Medicare Advantage Plans 2014

[nyclicker]

For those of you that had Preferred Care Partners which is no longer available which plans are you considering for 2014?

[coach]

Pup

[2BNTV]

I am considering going back to original Medicare as oppossed to UHC Medical advantage plans.

[Floridagal]

I just switched to BlueMedicare HMO. Had all my doctors on it. The only thing I will have to get used to is referrals. I always had a PPO.

[bigallis1]

Preferred Care partners is now called: The Villages Medicare Complete (HMO)
Now owned by United HealthCare.
Might want to check it out.

For those of you that had Preferred Care Partners which is no longer available which plans are you considering for 2014?

[gomoho]

PUP - they still have a part B rebate for 2014.

[nyclicker]

Bump

[ssmith]

HMO... for every doctor you want to see you have to have referral from Primary doctor....this is according to our insurance people in Cardiology...ok plan if you do not need to see specialists.

[Avista]

HMO... for every doctor you want to see you have to have referral from Primary doctor....this is according to our insurance people in Cardiology...ok plan if you do not need to see specialists.

New Villages HMO does not require a referral.

[gerryann]

New Villages HMO does not require a referral.

I believe you are incorrect. HMO requires referral. PPO does not require referral, except for a few exceptions and procedures.

[Avista]

I believe you are incorrect. HMO requires referral. PPO does not require referral, except for a few exceptions and procedures.

2014 United Healthcare The Villages Medicare Complete HMO
Page 4
Monthly premium. $0
Primary Care Physician $0 copay
Specialist $30 Copay NO REFERRAL NEEDED

[DDoug]

Personally will not go with UHC now because of the fact their connection with AARP and they are getting rid of the docs that are not with the villages health clinics. This is what UHC told me at their office so if this incorrect then they need to get on the same page with their reps. You will have to go to those clinics and I am not crazy about that. Humana is looking to be a good way to go with a PPO. Again just my opinion.

[gomoho]

Personally will not go with UHC now because of the fact their connection with AARP and they are getting rid of the docs that are not with the villages health clinics. This is what UHC told me at their office so if this incorrect then they need to get on the same page with their reps. You will have to go to those clinics and I am not crazy about that. Humana is looking to be a good way to go with a PPO. Again just my opinion.

UHC dropping the docs to steer people to the health centers was the intial thought of why they were dropping docs; however, they are doing this throughout the country so not sure what it is all about. Physicians in Connecticut actually have a lawsuit against UHC about this exact issue.

[Avista]

Personally will not go with UHC now because of the fact their connection with AARP and they are getting rid of the docs that are not with the villages health clinics. This is what UHC told me at their office so if this incorrect then they need to get on the same page with their reps. You will have to go to those clinics and I am not crazy about that. Humana is looking to be a good way to go with a PPO. Again just my opinion.

I have their new provider book. Lots of new doctors added including Ocala Eye and Fl heart and Vascular. Many doctors in list are NOT with Villages Health.

[gerryann]

New Villages HMO does not require a referral.

I believe that you are incorrect.......but I will investigate further.

[nyclicker]

Bump

[Villages PL]

New Villages HMO does not require a referral.

I'm not sure I understand. By "referral" do you mean "permission" to see a specialist? Any specialist you choose? Or do you mean permission to see only one in-network specialist?

If it's a certain in-network specialist, that makes sense to me because The Villages Health HMO has stated that their goal is to cut down on unnecessary expensive testing. Referring you to an in-network specialist gives them the control they need to do that.

Doctors in the network will share computer records and that will be part of that effort.

[Avista]

The Villages Eye Institute will be providers of the new UHC plan The Villages Medicare Complete.

Mid Florida Opthamalogists are also in the book. I have glaucoma, and that is where I go.

[Avista]

I'm not sure I understand. By "referral" do you mean "permission" to see a specialist? Any specialist you choose? Or do you mean permission to see only one in-network specialist?

If it's a certain in-network specialist, that makes sense to me because The Villages Health HMO has stated that their goal is to cut down on unnecessary expensive testing. Referring you to an in-network specialist gives them the control they need to do that.

