treatments. Easy peasy with great coverage and doctors.

[RUCdaze]

I can tell you from personal experience, I looked into Advantage and rejected it. I have Medicare parts A, B, and D., plus I have Blue Cross/Blue Shield. I have never had a problem; I go to whatever doctor I want without a referral, and I've never had a problem with anything. Advantage doesn't come without restrictions, obligations, and limitations,

[Janie123]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?
My wife and I are both using Medicare Part G due to the discontinuing of Advantage by our main cancer hospital… the Mayo Clinic in Jacksonville. The 2nd reason is if you are on Advantage and want to switch to a Part G and have underlying conditions, you could be denied. Here is ChatGPT describing why major hospitals are discontinuing… I hear Villagers say, I’m healthy and don’t need to pay extra for part G… well, today healthy, tomorrow, stroke, cancer, etc… it just happens.,..

Several major hospitals and health systems are opting to discontinue their participation in Medicare Advantage (MA) plans due to a combination of administrative and financial challenges. The primary reasons include: 
1. Delayed and Reduced Reimbursements: Hospitals report that MA plans often result in slower and lower payments compared to traditional Medicare, impacting their financial stability.
2. High Rates of Claim Denials: There is a significant occurrence of patient claim denials under MA plans, which can lead to increased administrative burdens and potential revenue loss for healthcare providers. 
3. Excessive Prior Authorization Requirements: The cumbersome process of obtaining prior authorizations for treatments and procedures under MA plans can delay patient care and add to the administrative workload of hospital staff.

These challenges have led to a notable shift, with nearly 1 in 5 health systems ceasing to accept one or more Medicare Advantage plans in recent years. 

For patients enrolled in MA plans, this trend may limit access to certain hospitals and healthcare providers. It’s crucial for beneficiaries to stay informed about their plan’s network and any changes to ensure continued access to preferred healthcare services.

[Kliegls5@gmail.com]

Medicare Advantage Plans work because they are supposed to keep patients healthy. In reality, the plan receives a certain amount of money for each person in the plan and it's in the plan's best interest to not spend money on patient's if they avoid it...because the less spent the more profit they make. That said, they are still obligated to provide the necessary health care to a patient, but they aren't obligated to go beyond what is strictly necessary. The main problem with Advantage Plans is you CANNOT choose to go to any facility or doctor you wish UNLESS they are inside the plans network.
We have traditional medicare with an AARP supplemental plan that covers all of our expenses the traditional medicare won't pay. We've had this plan for over 10 years now. So beyond our monthly premiums we pay zero dollars for healthcare. This works for us...we can go anwhere we choose and have any doctor we choose and it's completely covered...no issues.
I am a former healthcare provider and I would never recommend anyone get an Advantage Plan unless they simply cannot afford regular medicare with a supplemental plan attached. You lose too much control of your healthcare...and you are your best advocate...not someone else.
Why does everyone say they can go anywhere with a traditional medicare plan when in reality they can only go to doctors who accepts their plan. You can't go to any of the Villages Healthcare doctors, correct?

[Justputt]

I think Medicare advantage would put me in a network of doctors. Since I am a snowbird I need doctors in two locations that Medicare will cover. I don’t think that works for snowbirds.

Actually, it does work. We have in-network doctors both here, Upstate NY, and any other state we go to. Like traditional (government) Medicare, we have an Advantage plan that doesn't require pre-authorizations to specialists, tests, x-rays, etc. Unlike traditional Medicare, our Advantage plan gives us an allowance for over-the-counter meds, even food, etc., as well as dental, hearing, fitness, and vision coverage. So, the Advantage plan covers so much more and everywhere I want to go inside the US.

[MX rider]

My wife and I are both using Medicare Part G due to the discontinuing of Advantage by our main cancer hospital… the Mayo Clinic in Jacksonville. The 2nd reason is if you are on Advantage and want to switch to a Part G and have underlying conditions, you could be denied. Here is ChatGPT describing why major hospitals are discontinuing… I hear Villagers say, I’m healthy and don’t need to pay extra for part G… well, today healthy, tomorrow, stroke, cancer, etc… it just happens.,..

Several major hospitals and health systems are opting to discontinue their participation in Medicare Advantage (MA) plans due to a combination of administrative and financial challenges. The primary reasons include: 
1. Delayed and Reduced Reimbursements: Hospitals report that MA plans often result in slower and lower payments compared to traditional Medicare, impacting their financial stability.
2. High Rates of Claim Denials: There is a significant occurrence of patient claim denials under MA plans, which can lead to increased administrative burdens and potential revenue loss for healthcare providers. 
3. Excessive Prior Authorization Requirements: The cumbersome process of obtaining prior authorizations for treatments and procedures under MA plans can delay patient care and add to the administrative workload of hospital staff.

These challenges have led to a notable shift, with nearly 1 in 5 health systems ceasing to accept one or more Medicare Advantage plans in recent years. 

For patients enrolled in MA plans, this trend may limit access to certain hospitals and healthcare providers. It’s crucial for beneficiaries to stay informed about their plan’s network and any changes to ensure continued access to preferred healthcare services.

Like others here, you're painting with a broad brush. Not all MA plans are the same. Some are better than others.

