[LoriAnn]

The likelihood of attracting a larger well equipped not-for-profit hospital to the area has a lot to do with the prevalence of replacement policies. Traditional Medicare pays much higher than a replacement. Every provider of services which includes hospital, MD's, testing centers, labs, home health, DME must make a decision on being out-of-network or in-network with each replacement plan. Out-of-network means 25-30% copay along with deductibles. If they choose to be in network they must sign a contract agreeing to accept payments that are much lower than traditional Medicare. To complicate matters, the replacements pay very, very slow. That is why most providers accept traditional Medicare and the replacements have spottier available providers. If a provider such a specialist is in great demand, they are much less willing to accept poor paying insurances. My guess is that traditional Medicare with supplements are in the majority if only by a nose because of Moffitts willingness to open cancer treatment center here.

[2BNTV]

Originally Posted by ajdeck

The one thing that has kept us from moving to TV is the health insurance.

The major reason I didn't move when I first saw TV is that I wouldn't have health coverage and a very good friend who was the picture of health had developed a serious heart problem that required surgery. Shortly thereafter, the housing market crashed and burned.

I have cancer and have no idea of which is the best plan. After talking to a few people seems everyone is just as confused as I am. aj

I am so sorry to hear of your having cancer and I can fully understand why you are staying put so you can receive the care you would need. I started to look at the literature last night and had to put it down before my head exploded. So confusing and very unclear in their terminology.

Would be nice if one had one place to really get the whole story so you could make a real educated decison.

AMEN to that statement.

It would be helpful if all plans would generate a "Benefits at a Glance" booklet instead of a thick manuel that is a chore in itself to understand. I will call my plan today and find out how much the plan changed from last year.

So many options to choose from and everyone has to decide for themselves what plan best suits their needs.

Best wishes on your health ajdeck.

[VillagesFlorida]

Originally Posted by 2BNTV

I am so sorry to hear of your having cancer and I can fully understand why you are staying put so you can receive the care you would need. I started to look at the literature last night and had to put it down before my head exploded. So confusing and very unclear in their terminology.

Would be nice if one had one place to really get the whole story so you could make a real educated decison.

AMEN to that statement.

It would be helpful if all plans would generate a "Benefits at a Glance" booklet instead of a thick manuel that is a chore in itself to understand. I will call my plan today and find out how much the plan changed from last year.

So many options to choose from and everyone has to decide for themselves what plan best suits their needs.

Best wishes on your health ajdeck.

In the back of the new Medicare booklet for 2012 there are brief comparisons of the "Medicare Health Plans" available in our area. Check those out, narrow your choices down to a few, and examine those in detail by going to their web sites or ordering paper material that you can peruse at your leisure. Compare coverage and costs to original Medicare and don't forget to add in the expense of a good supplement if going with Medicare.

[chachacha]

The benefits from Preferred Care Partners and Freedom etc are tempting but i am sticking with my PPO because if something serious happens, i want to be able to go to Shands in Gainesville which is considered our best hospital, and even though it is out of my network, at least part of my bill would be paid, whereas i don't think ANYTHING would be covered under an HMO which is out of network. Am i correct about this or am i misguided?

[2BNTV]

Originally Posted by VillagesFlorida

In the back of the new Medicare booklet for 2012 there are brief comparisons of the "Medicare Health Plans" available in our area. Check those out, narrow your choices down to a few, and examine those in detail by going to their web sites or ordering paper material that you can peruse at your leisure. Compare coverage and costs to original Medicare and don't forget to add in the expense of a good supplement if going with Medicare.

Thanks for the hints. I saw a plan that might suit my needs better at less cost. The old plan was increasing cost for the same coverage as last year. I called the newer plan and asked for literature. Same doctors I go to now with lower deductibles.

I love this site as it has so many knowledgable and wonderful members.

Thanks again.

[EdV]

Originally Posted by VillagesFlorida

I HAVE done some research and here is what I found regarding some of the scenarios you pointed out. The figures I am presenting here are for Original Medicare with no supplemental insurance, and the advantage plan I have, which is Preferred Care Partners Gold Plan

A "long hospitalization" (I'm using the time limits on the Medicare website and the Preferred Care partners 2012 coverage booklet) of 150 days:

If all I have is Medicare I would pay out-of-pocket $43,582

PCP..........I would pay $350 co-pay, total, for the first 7 days only. No limit on additional days.

Rehab in skilled nursing facility:

Medicare: $0 for days 1-20
$ 141.50 per day, for days 21-100
Total for 100 days=$11,320 out-of-pocket

PCP: $0 for days 1-10
$ 50 a day, for days 11-20
$ 75 a day, for days 21-100
Total for 100 days $6500 out-of-pocket

Home Health Care coverages are the same and the costs are the same, $0.

Medicare pays 80% for out-patient rehab
PCP has a $25 co-pay

Hubby has required Durable Medical Equipment for 15 years for his sleep apnea. When we had Medicare and a supplemental policy that we paid extra for our cost was $0. On PCP our cost is $0.