Doctors in the network will share computer records and that will be part of that effort.

it would be an in-network specialist -- not necessarily part of Villages Health Care.

[Villages PL]

PUP - they still have a part B rebate for 2014.

Since PUP does not mainly serve this area, what hospitals will be participating in their plan?

[NotGolfer]

We signed up with the UHC that's affiliated with the USF clinics. NO referrals to doctors within network!! All of our doctors are in this network so don't have to change them. Only thing that is different that I can see is dental...no longer Dr. Fisher is in that network if you had PCP before. We're not familiar with any of the dentist (there are several) on their list. Eye doctors are Lange, Ocala Eye and I think Mid-Florida but I could be wrong. I'm thrilled with this as before PCP I was with Ocala and liked being with them since I have diabetes and some other issues.

The Part D drug thing is different--"IF" you have many drugs etc., you may have to shop around (do your homework now) for the better places to get them.

[nyclicker]

Bump

[shankerman]

For those of you that had Preferred Care Partners which is no longer available which plans are you considering for 2014?.
************************************************** ***********
Florida Blue Medicare Advantage.
Moffitt Cancer Center accepts BC/BS Medicare Advantage plans. Shands Hospital in Gainsville also accepts BC/BS Medicare Advantage plans. .

Moffitt does not accept United Health Care - The Villages. Now isn't that strange since so much press was given to Moffitt coming to The Villages.

Did you know that Gary Morse owns 51% of United Health Care - The Villages? Do you suppose that's why The Villages Primary Care Centers which he also owns, will only accept United Health Care - The Villages Medicare Advantage plans?

Choose wisely friends.

[champion6]

Did you know that Gary Morse owns 51% of United Health Care - The Villages?I can only assume that this is your OPINION, not fact. You have stated this before, but without any proof. Are we to believe that a private individual "owns" one health insurance plan which is offered by a diversified managed health care corporation?

[DDoug]

Kind of like self insurance

[NotGolfer]

The NEW United HealthCare plan that is a part of Villages Healthcare doesn't require a referral BUT you must still be in their network. We signed up with them.

[SusanOfWoodbury]

United Health Care, Villages does that mean you can only see there doctor's. at the new building on Santa Barbara?

[SusanOfWoodbury]

I read somewhere no sure where it was, maybe the Village News, but Morse does not own the hospital...

[2BNTV]

United Health Care, Villages does that mean you can only see there doctor's. at the new building on Santa Barbara?

Your primary care doctor is the one you will go to and if not available, another doctor will see you. I called yesterday as I was under the impression thay took other Medicare Advantag plans. The literature wasn't clear at least to me they only took the UHC Medical Advantage Plan. They accept other plans if you are not on Medicare. According to the literature, they accept straight Medicare.

You can call them at 352.674.1700.

[jazzeoneaj]

I recently wanted to 'scope out' what medical facilities were accepted by the Villages UHC HMO Plan if you had a serious dx or life threatening disease.

Moffet, Shands, Mayo..none of them take the new Medical Advantage HMO Plan. They are not in network according to the Agent at UHC to which I spoke. If you choose the other Medical Advantage Plan that has the option of 'going out of network'..youdo have a coinsurance to pay.. might cost a bit more but at least you have another option.

I asked then 'where do you go for something catastrophic..she replied' TVH, Leesburg, ORMC...so not sure there are a lot of choices. Be careful and scope out if the HMO is really for you.

HMO is fine if you don't have a lot of health issues. Too bad we lost Preferred Care.:cry:

[gomoho]

I am shocked Moffit is not included - thought that was part of The Villages! Don't quite understand the concept of making this the healthiest hometown and not giving us access to the best hospitals. Of course I still don't understand why they eliminated silver sneakers either - thought exercise was an important part of staying healthy. Do they speak with forked tongue???

[casita37]

I didn't see much "advantage" to the UHC Advantage plan. They do include your part D drug plan, which is a $40 per month savings and have a small dental coverage, but it's just so limiting in doctors, facilities, etc. Two main issues for us is that Shands is not included (my husband has a doctor at Shands) and once you sign up for an advantage plan, it is more difficult to then switch over to a supplemental plan. It's not impossible, but you have to have some special permission....not sure what is involved in getting that. Fact is, we are all likely to need more medical care as we age, and those co-pays and limited options could be a problem.