After much research, and talking to SHINE, we chose UHC MA. We're happy with our choice. And no, not every doctor or hospital takes UHC. But many top rated hospitals and specialists do.

[goneil2024]

It’s all about the money on all sides of the transaction (seller, service provider and buyer). For most of us if we are honest few truly understand the system and differences until services are delivered, at that point our ability to make change has passed.

According to published reports in 2010 25% of eligible beneficiaries were enrolled in Medicare Advantage Plans, while in 2024 the number is over 54% and growing. It is expected that in the next ten years the number will be 64%.

Like all insurance products the devil is in the details, and if you are so inclined there is a wealth of information discussing the pros and cons of traditional Medicare vs. Medicare Advantage Plans on line and from the US Government.

I elected traditional Medicare and then purchased a supplement, and yes the cost was more however after a detailed analysis it was the best fit for me.

The comments above are my personal opinion and not a recommendation. You should consult medical, insurance and finance subject matter experts when making important decisions.

[dlebuis]

Make sure you thoroughly read what and where plan allows you to go. Friend recently had to go to rehab and had to go to one of their approved facilities. It was horrible. Smelly, lack of getting her meds on time and sometimes forgotten meals. Tried to get released because rehab said she was good to go but facility doctor wouldn’t sign her out. Her own doctor didn’t have the power to do so. After 3 weeks she signed herself out and has been flourishing ever since. Lady from Orlando who was next door to my friend was sent there because of her insurance plan. This was in Wildwood and she lived in Orlando. Her family finally just took her out.

[tombpot]

If you want the insurance company to manage your healthcare then get an advantage plan.

[rustyp]

If you want the insurance company to manage your healthcare then get an advantage plan.

Who manages Medicare ? Hint DHHS - they have a new org chart.

[kingofbeer]

There are plenty of Medicare providers close by who do accept original Medicare. The developer builds, owns, and operates health care facilities on Villages property that are designed to be convenient to Villagers who want to use a Villages operated facility. Restricting these facilities to a few Medicare Advantage plan members makes it easier to use these facilities. If they could limit access to Villagers only, they probably would accept original Medicare. But they cannot because Medicare is a Federal program and they are not allowed to descriminate against non-Villagers. If they had to accept original Medicare, I think the developer would close the facilities. This is just my opinion and you don't need to agree.
I am not sure why a local non-Villages health doctor would not accept original Medicare. The patient needs to pay the difference.

[Aces4]

OMG! A business operating for profit!

Exactly and I have no problem with that premise, the family is here for the money. The premise that makes me chuckle is thinking that allowing only the Medicare Advantage Plan participants care at certain Village medical facilities and providers is doing all Villagers a favor.

[Aces4]

Surprised, shocked, why?

Medicare Advantage hands down IMO. Never had a issue, don’t need referrals and access to providers has been great.

Hang in there.. the show isn't over yet.:wave:

[maistocars]

Traditional Medicare here, we ran into too many problems with an advantage plan could not get access to desired specialists and the ones available were several weeks to months for appointments.
No idea on the compensation.
Totally agree. Traditional Medicare - best coverage and costs are small and limited.

[kingofbeer]

Personally, I think that The Villages health care facilities do not accept original Medicare because they want to make them more accessible to Villagers. If they accepted original Medicare, they would be required by law to accept all original Medicare patients from the surrounding areas, and they would soon become overcrowded with non-Villagers. These facilities were constructed within The Villages to be convenient to Villagers, not non-Villagers. Otherwise, what is the point of using Villages property to operate health care facilities within The Villages? My opinion.
Only accepting selected Medicare advantage plans keeps the volume of patients lower. Plus, the selected plans are 4 and 5 star plans not the inferior plans that you see advertised on TV'S. "Who wants coffee?". The Medicare Advantage plans pay Villages Health after you are enrolled even if you never use their services.

"Medical groups can get paid from Medicare Advantage plans, as these plans contract with healthcare providers, including medical groups, to provide the Medicare-covered benefits to their enrollees, and are paid a per-person amount to provide the care. "

[jcreason5616]

I choose Humana which covers FL and PA. So far so good. We are relatively healthy so not much experience

[MX rider]

Exactly and I have no problem with that premise, the family is here for the money. The premise that makes me chuckle is thinking that allowing only the Medicare Advantage Plan participants care at certain Village medical facilities and providers is doing all Villagers a favor.

I don't think the premise of The Villages health is to "do all villagers a favor".
It's simply their business plan to only accept MA. No different than some doctors and hospitals that don't accept MA plans and only take traditional Medicare.

As I've said, Medicare is not a one size fits all. Everyone should make an informed choice that works best for them.

[retiredguy123]

Only accepting selected Medicare advantage plans keeps the volume of patients lower. Plus, the selected plans are 4 and 5 star plans not the inferior plans that you see advertised on TV'S. "Who wants coffee?". The Medicare Advantage plans pay Villages Health after you are enrolled even if you never use their services.

"Medical groups can get paid from Medicare Advantage plans, as these plans contract with healthcare providers, including medical groups, to provide the Medicare-covered benefits to their enrollees, and are paid a per-person amount to provide the care. "
I totally agree with your first sentence. I think that is the goal.

