[jojo]

We knew it was coming and got the dreaded letters today. We will be making appointments with SHINE and the United Health Store but would like to hear if any of you have knowledge or experience with two questions. First question is if you are assured of continuing the Medicare Advantage plan if you are on it. One of our major fears is that we understand that we would have to requalify for the Supplement plan which we are now guaranteed to continue. We currently do not have any major health issues but like everyone else we are getting older. The second question relates to out of network coverage. If we do want a Sloan Kettering, Mayo, or MD Anderson e.g., is there any coverage of the 20%? We would go with our original decision to stick with the supplement plan if we were not very happy with the Villages Health System. Unfortunately we really like it and this is creating a huge dilemma for us.

[skyking]

Typically Medicare Advantage plans only cover emergency and urgent medical needs outside the network. They may allow a referral outside the network if no one in the network can provide the services.

Medicare supplement plans provide benefits for any services and at any provider that is covered by Medicare, that is, the Medicare intermediary makes the determination of benefits not the supplemental carrier.

[Investment Painting Contractors]

Mary & I have United Health Care Plan F & J After my $25,000 Linx Surgery at Mayo clinic my share of the bill was $8.00 because I took a Tylenol instead of an Oxy. That is the only time I have paid anything since I got the plan 5 years ago. We can go to any doctor we want in the US. ( No Co-Pays)

[Bogie Shooter]

Originally Posted by Investment Painting Contractors

Mary & I have United Health Care Plan F & J After my $25,000 Linx Surgery at Mayo clinic my share of the bill was $8.00 because I took a Tylenol instead of an Oxy. That is the only time I have paid anything since I got the plan 5 years ago. We can go to any doctor we want in the US. ( No Co-Pays)

Medicare eligible? Is F & J UHC Advantage?

[skyking]

Lettered Medicare plans are supplemental plans (aka Medigap) not Medicare Advantage. Few MA plans would cover care at Mayo.

Explanation of the standard Medigap plans:

Comparing Medicare Supplement Plans

[wendyquat]

Originally Posted by Bogie Shooter

Medicare eligible? Is F & J UHC Advantage?

The Medicare Advantage Plan is considered a "C" plan.

When I was approached about changing to Medicare Advantage I called my Cardiologists in Spanish Springs and they told me they had been "dumped" from participation as of December 31 and could not participate. That was good enough for me to stay with my current UHC Plan F.

[skyking]

Medicare Advantage is a replacement for traditional Medicare. The insurance company is paid directly by the government and assumes the risk for covering your care. By managing utilization and quality they typically can provide more benefits for the same or lesser cost than Medsup plans. The trade-off is that you agree to receive care in a limited network (like the Villages healthcare system). If you are happy with staying in the network it is a good choice but you can't have both...expanded benefits and unlimited choice of providers.

[skyking]

Originally Posted by wendyquat

The Medicare Advantage Plan is considered a "C" plan.

When I was approached about changing to Medicare Advantage I called my Cardiologists in Spanish Springs and they told me they had been "dumped" from participation as of December 31 and could not participate. That was good enough for me to stay with my current UHC Plan F.

Many years ago when I first entered the health insurance industry we used to refer to the private "Medigap" insurance as "Part C". Medicare Part A pays for inpatient hospital bills and Part B pays for hospital outpatient and professional services. Now "C" refers to one of standardized MedSup benefits. CMS developed the standard benefit plan designations to help beneficiaries compare cost between insurance carriers on an apples to apples basis. As a previous poster stated, pick the benefit plan most suitable for you and then choose the carrier with the lowest cost.

[dotti105]

Many of the posts I have read here and on other threads regarding the changes at The Villages Health Care imply that the UHC Advantage plan has a very small "in network" group of physicians. That is entirely wrong. The "in Network" group is very large and offers docs throughout Florida. Specialists are covered in every county in Florida and the Advantage plan offers "passport" coverage which covers you in 47 states.

There will be changes with any insurance plan every year. But we have found the UHC Advantage plan to be excellent for our needs which have included Cancer treatment and will soon be covering a total Knee replacement, both with top doctors in their specialty.

It is true that U.of F./Shands is not covered nor is Mayo. But we have found our top choice of specialists were indeed covered by our policy.

Do your homework. Ask all the questions and don't panic. If you have excellent insurance that you want to keep rather than change to UHC Advantage, you will have good options. Remember Florida is all about senior citizens. Most of the health care providers in Florida take some form of Medicare and many of those take several different insurance plans. There is no shortage of health care providers in this area. You should be able to find the care you need regardless of your insurance plan.

[londonsquare]

I am devastated.....got my letter last nite.....thought I would be ok because I was an original patient....medigap policy....no advantage....I really like Villages Health but?????? Have been here 13 years ...here I go again.....searching for a new primary......hate it!

[rubicon]

Like many other products it ends up with pay me now or pay me later. people are going to choose based on cost vis a vis their health care needs. One reminder if you are in a supplement plan and leave the plan then you may be subject to insurability issues. I am with Blue Plan F. If I leave and want to return I am subject to health pre-conditions criteria . Another consideration is that my docs seem pleased with my Plan F. Happy doc happy happy lot. Indeed its confusing out there and none of us know what tomorrow will bring in either our health care needs or health policies which always seem to be in flux these days

[Mudder]

I agree totally with what Dotti said. I have a need for a very special specialist, found her in Boston, called made an appointment for Oct when we'll be there for family wedding. You can find who/what you need in the system. For us, a very workable health care system. Being able to spend at least a half hour with primary care doctor on a routine visit is priceless.

[goodtimesintv]

Originally Posted by Mudder

I agree totally with what Dotti said. I have a need for a very special specialist, found her in Boston, called made an appointment for Oct when we'll be there for family wedding. You can find who/what you need in the system. For us, a very workable health care system. Being able to spend at least a half hour with primary care doctor on a routine visit is priceless.

Of these "Accepted Insurances" at TVHealth, which MA plan do you have?

Accepted insurance

If you are eligible for Medicare, we want you to know that the only Medicare Advantage plans The Villages Health participates in are those offered by UnitedHealthcare�.

UnitedHealthcare� The Villages� MedicareComplete� (HMO) Plan 1
UnitedHealthcare� The Villages� MedicareComplete� (HMO) Plan 2
AARP� Medicare Complete Choice� (Regional PPO)
AARP� Medicare Complete Choice� (HMO)
United Healthcare� Medicare Advantage Dual Complete

We continue to Participate with the following Commercial Insurances:
Avmed
Blue Cross & Blue Shield
Cigna
Multiplan
Private Healthcare System/PHCS
Tricare Standard
United Healthcare

[Villager Dude]

I have BCBS Part F but just checked the medicare.gov website and it appears it is not offered. Do any of you know if it will be offered in the next open enrollment if you are a current policy holder ?