If you are healthy and on the younger side of our medicare years, the UHC advantage plan is probably a good deal. For anyone with health issues, it seems to me the supplemental policy is the only way to go.

We will pay about $200 more per month (supplement plus part D), but we willl no longer have co-pays, plus we will have the added "insurance" for anything else major, or even minor, that might come along. I have a very thick folder of medical co pay receipts for my husband, and he hasn't even really been sick. A minor out-patient surgery, regular visits to the dermatologist, his specialist he visits about 4 times per year. Every little procedure creates several co-pay bills from doctors and labs, etc. It adds up quickly.

Also, to clear up what might have been misunderstood from a couple of previous posts. The Villages Health system will accept supplemental insurance and other insurance policies, as well as regular medicare, but....the ONLY ADVANTAGE plan they will accept is UHC-The Villages. If you have your advantage plan through another company like BCBS or Humana, etc., it's not accepted at TV. If you have a supplemental plan through another company, it is accepted. There may be exceptions they don't take, so best to check with them.

[jimmy D]

I believe you are incorrect. HMO requires referral. PPO does not require referral, except for a few exceptions and procedures.

avista is correct no referrals . only hmo that does not have referrals

[jazzeoneaj]

Yes, the Medical Advantage plans..are great ..one stop shop...but remember you get what you pay for.

Shand, Moffit and the others that have been listed do not have this plan available to honor should you need treatment if you are really sick, dying or whatever.

There is a window I believe to 'bow out' of the Advantage plans..only for a month..then you are stuck until reenrollment time which is usually in October.

Fortunately, I am pretty healthy and may try the HMO and HOPE that something changes for next year's plan. I hope Moffit Center here will take on patients under the Advantage Plans since they promoted themselves so. Doesn't seem fair, does it to put the bait out there and then reel it in saying 'we don't want you'.

I haven't signed up yet with Advantage Plan..just doing my homework like many others. I can't really afford the PPO Medical ADV. Plan with the option of going out of network and paying a huge coinsurance right now.

Keep the information coming and good luck.

[cinepuxon]

If your Medicare Advantage plan is ending you then have a 'guaranteed issue right' to go back to Original Medicare and pick up a Medigap policy ie., supplement. The rate the insurance company can charge you will only be based on your age and not on any existing medical condition. Medigap Plan F (most coverage) can be under $200/month and you will never see a co-pay. You will also need a Plan D which can be as low as $12/month with no co-pays for tier 1 and tier 2 generics by mail order. See a SHINE counselor at The Villages rec centers during the open enrollment season. 1-800-963 5337.

[jimmy D]

For those of you that had Preferred Care Partners which is no longer available which plans are you considering for 2014?

Just a short note. If you are picking your med adv program because it has a rebate, be careful. Lots of plans that continued with rebates are now out of business. With proper planning a rebate is unnecessary unless you need the $ to live on and if you do obviously you did not plan well for the future

[dstege]

I believe you are incorrect. HMO requires referral. PPO does not require referral, except for a few exceptions and procedures.

I sell the new UHC The Villages Medicare Complete and it does NOT require a referral

[DDoug]

I decided to go with Humana advantage plan PPO no rebate but looks better than being stuck with UHC. obamacare comes to mind with UHC. Not a good thing My opinion

[gomoho]

Just a short note. If you are picking your med adv program because it has a rebate, be careful. Lots of plans that continued with rebates are now out of business. With proper planning a rebate is unnecessary unless you need the $ to live on and if you do obviously you did not plan well for the future

Have to disagree - had PCP for 2013 and was able to have an additional $1200 in my pocket for the year (better mine than the governments). They no longer offer plans in this area, but not a big deal. Will switch to another plan the also offers a rebate (once again, better in my pocket than the governments). I understand the rebates will probably be gone for 2015, but in the meantime I have $2000 I wouldn't have had otherwise.

It's not always a matter of NEEDING the money, but sometimes it's a matter of managing your money to your benefit rather than someone else's. This is all based on the assumption the plan is something that works for you.