[Villagesgal]

Anyone can buy into the Villages Health Advantage plans, you do not need to live in the Villages. That said, I was a part of The Villages Health, I do live here, but opted for a standard medicare policy which meets my needs much better than the Villages Advantage plan. Everyone has to consider their own health, age, and what they can afford.

[Aces4]

Only accepting selected Medicare advantage plans keeps the volume of patients lower. Plus, the selected plans are 4 and 5 star plans not the inferior plans that you see advertised on TV'S. "Who wants coffee?". The Medicare Advantage plans pay Villages Health after you are enrolled even if you never use their services.

"Medical groups can get paid from Medicare Advantage plans, as these plans contract with healthcare providers, including medical groups, to provide the Medicare-covered benefits to their enrollees, and are paid a per-person amount to provide the care. "

People can't see the forest for the trees. Once enough seniors have been, IMHO, suckered into the Medicare Advantage plans, the party will be over. Every senior will be pushed into private insurance for their healthcare and the cutting of coverages begin. Insurance companies are in business for profit, not for anything else. I foresee coverages and care squeezed as insurance companies fatten up.

Again, I encourage everyone to read this report in it's entirety.

Just a moment... (https://www.cbpp.org/research/health/growth-in-medicare-advantage-raises-concerns)

[Marine1974]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?
I recently went to the ER in January in the villages .
I am a veteran. I gave the registration person my VA healthcare card , but the insisted I provide my regular Medicare card and my AARp supplemental insurance card . I was surprised to find out the hospital billed all three and was paid by all three .
When I reported this to the VA , they told me not to worry , the hospital will be audited and have to pay back regular Medicare and my supplemental. So I’m not sure about the villages hospitals not accepting regular Medicare.

[PPLEPEU]

I think Medicare advantage would put me in a network of doctors. Since I am a snowbird I need doctors in two locations that Medicare will cover. I don’t think that works for snowbirds.

We are snowbirds and have zero issues with UHC Advantage. We have doctors here in Florida, in Michigan, and the heart specialists at the Cleveland Clinic in Ohio.

We’ve never had a procedure denied or been limited in our choice of physician.

[RoboVil]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?
I have traditional Medicare. No delays in treatment, no referrals needed for specialists, limit of $2000/yr on meds. Problem with Medicare Advantage is delay in treatment and you never know from 1 year to the next if the hospital you want to go to will be covered.

[Jayhawk]

Medicare Advantage Plans work because they are supposed to keep patients healthy. In reality, the plan receives a certain amount of money for each person in the plan and it's in the plan's best interest to not spend money on patient's if they avoid it...because the less spent the more profit they make. That said, they are still obligated to provide the necessary health care to a patient, but they aren't obligated to go beyond what is strictly necessary. The main problem with Advantage Plans is you CANNOT choose to go to any facility or doctor you wish UNLESS they are inside the plans network.
We have traditional medicare with an AARP supplemental plan that covers all of our expenses the traditional medicare won't pay. We've had this plan for over 10 years now. So beyond our monthly premiums we pay zero dollars for healthcare. This works for us...we can go anwhere we choose and have any doctor we choose and it's completely covered...no issues.
I am a former healthcare provider and I would never recommend anyone get an Advantage Plan unless they simply cannot afford regular medicare with a supplemental plan attached. You lose too much control of your healthcare...and you are your best advocate...not someone else.

Really? Can you go to The Villages Health?

:ho:

[MX rider]

People can't see the forest for the trees. Once enough seniors have been, IMHO, suckered into the Medicare Advantage plans, the party will be over. Every senior will be pushed into private insurance for their healthcare and the cutting of coverages begin. Insurance companies are in business for profit, not for anything else. I foresee coverages and care squeezed as insurance companies fatten up.

Again, I encourage everyone to read this report in it's entirety.

Just a moment... (https://www.cbpp.org/research/health/growth-in-medicare-advantage-raises-concerns)

You seem to infer that anyone on MA is a sucker and not smart!
Very condescending actually.

Like many, we did our research, talked to people on our plan, read lots of reviews and articles, checked the provider network, and chose what works best for us.
Even SHINE said an advantage plan was a very good option. Btw, cost was not our main concern.

I don't buy into your doomsday scenario at all. Competition will make the ma plans even better over time or people will stop signing up for them, imo. Btw, all doctors and most hospitals are for profit.

[Taltarzac725]

I am rather new to Medicare. Quite a headache when you are around 65-66.

I do not know how long I will live in the Villages so I will have to take it year-by-year.

Are there some physicians here in the Villages who are not connected to the Villages health? I have been lucky so far and have been able to get by with using Urgent Care. But sometimes would have a problem while waiting to get on Medicare while no longer covered by Florida Blue. Time constraints on who I can belong to, etc.

I only have until the end of March to figure out what to do about Medicare Advantage.

[jimjamuser]

Traditional Medicare with additional options is the way to go.

