Talk of The Villages Florida

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-   Medical and Health Discussion (https://www.talkofthevillages.com/forums/medical-health-discussion-94/)
-   -   Medicare Supplement - Do Networks Apply? (https://www.talkofthevillages.com/forums/medical-health-discussion-94/medicare-supplement-do-networks-apply-348087/)

Indydealmaker 02-29-2024 09:46 AM

Quote:

Originally Posted by rustyp (Post 2305850)
Here is a big one -TVHS only accepts advantage plans once one is medicare eligible

How is that particularly good?

MX rider 02-29-2024 09:47 AM

Quote:

Originally Posted by Marine1974 (Post 2306188)
I’ll keep it short , why would I go to a primary care doctor if I have sciatica? Your burdening the healthcare system if you go to a primary care doctor and refers you to a orthopedic doctor which because I’m on regular Medicare
I don’t need a referral. My time is valuable. And I pay for regular Medicare and a supplemental insurance, which gives me a choice and I’m covered unlike
Medicare advantage plans which burden the healthcare system and make you see two doctors to get a referral before seeing a specialist. .

Your last sentence is not true. My advantage plan does not require this at all. I just used it to go to a specialist.

Indydealmaker 02-29-2024 09:50 AM

Quote:

Originally Posted by rustyp (Post 2305882)
55000 patients enrolled in TVHS most likely don't agree with you. Amazing that is over 1/3 the population of The Villages.

Just a marketing concept. Your healthcare is dictated by the profits. Advantage companies don't make money if you require more care than your allotment. Logic says that must effect the care.

TVTVTV 02-29-2024 10:10 AM

Quote:

Originally Posted by retiredguy123 (Post 2305944)
Note that the OP's only question was, if they have original (traditional) Medicare and a Medicare supplement plan, is there a network of providers that they must use to be paid by the supplement plan? The question has already been answered and the answer is no. If the provider accepts traditional Medicare, then the supplement plan will cover all or part of the coinsurance.

Thank you to the few of you who answered my direct question. I wasn't looking for advice on every other aspect of health care, just a direct inquiry if "in network" and "out of network" exists with any Medicare supplement (= Medigap). I have a great PCP that I see regularly. I have done a lot of reading on Medicare, and will be in contact with SHINE. I know everyone's situation is different, so what fits my needs may not be the choice for someone else. Since PCP's and specialists may move or join another company, they may be in an Advantage plan one year and not the next. When I am faced with a medical crisis, I want to decide where in the country I want my treatment. For example, there don't seem to be any Advantage plans locally that would permit me to go to the Mayo Clinic if that's where my PCP said had the best treatment. I'd have to use an "in-network" provider that may not be my preference. (If there is one, no need to tell me which one). This is just an example, and could apply if you wanted to go somewhere with advanced treatment options for a myriad of health issues.

I really appreciate your direct answer to my general question, which was if I choose a specific company (like FL Blue or UHS) SUPPLEMENT, then I can go anywhere and see any PCP or specialist (yes, if they are accepting new patients, etc.), as NETWORKS don't apply with supplement (medigap) plans, but do with Advantage Plans. I will continue to research.

rustyp 02-29-2024 10:11 AM

Quote:

Originally Posted by Indydealmaker (Post 2306191)
How is that particularly good?

About The Villages Health - The Villages Health

biker1 02-29-2024 10:28 AM

Just in case you didn't realize, all of the Supplemental Plans are identical in terms of coverage. In other words, one insurance company's Plan G is identical to another insurance company's Plan G. The cost, however, will vary. In addition, some of the insurance companies may allow you change from one plan to another (say move from Plan G to Plan N) without going through underwriting. For example, UHC in Florida allows this.

Quote:

Originally Posted by TVTVTV (Post 2306202)
Thank you to the few of you who answered my direct question. I wasn't looking for advice on every other aspect of health care, just a direct inquiry if "in network" and "out of network" exists with any Medicare supplement (= Medigap). I have a great PCP that I see regularly. I have done a lot of reading on Medicare, and will be in contact with SHINE. I know everyone's situation is different, so what fits my needs may not be the choice for someone else. Since PCP's and specialists may move or join another company, they may be in an Advantage plan one year and not the next. When I am faced with a medical crisis, I want to decide where in the country I want my treatment. For example, there don't seem to be any Advantage plans locally that would permit me to go to the Mayo Clinic if that's where my PCP said had the best treatment. I'd have to use an "in-network" provider that may not be my preference. (If there is one, no need to tell me which one). This is just an example, and could apply if you wanted to go somewhere with advanced treatment options for a myriad of health issues.

I really appreciate your direct answer to my general question, which was if I choose a specific company (like FL Blue or UHS) SUPPLEMENT, then I can go anywhere and see any PCP or specialist (yes, if they are accepting new patients, etc.), as NETWORKS don't apply with supplement (medigap) plans, but do with Advantage Plans. I will continue to research.


MX rider 02-29-2024 10:35 AM

Quote:

Originally Posted by Indydealmaker (Post 2306195)
Just a marketing concept. Your healthcare is dictated by the profits. Advantage companies don't make money if you require more care than your allotment. Logic says that must effect the care.

