The way these plans work, based on my understanding of them through my own research, is that the government pays the medicare C insurance company a fixed amount of money per year to provide healthcare to you. I think it is around $10,000 per year. You still pay the government your medicare premium each month. The government is not in the business of making a profit. So they probably calculated what the average cost is for a medicare eligible person ($10,000?). Based on that average cost they pay the insurance company a flat fee of $10,000?. The insurance company is in the business to make a profit. So the insurance company wants to be sure that, on average, the customer, you, does not cost $10,000, or even close to $10,000 per year. They can do this by limiting the doctors/specialists you are allowed to see, or they can change your copays, or your deductibles, limit drug choices, etc. Now, on the surface, do you think you're going to get better overall healthcare deal with the profit driven insurance healthcare providing company or the non-profit government medicare system? If you think the insurance company that is paid a flat fee from the government will do a better job in your interest, then go with the insurance company. If not, then you need to look outside TVHC if you are close to 65.

But the thing is Villages Health covers so much more without paying a supplemental to a for profit company. Even our Tier One and Tier Two meds are covered without a copay.

Well those "profit-driven insurance healthcare companies" are what the "non-profit government" officeholders and employees choose for themselves, and so I would say they "profit" by us taxpayers having to pay for about 70+ percent of their private insurance plan premiums:

https://www.opm.gov/healthcare-insur...postal-hmo.pdf

Florida Plan Choices for Federal Employees:
https://www.opm.gov/healthcare-insur.../2016/state/fl

You forget that government run healthcare is at 34% overhead. Private insurers do it for 12%, and still make a profit. This leaves a lot more dollars to be spent on YOUR health, rather than bureaucrats, gov't waste, and Las Vegas parties.

Thats where I am...but turn 65 next week...They told me that as of Jan 1st, I am considered a new patient when I turn 65 (due to Medicare) and required an Advantage plan administered by United Health to stay in the Villages health system. The alternative was to find another Doctor who is in the Tricare system.

The letter stated that "If you choose a different insurance option other than Medciare Advantage, we will help you transition your care from Villages Health."

So I signed up for a PPO plan,no monthly premium, and Tricare for life said they will cover most of the deductible/copays.

Please share
 

what "Morse promises" you are worried about losing?

Quality of life issues, Grounds upkeep, Rec centers, pools, Town squares.

I'm sorry. I meant Medicare. I'll change my post.

I meant to say I'm on Medicare.

I really don't understand your comment. Federal workers are under an "employee" type health program that involves insurance companies providing their healthcare coverage, with their employer (the government) paying about 75% of the premium, and the employee (Federal worker) paying the remaining 25%. Different than medicare part B versus part C, which is what this thread is about.

Are you sure the government overhead is not paid out of a completely different bucket? Do you know if the government's payment to the insurance company included any administration costs, or was it just the cost paid out to care givers?

It's all about the money. An insurance broker for United Heathcare told me the villages health has a goal of enrolling 20k people in its Medicare Advantage program. This is a capitation program which the government pays $10k per enrollee per year. This will place the villages health into a positive cash position and a positive bottom line.

I believe that $10,000 per person is paid to the insurance company, in this case UHC. The question then would be how much of that does UHC kickback to TVH. Another question might be, are their additional financial incentives paid to TVH to reduce claims.

A capitation program typically involves the sharing of a pool of funds that are set aside throughout the year. The funds can then be distributed based on criteria established in advance. Quality of care, reduction of test usage, and decreased referral to specialists (all based on data and usually evidence based medicine) are examples.

I'm more familiar with the hospital side of capitation so it would be interesting to see if GE weighs in on the doc side.

So I'm on Medicare & have Tri Care. If OP was correct, wouldn't I have received one of those letters ? They told me awhile back I would be grandfathered in.

Our practice never got involved in any capitation plans, but I can give you an idea of how they work. The insurer will pay $x.xx per month for each enrollee, regardless of whether you see them or not. They then keep statistics on your "performance"---% of generic drugs prescribed, cost of drugs, cost of referrals, cost of radiologic exams, etc. They then compare this to all physicians in the plan, adjusted for patient demographics and underlying illnesses. As capitation got started, this information was "educational", but in the future I'm sure they will adjust payment based on this data. The problem here is that you can get destroyed by the chronic complainers and hypochondriacs who will try to make appointments every day and demand expensive testing for no reason. Like most things in life, 10% of the people can eat up 90% of the dollars very quickly. At the other end of the spectrum you'll get people who stay home and get sicker and sicker because "they don't want to bother you", or "they were waiting for their next regular appointment" I guess it takes all kinds.