[coleprice]

If it is within your budget, sign up for Medicare Plan G or Plan F, which are Medicare "Supplement" plans. Although the monthly cost is higher than a Medicare Advantage Plan, they cover many more services, and besides a small annual deductible, there are no co-pays. Also, you don't need a Primary Care Physician to recommend a procedure. Many more doctors take the Supplement plans because these plans pay them better. Check out the following website to watch videos that will educate you on the alternatives: medicare school.com

[ckcapaul]

Snowbirds, just went to a doctor outside the villages to have one here and up north. Traditional Medicare and supplement G, handed my cards to receptionist and she says " you got the good insurance"

[LuvtheVillages]

I am rather new to Medicare. Quite a headache when you are around 65-66.

I do not know how long I will live in the Villages so I will have to take it year-by-year.

Are there some physicians here in the Villages who are not connected to the Villages health? I have been lucky so far and have been able to get by with using Urgent Care. But sometimes would have a problem while waiting to get on Medicare while no longer covered by Florida Blue. Time constraints on who I can belong to, etc.

I only have until the end of March to figure out what to do about Medicare Advantage.

There are LOTS of physicians here who are not connected to Villages health. And all of them take basic Medicare and many of the Advantage plans. Most of them are good. Some of them are great. Many are within golf cart access. The only trick is finding one who is accepting new patients.

Villages Health is not the only option. Different people have different needs. Go talk to SHINE, a free healthcare advisory service. (Not located inside the Villages Health clinics.)

Be aware that once you are with an Advantage plan, it may not be possible to switch back to basic Medicare, especially if your health changes.

[starflyte1]

Who pays for ambulance? Does advantage?

[LuvtheVillages]

I recently went to the ER in January in the villages .
I am a veteran. I gave the registration person my VA healthcare card , but the insisted I provide my regular Medicare card and my AARp supplemental insurance card . I was surprised to find out the hospital billed all three and was paid by all three .
When I reported this to the VA , they told me not to worry , the hospital will be audited and have to pay back regular Medicare and my supplemental. So I’m not sure about the villages hospitals not accepting regular Medicare.

The hospitals DO accept regular Medicare. All hospitals do. Some do not accept Advantage plans.

But this discussion is about clinics and doctors, not hospitals.

The Village hospital, now renamed Spanish Plaines hospital, is not part of the Village Healthcare system and clinics.

[Taltarzac725]

There are LOTS of physicians here who are not connected to Villages health. And all of them take basic Medicare and many of the Advantage plans. Most of them are good. Some of them are great. Many are within golf cart access. The only trick is finding one who is accepting new patients.

Villages Health is not the only option. Different people have different needs. Go talk to SHINE, a free healthcare advisory service. (Not located inside the Villages Health clinics.)

Be aware that once you are with an Advantage plan, it may not be possible to switch back to basic Medicare, especially if your health changes.

I am aware of the problem of finding a doctor here in the Villages. Have not needed one other than Urgent Care so far. Knock on wood.

[biker1]

For Plan F, you need to have turned 65 before Jan 1, 2020. However, if you have Plan F, you may be better off switching to Plan G (assuming you can) because the difference between the Plan F and Plan G premiums might be greater than the Part B deductible, which Plan F includes but Plan G doesn't.

If it is within your budget, sign up for Medicare Plan G or Plan F, which are Medicare "Supplement" plans. Although the monthly cost is higher than a Medicare Advantage Plan, they cover many more services, and besides a small annual deductible, there are no co-pays. Also, you don't need a Primary Care Physician to recommend a procedure. Many more doctors take the Supplement plans because these plans pay them better. Check out the following website to watch videos that will educate you on the alternatives: medicare school.com

[ridge]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only

accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?


Yes in speak with a Medicare specialist Advantage plans reimbursement is better for annual checkup but for specialist the reimbursement is better. Thus why specialist even in The Villages accept regular Medicare. I think more people here in The Villages have Advantage plans dye to budget. Nationwide it's roughly 50/50.

[westernrider75]

Why does everyone say they can go anywhere with a traditional medicare plan when in reality they can only go to doctors who accepts their plan. You can't go to any of the Villages Healthcare doctors, correct?

I might just be lucky but I have yet to find a doctor that DID NOT accept my original Medicare with supplement.

[BlueStarAirlines]

Personally, I think that The Villages health care facilities do not accept original Medicare because they want to make them more accessible to Villagers. If they accepted original Medicare, they would be required by law to accept all original Medicare patients from the surrounding areas, and they would soon become overcrowded with non-Villagers. These facilities were constructed within The Villages to be convenient to Villagers, not non-Villagers. Otherwise, what is the point of using Villages property to operate health care facilities within The Villages? My opinion.

Villages Health decision on only having the advantage plan is being really shortsighted. We moved here at age 55 and couldn't get ANY doctors or services from Villages Health (VH) because we did not have the Medicare advantage plan and were 10 years too young to qualify. All our doctors are outside VH and we will probably never leave those doctors. I see this same situation all over (especially in the southern villages) and as Middleton builds out.

If Orlando Health or Advent Health built a primary care location in the southern area and used that as a feeder into their overall system the future demand for VH services might not be there. I know I'm not changing doctors and going on a Medicare advantage plan in the future just because of Villages Health restrictions.

