[BrianL99]

Originally Posted by Caymus

You mean television pitchmen such as Joe Namath and Jimmie JJ Walker are not telling the whole story?

TV is not what it used to be. You can only rely on the Internet to get honest & complete information.

[billethkid]

Originally Posted by BrianL99

TV is not what it used to be. You can only rely on the Internet to get honest & complete information.

Bait right!!!!


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[BrianL99]

Originally Posted by bsloan1960

My employer allows me to take my group BC/BS into retirement so I'll have private insurance as well as Medicare. Will I face the same issues outlined in OP's post? I'm told that even though I'll have BC/BS, Medicare will be my "primary" insurance.

That will depend on which BC/BS plan you have. BC/BS offers a Medicare Advantage Plan in most states. I believe Florida Blue offers an Advantage plan.

The issue has nothing to do with Medicare being your primary insurer. It has to do with who picks up the difference. Your choice is Medicare Supplemental or Medicare Advantage. Think of it as an HMO vs PPO.

If you want to use The Villages health care system, you generally can't do it, unless you have one of their preferred Advantage Plans. I wouldn't concern yourself with being denied medical care by The Villages healthcare system ... it's atrocious. Look up reviews on the hospital or the other providers. I wouldn't go to them with a hangnail.

[pokeefe45@aol.com]

Amazed to see the disparity of opinions on the topic of 'Villages Health' and 'advantage' plans. I agree to not believe the obvious 'hater's' who form opinions prematurely, without any real exposure, and then become rigid in proving themselves correct. All I got is my personal experience- 1)Have never had a more responsive or accomodating health care situation as I have with the Villages Health. I feel like a person, and not a social security #. 2)Advantage plans have incentives to KEEP you healthy, so will work harder to prevent issues, rather than just reacting to them. It's true-they are paid a fixed fee per patient, so the healthier you are, the better off they are. That's a win/win to me, not to you? 3) The extras-free gym memberships, OTC $$ given, eye exam and glass allowances, discounted hearing aids and even dental benefits, sometimes in the thousands of $$ make it a tremendous value.
My perspective might be skewed by the fact that I am relatively healthy right now, but my hope and belief is that the 'Villages Health' will be keeping me that way for years to come. Again- no hater's please-this is MY experience here.

[Professor]

Dr. Kathy Greene over in the Lake Deaton facility accepts regular Medicare and plans to continue to do so. We switched to her last year when our previous physician over at the Colony facility retired and no one else would take a regular Medicare patient there at that time. Give her a try.

[Professor]

I would agree with your comments with one caveat. If you plan to travel a lot, or have multiple residences in other states like we do, the Medicare Advantage Plan can be inconvenient since you need to have a primary physician referral for specialty care and you may be out of your network coverage area other places. The ability to pick any physician where ever you are is a plus for regular Medicare. If you have some serious health problems, which we have experience with, and have extended stays in multiple cities regularly, you may be better off with regular Medicare. Do your homework and then make the determination based on your lifestyle. It can be tricky.

[midiwiz]

Originally Posted by retiredguy123

If The Villages health system accepted original Medicare for their primary care doctors, they would be inundated with patients from the surrounding areas, and the health centers would no longer be convenient for Villages residents to use. If you accept original Medicare, you must accommodate all patients who have it.

totally off base, This is about money only. The advantage plan provides a revenue stream for these organizations far better than what they were getting. There are several companies making a pretty penny off the advantage plan. They have quotas, check offs, etc. As for demographics there really isn't a lot of people (in comparison) on the original Medicare.

[Rzepecki]

Originally Posted by Babubhat

United healthcare advantage has been wonderful here. Ignore the haters nonsense

A serious question: How do you know you’re getting all the services you need? Doctors who accept advantage plans are paid more for providing fewer services. So how do you know if your doctor is doing all he can to help you?

[snhmhg]

I was told that’s the reason by a care professional at one of the centers, it was a financial decision.

[tuccillo]

Not exactly correct when you say that “it has to do with who picks up the difference”. If you select a MA plan, Medicare is no longer involved in your healthcare. Your MA plan, and you, are responsible for all the costs. Medicare, with the exception of you still having to pay the Part B premium, is out of the picture.

Originally Posted by BrianL99

That will depend on which BC/BS plan you have. BC/BS offers a Medicare Advantage Plan in most states. I believe Florida Blue offers an Advantage plan.

The issue has nothing to do with Medicare being your primary insurer. It has to do with who picks up the difference. Your choice is Medicare Supplemental or Medicare Advantage. Think of it as an HMO vs PPO.

If you want to use The Villages health care system, you generally can't do it, unless you have one of their preferred Advantage Plans. I wouldn't concern yourself with being denied medical care by The Villages healthcare system ... it's atrocious. Look up reviews on the hospital or the other providers. I wouldn't go to them with a hangnail.