[2BNTV]

I didn't see much "advantage" to the UHC Advantage plan. They do include your part D drug plan, which is a $40 per month savings and have a small dental coverage, but it's just so limiting in doctors, facilities, etc. Two main issues for us is that Shands is not included (my husband has a doctor at Shands) and once you sign up for an advantage plan, it is more difficult to then switch over to a supplemental plan. It's not impossible, but you have to have some special permission....not sure what is involved in getting that. Fact is, we are all likely to need more medical care as we age, and those co-pays and limited options could be a problem.

If you are healthy and on the younger side of our medicare years, the UHC advantage plan is probably a good deal. For anyone with health issues, it seems to me the supplemental policy is the only way to go.

We will pay about $200 more per month (supplement plus part D), but we willl no longer have co-pays, plus we will have the added "insurance" for anything else major, or even minor, that might come along. I have a very thick folder of medical co pay receipts for my husband, and he hasn't even really been sick. A minor out-patient surgery, regular visits to the dermatologist, his specialist he visits about 4 times per year. Every little procedure creates several co-pay bills from doctors and labs, etc. It adds up quickly.

Also, to clear up what might have been misunderstood from a couple of previous posts. The Villages Health system will accept supplemental insurance and other insurance policies, as well as regular medicare, but....the ONLY ADVANTAGE plan they will accept is UHC-The Villages. If you have your advantage plan through another company like BCBS or Humana, etc., it's not accepted at TV. If you have a supplemental plan through another company, it is accepted. There may be exceptions they don't take, so best to check with them.

Excellent post with correct info.

If your Medicare Advantage plan is ending you then have a 'guaranteed issue right' to go back to Original Medicare and pick up a Medigap policy ie., supplement. The rate the insurance company can charge you will only be based on your age and not on any existing medical condition. Medigap Plan F (most coverage) can be under $200/month and you will never see a co-pay. You will also need a Plan D which can be as low as $12/month with no co-pays for tier 1 and tier 2 generics by mail order. See a SHINE counselor at The Villages rec centers during the open enrollment season. 1-800-963 5337.

According to the Shine couselor I saw today. You have 12 months to switch to original Medicare with a supplement, if you have been on a Medical Advantage program for several years.

In addition, you have to be careful if you have previous problems as you only get one bite at the apple. You can be rejected, so do your homework.

[gerryann]

Have to disagree - had PCP for 2013 and was able to have an additional $1200 in my pocket for the year (better mine than the governments). They no longer offer plans in this area, but not a big deal. Will switch to another plan the also offers a rebate (once again, better in my pocket than the governments). I understand the rebates will probably be gone for 2015, but in the meantime I have $2000 I wouldn't have had otherwise.

It's not always a matter of NEEDING the money, but sometimes it's a matter of managing your money to your benefit rather than someone else's. This is all based on the assumption the plan is something that works for you.

Which advantage plan will be giving the rebate...and what is the amount of the rebate for 2014? I need to do more research.....thanks

[gomoho]

PUP is offering $90 for 2014. The few others offering rebates are only doing so on a special needs basis.

[rpensabene]

Not The Villages HMO. It definitely does not require referrals.

[juneroses]

For those who are still undecided as to which Medicare Plan to choose for 2014, I highly recommend contacting Donna Stegmeier, a Villages resident, who is also a representative for many of the plans available to us.

I'd done my homework and knew which plan my husband and I wanted. We made an appointment with Donna to make our decision official. Instead of just signing us up and going on her way, however, she made a suggestion for a different plan for one of us because of an existing medical condition. That plan also saved us money.

She then pointed out some subtle differences in plans for the other of us, which led to a better choice.

It ended up that neither of the plans we've officially signed onto are the plan that I had thought we would chose.

I'm grateful to Donna for her knowledge of the various plans nuances and her guidance in choosing ones that were best for us individually.

If you'd appreciate the same type of individual attention, consider giving her a call at 352-350-7135. There's no cost to you.