[Nana2Teddy]

I can tell you from personal experience, I looked into Advantage and rejected it. I have Medicare parts A, B, and D., plus I have Blue Cross/Blue Shield. I have never had a problem; I go to whatever doctor I want without a referral, and I've never had a problem with anything. Advantage doesn't come without restrictions, obligations, and limitations,
This is what we have, and it works great for us.

[MX rider]

Villages Health decision on only having the advantage plan is being really shortsighted. We moved here at age 55 and couldn't get ANY doctors or services from Villages Health (VH) because we did not have the Medicare advantage plan and were 10 years too young to qualify. All our doctors are outside VH and we will probably never leave those doctors. I see this same situation all over (especially in the southern villages) and as Middleton builds out.

If Orlando Health or Advent Health built a primary care location in the southern area and used that as a feeder into their overall system the future demand for VH services might not be there. I know I'm not changing doctors and going on a Medicare advantage plan in the future just because of Villages Health restrictions.

Over 50% of new medicare enrollees choose Advantage plans. I think The VIllages Health business plan is working very well.

[kendi]

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?

There is a lot of advertising for advantage plans. Rarely if ever for traditional plans. I read an article that this is a big influencer on the large number of people choosing the advantage plans.

I know too many people who have not been able to get the care they need approved by their advantage plan. One I know even died because of this.

It surprises me that so many are okay with leaving their health in the hands of the insurance companies. Not me! Freedom to choose who and where I want to go is priceless imho.

[Michael 61]

So much has been said already on this thread - my primary doctor is through Villages Health, but I am still under Medicare age, and they accept my Obamacare plan. Once I turn 65, I plan to go with traditional Medicare + supplement. I will have to leave Villages Health at that time, and I’m OK with that. I’ve done so much research on my own, as well have talked with SHINE (great resource I encourage everyone under 65 to engage with before making this important decision of which route to go). I think the error that many make, is they let cost alone guide their decision, and also are short-sighted, looking only at their current health situation, rather than anticipating what that could look like 20 years from now.

[biker1]

Hmmm, I'm not sure I understand that. I used the Villages Health Care (Primary Care Physician) until I reached age 65, at which time was I no longer eligible because I chose traditional Medicare and a Supplemental Plan. Before I reached age 65, I had health insurance through my employer and The Villages Health Care was more than happy to accommodate me with private insurance, which actually included an obamacare plan for about 24 months.

Villages Health decision on only having the advantage plan is being really shortsighted. We moved here at age 55 and couldn't get ANY doctors or services from Villages Health (VH) because we did not have the Medicare advantage plan and were 10 years too young to qualify. All our doctors are outside VH and we will probably never leave those doctors. I see this same situation all over (especially in the southern villages) and as Middleton builds out.

If Orlando Health or Advent Health built a primary care location in the southern area and used that as a feeder into their overall system the future demand for VH services might not be there. I know I'm not changing doctors and going on a Medicare advantage plan in the future just because of Villages Health restrictions.

[Michael 61]

Hmmm, I'm not sure I understand that. I used the Villages Health Care (Primary Care Physician) until I reached age 65, at which time was I no longer eligible because I chose traditional Medicare and a Supplemental Plan. Before I reached age 65, I had health insurance through my employer and The Villages Health Care was more than happy to accommodate me with private insurance, which actually included an obamacare plan for about 24 months.

Although things keep changing, when I moved here is 2023, I attempted to get into Villages Health with my Obamacare. I was told then, that they will not accept any new patients under the age of 60, and if between 60-65 they would put me on a waiting list. It took one year for me to clear that waiting list (I was with Orlando Health during that first year, and drove to the facility off the Turnpike and the intersection with Hwy 27). I’m still a few years away from 65, but will need to leave Villages Health at 65, since I won’t be going the Medicare Advantage route.

[tophcfa]

People can't see the forest for the trees. Once enough seniors have been, IMHO, suckered into the Medicare Advantage plans, the party will be over. Every senior will be pushed into private insurance for their healthcare and the cutting of coverages begin. Insurance companies are in business for profit, not for anything else. I foresee coverages and care squeezed as insurance companies fatten up.

Again, I encourage everyone to read this report in it's entirety.

Just a moment... (https://www.cbpp.org/research/health/growth-in-medicare-advantage-raises-concerns)

Bingo, that’s my fear. Hopefully, in that scenario, those up us already in a Medigap plan will be grandfathered in for life?

[biker1]

I suspect the issue is not enough PCPs. When we moved to The Villages in 2014, they had just opened up the facility at Pinellas and there was no issue with getting a PCP.

Although things keep changing, when I moved here is 2023, I attempted to get into Villages Health with my Obamacare. I was told then, that they will not accept any new patients under the age of 60, and if between 60-65 they would put me on a waiting list. It took one year for me to clear that waiting list (I was with Orlando Health during that first year, and drove to the facility off the Turnpike and the intersection with Hwy 27). I’m still a few years away from 65, but will need to leave Villages Health at 65, since I won’t be going the Medicare Advantage route.