Now, if one wants to buy a supplemental policy that will pick up the 20% that Medicare doesn't cover that is an extra cost every month. When we left AARP United Health Care supplemental coverage last year we were paying $200 a month ea. for medical and drug coverage. PCP includes drug coverage at no cost and it is every bit as good as what I was paying almost $40 a month for. PCP will be returning $75 to me in 2012, every month, for the Medicare Part B premium. If I stay reasonably healthy I will have an extra $3300 a year in my savings account. (Yes, we tuck away the savings we are realizing every month). If, worst case scenario I have a serious illness, I have a $5000 out-of-pocket maximum.

As for not being able to go to any doctor I want, or not receiving good medical care in the future should I need "specialists", etc., there are many good and qualified doctors on the PCP provider list. As far as I am concerned the care I have received from the PCP doctors has been as good, and maybe even better as what I got when I was paying the big bucks.

We could all go on debating this issue for years, and we probably will. In the end, we have to educate ourselves and then make the best decision we can about our health care coverage.

Excellent post VillagesFlorida, this is an example of “Facts In Evidence”. Unless someone can find an error in the math it should be able to stand on its own. It doesn’t mean it’s the final answer, but it sure beats the “Trust me I know posts”.

[B&BTexas]

Do you have any Primary Care Physician recommendations for the Prefered Care Partners Gold Plan? We will be using this plan when we move around the first of 2012. We are both healthy and only have one prescription between us. For us this plan makes the most sense given our health, at least the first year.
B&BTexas

[LoriAnn]

Originally Posted by EdVinMass

Excellent post VillagesFlorida, this is an example of “Facts In Evidence”. Unless someone can find an error in the math it should be able to stand on its own. It doesn’t mean it’s the final answer, but it sure beats the “Trust me I know posts”.

I don't think anyone ever implied that traditional Medicare alone is the best option. The ideal protection includes a supplement or secondary insurance. I understand that everyone cannot afford that option. In that case, you do the best you can. I never said "trust me I know". But, unfortunately I do. I am a managing partner of a physician-owned hospital that has a home health, hospice, free standing therapy, and rehab component. Learn from what I know, or ignore it. It's your choice. If I thought you really wanted to understand (EdVinMass) I would be more specific ,but, I suspect you prefer to argue and insult. I'm moving to another thread to talk about tempur-pedic beds or something a bit less prone to anger.

[EdV]

Originally Posted by LoriAnn

. If I thought you really wanted to understand (EdVinMass) I would be more specific ,but, I suspect you prefer to argue and insult. I'm moving to another thread to talk about tempur-pedic beds or something a bit less prone to anger....

I'm not angry, where did that come across? I'm just trying to debate the issue, and it's a very important one, don't you thinK?

[Avista]

Originally Posted by B&BTexas

Do you have any Primary Care Physician recommendations for the Prefered Care Partners Gold Plan? We will be using this plan when we move around the first of 2012. We are both healthy and only have one prescription between us. For us this plan makes the most sense given our health, at least the first year.
B&BTexas

My husband is pleased with Janmejay Shaktawat (Dr Jay). I am in the process of transferring to him. He is a board certified Internist. Did his residency in PA. Website is:
www.tcp,group.com

He is on Wedgewood Dr and also in Spanish Springs.

I'm sure there are other good docs as well.

[English Ivy]

For everyone posting about Preferred Care Partners Gold Plan for 2012, are you aware that it is not the same Gold plan as for 2011?

In 2011 the Gold plan was the "better" plan with more coverage but no reimbursement of $'s. In 2012 the "better" plan will, I believe, be referred to as the "Select" plan.

It's very confusing!

[Avista]

Originally Posted by English Ivy

For everyone posting about Preferred Care Partners Gold Plan for 2012, are you aware that it is not the same Gold plan as for 2011?

In 2011 the Gold plan was the "better" plan with more coverage but no reimbursement of $'s. In 2012 the "better" plan will, I believe, be referred to as the "Select" plan.

It's very confusing!

Yes, there a some minor changes. They merged the 2 2011 plans into one. This year we will receive $75 back, and $25 quarterly for
OTC medication. Also, we will need a referral for some specialists. Specialists are $10 copay. Primary care docs do not have a copay. Hospital days are $50 for first 5 days then zero.

[drdodge]

You should go to a Freedom Health seminar. I have been with them for 3years and I have a good relationship with them. I do not pay anything for their plan. Last year they took care of about 70.000 in charges. It does not cost anything to listen
drd

[VillagesFlorida]

Originally Posted by drdodge

You should go to a Freedom Health seminar. I have been with them for 3years and I have a good relationship with them. I do not pay anything for their plan. Last year they took care of about 70.000 in charges. It does not cost anything to listen
drd

I was thinking of doing that, just to compare to PCP's plan. You are correct, it doesn't cost a thing to sit there and take notes! Information is power! My main concern would be the list of providers and how that compares to the Preferred care Partners list. I am going to go online to see what information I can find there. I should be able to see a provider list there.

[Avista]

Originally Posted by drdodge

You should go to a Freedom Health seminar. I have been with them for 3years and I have a good relationship with them. I do not pay anything for their plan. Last year they took care of about 70.000 in charges. It does not cost anything to listen
drd

We looked into Freedom. One of the differences I see is that their first five hospital days are $225 each, whereas Preferred Care Partners is $50/day. Their specialists have a $30 copay and Preferred Care $10.

Also, our physicians are not on Freedom.

This is a great discussion. I keep looking to see if I can find anything better, but so far I like Preferred Care Partners.