You're making assumptions. Btw, doctors and hospitals are for profit. Advantage plans aren't for everyone, but they're a good option. Choice is a good thing.

Kittyjohn 02-29-2024 10:47 AM

Secondary ins
 
Please check with SHINE. There are also secondary policies such as may be offered along w Medicare from a previous employer. Other rules such as networks etc may apply.

rustyp 02-29-2024 10:57 AM

Quote:

Originally Posted by rustyp (Post 2305882)
55000 patients enrolled in TVHS most likely don't agree with you. Amazing that is over 1/3 the population of The Villages.

Quote:

Originally Posted by Indydealmaker (Post 2306195)
Just a marketing concept. Your healthcare is dictated by the profits. Advantage companies don't make money if you require more care than your allotment. Logic says that must effect the care.

Apparently 55000 patients in TVHS have yet to require more care than their allotment or they would be heading for the exit. FYI 2023 53% of all Medicare eligible seniors are enrolled in an Advantage plan.

Do not interpret my position as an Advantage plan is better or worse than Medicare with a supplement. I have had both. Both worked equally well for me. I went with the Advantage plan due to my desire to be in TVHS. Have you been in enrolled in both or are you speaking as an internet surfer ?

TVTVTV 02-29-2024 11:01 AM

Quote:

Originally Posted by biker1 (Post 2306210)
Just in case you didn't realize, all of the Supplemental Plans are identical in terms of coverage. In other words, one insurance company's Plan G is identical to another insurance company's Plan G (based on county you live in). The cost, however, will vary. In addition, some of the insurance companies may allow you change from one plan to another (say move from Plan G to Plan N) without going through underwriting. For example, UHC in Florida allows this.

Yes, thanks for the reminder of that. So for example, all G Supplements have = and identical coverage, and your choice is the company and price (based on the county you live in). With Advantage plans, you need to consider more: company, price, specific coverage and co-pays, possible perks, perhaps specific Rx sites you can use, and most importantly, the PCP's, specialists, and facilities you have in-network when you need health care.

retiredguy123 02-29-2024 11:14 AM

Quote:

Originally Posted by TVTVTV (Post 2306226)
Yes, thanks for the reminder of that. So for example, all G Supplements have = and identical coverage, and your choice is the company and price (based on the county you live in). With Advantage plans, you need to consider more: company, price, specific coverage and co-pays, possible perks, perhaps specific Rx sites you can use, and most importantly, the PCP's, specialists, and facilities you have in-network when you need health care.

Note that Medicare supplement plans for traditional Medicare are not really health insurance plans at all. They rely exclusively on the Government to review and approve claims submitted by providers of Medicare services. If the claim is approved, then the supplement plan will pay all or part of the coinsurance as specified in the plan. If the claim is rejected, the supplement plan will pay nothing. So, for them, it is just a math calculation.

Dusty_Star 02-29-2024 12:08 PM

Quote:

Originally Posted by TVTVTV (Post 2306226)
Yes, thanks for the reminder of that. So for example, all G Supplements have = and identical coverage, and your choice is the company and price (based on the county you live in). With Advantage plans, you need to consider more: company, price, specific coverage and co-pays, possible perks, perhaps specific Rx sites you can use, and most importantly, the PCP's, specialists, and facilities you have in-network when you need health care.

Teeny, tiny bit more complicated, you also purchase Plan D for drug coverage, & that choice will dictate pharmacies, but I think they also allow you to choose online or mail in pharmacies. Anyone know better, please chime in.

retiredguy123 02-29-2024 12:18 PM

Quote:

Originally Posted by Dusty_Star (Post 2306250)
Teeny, tiny bit more complicated, you also purchase Plan D for drug coverage, & that choice will dictate pharmacies, but I think they also allow you to choose online or mail in pharmacies. Anyone know better, please chime in.

I think you are referring to Medicare Part D, not Plan D. Part D is a separate drug insurance plan, not a supplement plan for Medicare Parts A and B. Medicare Part A is for hospitalization, Part B is for doctor visits, labs, surgery, etc., and Part D is for prescription drugs. You can buy a supplement plan to cover your coinsurance for Parts A and B, but I don't think you can buy a supplement plan for Part D.

Pugchief 02-29-2024 01:28 PM

Quote:

Originally Posted by golfing eagles (Post 2306073)
The Plan I signed up for is a PPO, not an HMO. Big difference

Yes, it is a big difference. Maybe I misunderstood; didn't you say you had a Medicare Advantage plan? And if so, aren't those essentially HMOs?

Hallmarks of HMOs are:
limited network of providers, zero benefits out-of-network, and "gate keeping" by PCP. Please correct me if any of this is untrue.

Pugchief 02-29-2024 01:30 PM

Quote:

Originally Posted by Marine1974 (Post 2306188)
I’ll keep it short , why would I go to a primary care doctor if I have sciatica? Your burdening the healthcare system if you go to a primary care doctor and refers you to a orthopedic doctor which because I’m on regular Medicare
I don’t need a referral. My time is valuable. And I pay for regular Medicare and a supplemental insurance, which gives me a choice and I’m covered unlike
Medicare advantage plans which burden the healthcare system and make you see two doctors to get a referral before seeing a specialist.

I agree 100% with this philosophy. Also, the provider network for Advantage plans are more limited.


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