[Keninches]

Medicare Advantage Plans work because they are supposed to keep patients healthy. In reality, the plan receives a certain amount of money for each person in the plan and it's in the plan's best interest to not spend money on patient's if they avoid it...because the less spent the more profit they make. That said, they are still obligated to provide the necessary health care to a patient, but they aren't obligated to go beyond what is strictly necessary. The main problem with Advantage Plans is you CANNOT choose to go to any facility or doctor you wish UNLESS they are inside the plans network.
We have traditional medicare with an AARP supplemental plan that covers all of our expenses the traditional medicare won't pay. We've had this plan for over 10 years now. So beyond our monthly premiums we pay zero dollars for healthcare. This works for us...we can go anwhere we choose and have any doctor we choose and it's completely covered...no issues.
I am a former healthcare provider and I would never recommend anyone get an Advantage Plan unless they simply cannot afford regular medicare with a supplemental plan attached. You lose too much control of your healthcare...and you are your best advocate...not someone else.

This is so true. We were with The Villages Health and were told we had to get out if we didn’t change to Advantage.
There was another point made earlier about the doctors at VH. We were told by someone in the healthcare that the doctors get $1200 month per patient whether you go to them or not. We got out. The other point was both of us went to Moffitt in Tampa and would not be accepted there.
What a Disadvantage, Advantage Plans are. I guess it’s ok if you are not sick and a healthy person.

[bumpa]

I think the error that many make, is they let cost alone guide their decision, and also are short-sighted, looking only at their current health situation, rather than anticipating what that could look like 20 years from now.

Very true, cost is often the decision maker. As someone who has had both a Medicare supplement plan and now a UHC advantage plan I can speak to both the benefits and cost issues. When we retired at 65, 15 years ago, we choose Plan F initially and experienced no issues with the plan or the care we required (very very little). Both my wife and I were quite healthy. Now while we could then and now readily afford the high monthly fee for plan F or G the cost seemed to increase dramatically each year.

We arrived at a point 10 years ago where we were paying about $400 a month for plan F with the prospect that it would go even higher. We were healthy and therefore receiving no benefit from a high priced plan. We than looked at the UHC advantage plan with a total cost of $38 per month. A savings of about $320 a month or $3800 a year. We switched and have had zero issues with the care and coverage. Kept all our doctors, picked up dental and vision coverage in addition.

Now we arrive in 2025 and my wife at 77 has been diagnosed with stage 2 breast cancer, it's 99% curable but there are operations (2) and radiation treatments costing well into the 1000's of dollars. Every test and process has been approved without any delay. The treatment process has been excellent

With UHC we have a max out of pocket per year of $6700 and of course with the expected expense we will hit that figure. However over ten years we have saved more than $38000, all of it tucked safely away, so the figure does not concern me in any way.

In my opinion the choice people make should be based first on the state of their health and the health of their elders and ancestors. As always insurance is a bet for or against yourself.

[Taltarzac725]

Very true, cost is often the decision maker. As someone who has had both a Medicare supplement plan and now a UHC advantage plan I can speak to both the benefits and cost issues. When we retired at 65, 15 years ago, we choose Plan F initially and experienced no issues with the plan or the care we required (very very little). Both my wife and I were quite healthy. Now while we could then and now readily afford the high monthly fee for plan F or G the cost seemed to increase dramatically each year.

We arrived at a point 10 years ago where we were paying about $400 a month for plan F with the prospect that it would go even higher. We were healthy and therefore receiving no benefit from a high priced plan. We than looked at the UHC advantage plan with a total cost of $38 per month. A savings of about $320 a month or $3800 a year. We switched and have had zero issues with the care and coverage. Kept all our doctors, picked up dental and vision coverage in addition.

Now we arrive in 2025 and my wife at 77 has been diagnosed with stage 2 breast cancer, it's 99% curable but there are operations (2) and radiation treatments costing well into the 1000's of dollars. Every test and process has been approved without any delay. The treatment process has been excellent

With UHC we have a max out of pocket per year of $6700 and of course with the expected expense we will hit that figure. However over ten years we have saved more than $38000, all of it tucked safely away, so the figure does not concern me in any way.

In my opinion the choice people make should be based first on the state of their health and the health of their elders and ancestors. As always insurance is a bet for or against yourself.

I applied for the UHC Advantage plan. I needed to make a decision by the end of March.


I will probably be in the Villages for a few more years.

[rustyp]

I applied for the UHC Advantage plan. I needed to make a decision by the end of March.


I will probably be in the Villages for a few more years.

As you pick make sure you understand the difference between a HMO and a PPO advantage plan. Being as young as you are I would start with the UHC PPO. Slightly higher deductibles and out of pocket but much more flexible for nationwide coverage. We have TVH since its inception and are snowbirds. We very much like it. With the PPO we have had no issues in either location. In fact we have two primary docs - one here one and one in our seasonal home. We have not encountered one refusal or out of network yet. Been to hospitals, and specialists in both locations and once on our journey between locations - seamless.

[Taltarzac725]

As you pick make sure you understand the difference between a HMO and a PPO advantage plan. Being as young as you are I would start with the UHC PPO. Slightly higher deductibles and out of pocket but much more flexible for nationwide coverage. We have TVH since its inception and are snowbirds. We very much like it. With the PPO we have had no issues in either location. In fact we have two primary docs - one here one and one in our seasonal home. We have not encountered one refusal or out of network yet. Been to hospitals, and specialists in both locations and once on our journey between locations - seamless.