June

P.S. I realize this sounds like an ad, but I promise this is TOTALLY unsolicited. I'm just so doggone pleased with Donna's input that I want to spread the word. She has NOT promised to weed my garden or do ironing in exchange. However, Donna, if you're reading this, you do know my address, so if you see a weed…

[katyk]

Hi: I too am considering PUP because of the Medicare premium return. but the agent I spoke with said that there was a possibility they will not be covering Sumter and Marion counties come February so that could put some people at risk of not having a plan any longer. Has anyone else heard anything about Pup in that respect?

[gerryann]

Hi: I too am considering PUP because of the Medicare premium return. but the agent I spoke with said that there was a possibility they will not be covering Sumter and Marion counties come February so that could put some people at risk of not having a plan any longer. Has anyone else heard anything about Pup in that respect?

That sounds kinda weird. If they are enrolling people now for jan 2014.....it is a one year contract. They wouldn't drop folks in February.......but, nowadays....who knows????? I had heard last month that the plan was not going to be offered at all for 2014....but since then I heard that folks have been signing up......so I guess we won't know anything until it happens.

[gomoho]

Hi: I too am considering PUP because of the Medicare premium return. but the agent I spoke with said that there was a possibility they will not be covering Sumter and Marion counties come February so that could put some people at risk of not having a plan any longer. Has anyone else heard anything about Pup in that respect?

Agents are putting all sorts of scares into people over PUP 'cause they can't write the policy 'cause there is no commission for them. So they are trying to convince people it's a bad idea. Shame on them - it is perfect for some - not all. Do your homework and if that plan meets your needs take advantage of the $90 rebate 'cause it may be the last year for that. You have to call PUP and enroll over the phone. If for some bizarre reason they were no longer in business in 2014 you would be allowed to enroll in another Medicare plan through a special enrollment period.

[shcisamax]

Where, when and how is SHINE?

[katyk]

Thanks for your responses about PUP. I thought my agent's information was a little "off". I suspected she may be putting me off because of her commission. Now I am pretty much convinced. She is the same agent who told me that I would qualify for a Special Needs Plan with Freedom because high cholesterol is considered a "vascular " condition. I told her my arteries are not clogged yet so am pretty sure high cholesterol (borderline) at that would not qualify me. I need the $90.00 rebate and PUP fits my needs all around so am going to go with them.
Thanks you again for your help. This forum is invaluable.

[gerryann]

I will be very curious to find out what happens with the pup plan. My agent not only told me that pup is almost out the door, but that HE has pup and is concerned himself. I hadn't at the time thought that he was telling me this due to commission...but now I'm starting to think...hmmmmm.....

On the other hand however, I went and spoke to a BLue cross agent yesterday regarding the Blue cross advantage plan and when I asked him what he thought of the pup plan, he said it's the ONLY other plan other than his, that he would recommend. Although...he said to be cautious because it may not be around forever.

[twiceis]

Optimum which is Freedom. Still gives $39 back, has Silver Sneakers & gives you over the counter perks as well

[2BNTV]

Maybe I am wrong as I frequently am but:

1. I thought all Medical Advantage Plans do not allow a supplemental plan to be purchased.

2. You can only get a supplemental plan if you are on straight Medicare. The monthly payment will be higher but there are no surprises, and you can go to any doctor that accepts Medicare.

3. If you still retain some form of coverage thru an employer/union, that will pay bills after Medicare and Medical Advantage Plans have paid out their reimbursement.

[Hky01]

From UHC The Villages online book:

"Even though your PCP is trained to handle the majority of common health care needs, there may be a
time when you feel that you need to see a network specialist. YOU DO NOT NEED A REFERRAL FROM YOUR
PCP TO SEE A NETWORK SPECIALIST OR BEHAVIORAL/MENTAL HEALTH PROVIDER. Although you do not need a
referral from your PCP to see a network specialist, your PCP can recommend an appropriate"

I am not using UHCTV they are two expense on drugs going with Blue/Cross HMO

[jazzeoneaj]

A Medicare Supplement Plan G or N are great alternatives to a Medicare Advantage/HMO/PPO.

No network. Can go to any doctor or hospital in any state that you want. The benefits can't change from year to year like on a Medicare Advantage. Max out of pocket costs are way less. No referrals needed. You budget for a monthly premium and don't have to worry about surprises later.

Working with an independent agent is the best way to go if you want unbiased advice on carriers and plans. Plus having a contact to manage it going forward.

