[Indydealmaker]

Originally Posted by rustyp

Here is a big one -TVHS only accepts advantage plans once one is medicare eligible

How is that particularly good?

[MX rider]

Originally Posted by Marine1974

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]

Originally Posted by rustyp

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]

Originally Posted by retiredguy123

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]

Originally Posted by Indydealmaker

How is that particularly good?

About The Villages Health - The Villages Health

[biker1]

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.

Originally Posted by TVTVTV

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]

Originally Posted by Indydealmaker

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]

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]

Originally Posted by rustyp

55000 patients enrolled in TVHS most likely don't agree with you. Amazing that is over 1/3 the population of The Villages.

Originally Posted by Indydealmaker

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]

Originally Posted by biker1

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]

Originally Posted by TVTVTV

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]

Originally Posted by TVTVTV

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]

Originally Posted by Dusty_Star

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]

Originally Posted by golfing eagles

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]

Originally Posted by Marine1974

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.