I might change next year. The Medicare site kind of pushed me towards what I applied for. Not sure if it was the PPO or the HMO. Just went by what they had online. I do not see myself moving for a few years and if I did it probably would be very close to the Villages unless family matters pull me somewhere else.

[Aces4]

Very true, cost is often the decision maker. As someone who has had both a Medicare supplement plan and now a UHC advantage plan I can speak to both the benefits and cost issues. When we retired at 65, 15 years ago, we choose Plan F initially and experienced no issues with the plan or the care we required (very very little). Both my wife and I were quite healthy. Now while we could then and now readily afford the high monthly fee for plan F or G the cost seemed to increase dramatically each year.

We arrived at a point 10 years ago where we were paying about $400 a month for plan F with the prospect that it would go even higher. We were healthy and therefore receiving no benefit from a high priced plan. We than looked at the UHC advantage plan with a total cost of $38 per month. A savings of about $320 a month or $3800 a year. We switched and have had zero issues with the care and coverage. Kept all our doctors, picked up dental and vision coverage in addition.

Now we arrive in 2025 and my wife at 77 has been diagnosed with stage 2 breast cancer, it's 99% curable but there are operations (2) and radiation treatments costing well into the 1000's of dollars. Every test and process has been approved without any delay. The treatment process has been excellent

With UHC we have a max out of pocket per year of $6700 and of course with the expected expense we will hit that figure. However over ten years we have saved more than $38000, all of it tucked safely away, so the figure does not concern me in any way.

In my opinion the choice people make should be based first on the state of their health and the health of their elders and ancestors. As always insurance is a bet for or against yourself.

So in 5 1/2 to 7 years you could be behind the eight ball coverage wise. Nothing like playing a little Russian roulette. BTW, is that out-of-pocket per person or a total for the two of you per year?

[MX rider]

Very true, cost is often the decision maker. As someone who has had both a Medicare supplement plan and now a UHC advantage plan I can speak to both the benefits and cost issues. When we retired at 65, 15 years ago, we choose Plan F initially and experienced no issues with the plan or the care we required (very very little). Both my wife and I were quite healthy. Now while we could then and now readily afford the high monthly fee for plan F or G the cost seemed to increase dramatically each year.

We arrived at a point 10 years ago where we were paying about $400 a month for plan F with the prospect that it would go even higher. We were healthy and therefore receiving no benefit from a high priced plan. We than looked at the UHC advantage plan with a total cost of $38 per month. A savings of about $320 a month or $3800 a year. We switched and have had zero issues with the care and coverage. Kept all our doctors, picked up dental and vision coverage in addition.

Now we arrive in 2025 and my wife at 77 has been diagnosed with stage 2 breast cancer, it's 99% curable but there are operations (2) and radiation treatments costing well into the 1000's of dollars. Every test and process has been approved without any delay. The treatment process has been excellent

With UHC we have a max out of pocket per year of $6700 and of course with the expected expense we will hit that figure. However over ten years we have saved more than $38000, all of it tucked safely away, so the figure does not concern me in any way.

In my opinion the choice people make should be based first on the state of their health and the health of their elders and ancestors. As always insurance is a bet for or against yourself.

Very well said. We're on UHC Advantage and our experience has been excellent as well.

[Taltarzac725]

I am on UHC the Villages Medicare Advantage HMO-POS. They did assign a doctor for me. I have just been using Urgent Care so far but did have Florida Blue.

It will take me a while to figure out how all this works.

[BrianL99]

Very true, cost is often the decision maker.

$38000, all of it tucked safely away, so the figure does not concern me in any way.



So in 5 1/2 to 7 years you could be behind the eight ball coverage wise. Nothing like playing a little Russian roulette. BTW, is that out-of-pocket per person or a total for the two of you per year?

It is almost always about "cost".

In the 1000's of posts about this subject on TOTV and other sites, I have never ONCE heard ...

"Oh, I have a Medicare Advantage Plan", because the health care is soooooo much better".

Cost or convenience is always the driving force.

If you're willing to pay enough to have a Medicare Supplemental, you are in control of your healthcare.

If you want to save a few bucks and go with Medicare Advantage, an Insurance company is in charge of your healthcare.

This is not a complicated or mysterious subject.

[jimbomaybe]

I understand your opinion. But, if a Villager cannot get an appointment at a Villages health care facility because of overcrowding, what is the point of building health care facilities on Villages property? The developer is trying to create a convenient environment for people who want to buy houses and get convenient health care.
People buy things on the basis of perception to a greater extent than the reality , that one deals with when the devil in the details emerge

[ROCKETMAN]

We have had advantage plans for 15 years and no issues until now. My wife has cataracts both eyes and Freedom had only 1 provider. Unfortunately for cataract surgery you needed a third party approval which we never got. Appointment got cancelled 15 minutes before we got to appointment. Fortunately freedom now has mid Florida eye and finally have appointment for pre surgery. Dr. Panzo has been great to work with.

[MX rider]

It is almost always about "cost".

In the 1000's of posts about this subject on TOTV and other sites, I have never ONCE heard ...

"Oh, I have a Medicare Advantage Plan", because the health care is soooooo much better".

Cost or convenience is always the driving force.