Bill

But what is the Cost..thats the key. Many of us need a 'package'..many of the supplements are high cost..PLUS you have to pay the Part B of Medicare.

[jebartle]

Donna was all you promised and more....Great gal, we highly recommend anyone contacting Donna for their insurance needs...:BigApplause:
p.s. we would like some weed removal also, :D:D:D




For those who are still undecided as to which Medicare Plan to choose for 2014, I highly recommend contacting Donna Stegmeier, a Villages resident, who is also a representative for many of the plans available to us.

I'd done my homework and knew which plan my husband and I wanted. We made an appointment with Donna to make our decision official. Instead of just signing us up and going on her way, however, she made a suggestion for a different plan for one of us because of an existing medical condition. That plan also saved us money.

She then pointed out some subtle differences in plans for the other of us, which led to a better choice.

It ended up that neither of the plans we've officially signed onto are the plan that I had thought we would chose.

I'm grateful to Donna for her knowledge of the various plans nuances and her guidance in choosing ones that were best for us individually.

If you'd appreciate the same type of individual attention, consider giving her a call at 352-350-7135. There's no cost to you.

June

P.S. I realize this sounds like an ad, but I promise this is TOTALLY unsolicited. I'm just so doggone pleased with Donna's input that I want to spread the word. She has NOT promised to weed my garden or do ironing in exchange. However, Donna, if you're reading this, you do know my address, so if you see a weed…

[2BNTV]

From UHC The Villages online book:

"Even though your PCP is trained to handle the majority of common health care needs, there may be a
time when you feel that you need to see a network specialist. YOU DO NOT NEED A REFERRAL FROM YOUR
PCP TO SEE A NETWORK SPECIALIST OR BEHAVIORAL/MENTAL HEALTH PROVIDER. Although you do not need a
referral from your PCP to see a network specialist, your PCP can recommend an appropriate"

I am not using UHCTV they are two expense on drugs going with Blue/Cross HMO

:agree: I want to see the doctors I feel comfortable with, and not have to start over. FL Blue HMO Lifetime for me. Their website is very easy to navigate unlike UHC. UHC reps have informed incorrectly on providers that were suppossed to be in network. They need to update their network more frequently or maybe their dropping doctors that don't submit to their reduced rate of payment schedule. One doctor complained to me there is nothing left for him, after UHC receives a service notice, and the corresponding reimbursement.

Just sayin......

[gomoho]

:agree: I want to see the doctors I feel comfortable with, and not have to start over. FL Blue HMO Lifetime for me. Their website is very easy to navigate unlike UHC. UHC reps have informed incorrectly on providers that were suppossed to be in network. They need to update their network more frequently or maybe their dropping doctors that don't submit to their reduced rate of payment schedule. One doctor complained to me there is nothing left for him, after UHC receives a service notice, and the corresponding reimbursement.

Just sayin......

Please understand - doctors renegotiate their contracts annually with the insurance companies - so they can come and go anytime of the year. There is no guarantee you will always be able to see the doctor of your choice unless you have a supplement which allows you to see any doctor in the country that accepts Medicare.

[2BNTV]

Please understand - doctors renegotiate their contracts annually with the insurance companies - so they can come and go anytime of the year. There is no guarantee you will always be able to see the doctor of your choice unless you have a supplement which allows you to see any doctor in the country that accepts Medicare.

Very good point as this same doctor said he was dropping from Florida Blue in February 2014, as the result of litlle reimbursement. Maybe I need to reconsider going, to Original Medicare with a supplement assuming I can get accepted, as SHINE informed me that you only get one bite at the apple if you have been on a medical advantage plan for more than 12 months and have been to a doctor for a well documented condition that might get one rejected. ARGGGGGGGGGGGGG!!!!!!!!!

Selecting a plan will keep anyone mentally sharp, as they are so many things to consider. They should make it easier for us older folks, and not have to consider so many alternatives :smiley:

[BigJohn]

I am a Villager who happens to be a Medicare Advantage sales agent. If you would like to know more about the Plans available here in the Villages, just send me a "Private Reply". There is a bit of inaccurate info on this thread.