[clouwho]

Originally Posted by retiredguy123

If The Villages health system accepted original Medicare for their primary care doctors, they would be inundated with patients from the surrounding areas, and the health centers would no longer be convenient for Villages residents to use. If you accept original Medicare, you must accommodate all patients who have it.

Medicare advantage plans are the plans of choice for low income seniors by virtue of low cost (and the seniors in our surrounding area tend to be lower income than Villagers), so this statement doesn’t make sense to me.

If you wanted to limit healthcare within The Villages, the doctors would only accept the more costly Medicare Supplement plans. Unless There is some type of Medicare advantage plan that only lets you use The Villages health care system? Which is a scary thought based on what we have seen and heard these past few years from our neighbors.

The Medicare supplement plans are more costly and have much better coverage, and a far greater selection of specialists and top notch health care facilities in the unlikely event you wind up with some unpleasant disease. You pick your doctor and your care. You are not stuck with a primary care doctor playing God with your health. Advantage plans are all well and good til you actually need serious medical care.

I am now very curious how many Villagers choose advantage vs supplements. Having listened to the health care adventures of so many of our friends and neighbors here, we will absolutely be getting a great supplement when we start Medicare next year.

[retiredguy123]

Originally Posted by clouwho

Medicare advantage plans are the plans of choice for low income seniors by virtue of low cost (and the seniors in our surrounding area tend to be lower income than Villagers), so this statement doesn’t make sense to me.

If you wanted to limit healthcare within The Villages, the doctors would only accept the more costly Medicare Supplement plans. Unless There is some type of Medicare advantage plan that only lets you use The Villages health care system? Which is a scary thought based on what we have seen and heard these past few years from our neighbors.

The Medicare supplement plans are more costly and have much better coverage, and a far greater selection of specialists and top notch health care facilities in the unlikely event you wind up with some unpleasant disease. You pick your doctor and your care. You are not stuck with a primary care doctor playing God with your health. Advantage plans are all well and good til you actually need serious medical care.

I am now very curious how many Villagers choose advantage vs supplements. Having listened to the health care adventures of so many of our friends and neighbors here, we will absolutely be getting a great supplement when we start Medicare next year.

I'm not a Medicare expert. But, about half of the people on Medicare have original Medicare, not an advantage plan. And, The Villages Health system only accepts about 2 or 3 advantage plans for primary care, even though there are many other advantage plans available to Medicare recipients. I am sure they are making a financial decision, but it seems to me that they are also trying to limit the number of patients that they serve, and that they would prefer to serve as many Villagers as they can. Otherwise, what would be the point of building so many primary care centers on Villages property? That is just my opinion.

[Caymus]

Does IRMMA surcharges also effect advantage plans?

[M2inOR]

My wife and I had health insurance from our employers for our working years until we retired in 2019. We both had HMO plans from Kaiser Permanente, and would have continued with them if they had facilities here in Florida.

We view the Medicare Advantage plans here in The Villages to be quite similar.

Back when we were under Kaiser, we had to go out of network, and Kaiser took care of everything. Just a small copay.

Same is true here under Medicare Advantage via United Healthcare at Villages Health.

We've had very good experiences. Only big expense we've had is to pay for medical procedures that Medicare did not cover; we both recently had cataract surgery. Rather than get the normal replacement lenses that Medicare would have covered, we got the deluxe lenses which take care of vision at all distances. Yes $$$.

We've also been referred to other specialists for other procedures, and all was paid by our plan except for small copays.

We are both in our late 60s, and both healthy and active. My wife is a cancer survivor. 10+ years ago, when Kaiser could not handle her early stage breast cancer, she was referred to a specialist outside of their network, and they did a great job. When my son had a severe concussion, again we got a specialist outside of the network via referral, and he was taken care of in record time. Similarly for a sports injury.

With Villages Health, we have a great PCP who addresses our questions quickly, and if we need routine care it's taken care of right away.

Last thing:
- for routine care, we go thru Villages Health and our PCP. If special care is necessary, it will be handled within Villages Health or we get a referral to specialists outside of the network if Villages Health does not have someone with the right specialty.
- if we need Urgent Care, we can go to any Urgent Care facility that Villages Health refers to us. Call first, and they will tell us where to go.
- in an emergency, we can go to wherever in the US we are close too, and when able to, let The Villages know for follow-up action.

Medicare Advantage works for us within the US. Outside the US, need to have separate travel insurance. We aren't covered by Medicare outside the US.

Yes, it can be complicated, but best to read up on how coverage works while you are healthy.

Finally, there are other Medicare Advantage plans that are offered in the area that aren't as compressive as the Florida Blue and United Healthcare plans that The Villages accepts.

[retiredguy123]

Originally Posted by Caymus

Does IRMMA surcharges also effect advantage plans?

Yes, it does