If you're willing to pay enough to have a Medicare Supplemental, you are in control of your healthcare.

If you want to save a few bucks and go with Medicare Advantage, an Insurance company is in charge of your healthcare.

This is not a complicated or mysterious subject.

Wrong!
You're painting with a broad brush, never a good idea.
For us it was about value not cost.
We chose UHC Advantage because of the overall package that includes vision, dental and the wellness benefits.

Many of us did our homework and chose MA. It works for us. Btw, SHINE said it was a very good option.

Their provider network is nationwide and we were very happy with the in network providers available to us. We're part of The Villages Health and really like it. Now, does every doctor and hospital take UHC MA? No, but many excellent providers do. We know because we checked.

Btw, our out of pocket max is $3700. That's less than the max I had with my insurance when I was working.

[Aces4]

It is almost always about "cost".

In the 1000's of posts about this subject on TOTV and other sites, I have never ONCE heard ...

"Oh, I have a Medicare Advantage Plan", because the health care is soooooo much better".

Cost or convenience is always the driving force.

If you're willing to pay enough to have a Medicare Supplemental, you are in control of your healthcare.

If you want to save a few bucks and go with Medicare Advantage, an Insurance company is in charge of your healthcare.

This is not a complicated or mysterious subject.

You mean Medicare Advantage is kinda like having all our products come from China, it's cheaper.

[eremite06]

The wife and I were enrolled in UHC with an original Villages Health PCP. When I picked up regular Medicare with a supplement I was thrown out. We now have doctors in the Villages Health Specialty system and no PCP. My wife lost her endocrinologist and two cardiologists. They want to refer her to Citrus or Advent for cardiology. We have no desire to go with Medicare Disadvantage. But it seems as though the Advantage PCP patients are being prioritized and kept in their Speciallty system over us.

[mrsstats]

One of my biggest concerns about moving to the Villages at our ages of 74 and 75 are having medical care. We have Medicare and AARP supplemental insurance now on Long Island. While our health is ok we are starting to deal with age issues. DH will need hip replacement within the next few years. While we love the Villages and know our life would be better there the health issue is a concern.

[BrianL99]

One of my biggest concerns about moving to the Villages at our ages of 74 and 75 are having medical care. We have Medicare and AARP supplemental insurance now on Long Island. While our health is ok we are starting to deal with age issues. DH will need hip replacement within the next few years. While we love the Villages and know our life would be better there the health issue is a concern.

I have a home in TV and would never consider living there, full time. I'm 72 and healthy, but the minute I start having any sort of age related medical issues, my home in TV goes on the market and I'm staying up north, where quality healthcare is available, accessible and convenient ... none of those adjectives can be applied to TV.

TV is an "Active Retirement Community" ... once the "active" part becomes challenging, it's time to get out of Dodge.

[Michael 61]

I have a home in TV and would never consider living there, full time. I'm 72 and healthy, but the minute I start having any sort of age related medical issues, my home in TV goes on the market and I'm staying up north, where quality healthcare is available, accessible and convenient ... none of those adjectives can be applied to TV.

TV is an "Active Retirement Community" ... once the "active" part becomes challenging, it's time to get out of Dodge.

You bring up a good point to ponder for those of us who are “planners”. I’m a fairly younger retiree in my early 60’s. I chose The Villages after carefully visiting and investigating many 55+ Communities throughout the US, based on how active the lifestyle is. However, as you mention, the health care situation here is sub-par where you compare to other regions of the country.

So the question - Is The Villages the optimal place to reside when one is in their 80s, no longer as active as they were in their 60s, and in need of constant and continual medical care? And if not, do you plan to remain here and make the best of it, or relocate to another state with more superior health care? Something to think about it.

[BrianL99]

You bring up a good point to ponder for those of us who are “planners”. I’m a fairly younger retiree in my early 60’s. I chose The Villages after carefully visiting and investigating many 55+ Communities throughout the US, based on how active the lifestyle is. However, as you mention, the health care situation here is sub-par where you compare to other regions of the country.

So the question - Is The Villages the optimal place to reside when one is in their 80s, no longer as active as they were in their 60s, and in need of constant and continual medical care? And if not, do you plan to remain here and make the best of it, or relocate to another state with more superior health care? Something to think about it.

I think "sub-par" is charitable.

Compared with the Northeast (& other areas of the country, I'm sure), the available healthcare in TV is abysmal. You need to go to Tampa, Orlando or Jacksonville, just to get to average.

[Michael 61]

I think "sub-par" is charitable.

Compared with the Northeast (& other areas of the country, I'm sure), the available healthcare in TV is abysmal. You need to go to Tampa, Orlando or Jacksonville, just to get to average.

I would sadly have to agree with your statement. I have accompanied several Villagers to the ER and visited them while in the hospitals in The Villages, Leesburg and Ocala area. It was an eye-opening experience for sure. I wouldn’t want to be treated in any of those hospitals if I could help it. All poorly managed, extremely poor communication, unprofessionalism amongst staff, incompetent medical care, poor bedside manner, inattentive, and in one case botched surgery on a broken wrist, causing additional corrective surgeries.

In each visit to these hospitals, I said to myself, I would never want to be treated here.