According to The Villages Helath website:

"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®."

I interpret that to mean that if you choose to have a Medicare Advantage plan, it must be offered by UnitedHealthcare. If you do not have a Medicare Advantage plan, their new ploicy does not affect you. That would explain why some people (i.e., those with Medicare Advantage plans other than UnitedHealthcare) are getting letters, while others (i.e., those with no Medicare Advantage plan) are not.

One thing is clear - the information regarding their policy change is unclear.

You said you were 64. Medicare eligibility is at age 65? If you were already on medicare and had a supplemental, when they changed their policy at the beginning of the year or Oct of 2014 (don't remember), you would be grandfathered in. The issue is if you were a patient with them but not yet on medicare (under 65 yo). Then you will probably get the letter.

That's why lawyers get the big bucks. BTW, I hope you're right, but I don't think you are. It sounds weasel worded to me.

Yes, I just visited Colony Health care center this morning and asked about what is going to happen when my wife turns 65. I was told she has to get united health care or find a new doctor. I retired from a company which supplies medical insurance for both of us. [BCBS ] So now, after we helped them get started, and having a relationship with our doctors for three years they tell us to find a new doctor. Very sad, so much for the Hometown Doctor. I wonder if this is Mr. Morse's vision.

The more I read in the Daily Sun about healthcare system in the Villages and the nice story about the hospital expansion, I have to wonder if we are getting the entire story or just a sales pitch with lots of happy talk. I was already living here when we were told the only way we would see an expanded hospital was if we supported a new tax to pay for it. The referendum was defeated because when all of the facts were made known people rejected it and soon after, money was found and construction began without the tax.

Yes, I'm 64 but I have been on Medicare for a few years.
I joined the Villages Health before they started taking patients.

If it's not too personal, how does one get on medicare before age 65? Just curious.

ssdi

Yes I have Tricare and will turn 65 in a few weeks. I got "the call". The Tricare drug benefit is far superior to United Healthcare Medicare Advantage a la Villages HMO. I called Tricare to verify that I would have no drug benefit with them if I opted for a Medicare Advantage program.

Maybe it's because it's late and past my bedtime, but somewhere in my mind (somewhere), I understood that hospital expansions, new hospitals, etc. must meet certain State of Florida criteria before anything can happen. Maybe that's where the tax part came in? Seems like in some respects, Florida is kind of a "Mother, may I?" state when he comes to healthcare and new/expanded facilities on if and where.

Can you or anyone else enlighten me?

As for TVHC, I like the doctors I already had before that idea came along. None of them participate and that is A-OK with me. I hate HMO's with a passion and how the rules can constantly change and then bite you where it hurts most. Seems like all of them are run by people (bureaucrats) who know about as much about health/patient care as my cat and care about as much. (To be clear: The bureaucrats, not the doctors/nurses.)

G'nite. I'll check back tomorrow for a possible answer to my question.

These are not nasty rumors. I received my letter today. Two months before I go on Medicare. I must use a Medicare Supplement Plan to be seen at Moffitt Cancer Center. If you want to choose second class cancer care, go with the Medicare Advantage Plan. Be my guest to put your health at risk!

Received my The Villages Health notice last week
 

You're smart.

I think the latest story in The Sun was meant to cushion the rash of Dear John letters being delivered to current patients. No help to those receiving the letters. Just more propaganda to the unsuspecting.

Why are you curious ? Just curious.

I have tried really hard to stay away from this thread. (Maybe I will delete this one before it posts, just like I deleted the one I wrote yesterday. Will see.).........

Anyway, golfing eagles, I must respectfully ask if you would mind citing your source for that "34% overhead" statement.

I also wonder why nobody ever mentions the fact that stockholders are in line to be paid out of that profit -- either behind or in front of, or right alongside those bloated CEOs.

And before somebody comes in here and calls me a commie pinko profit-hater or whatever, I will play a little offense and say that I am perfectly comfortable with the market......Gimme soap and toothpaste and maybe a little telecom on the side, but owning a piece of somebody's health needs just does not seem right to me.

I was at contract tables during the time when health insurance began to morph into the mess it is now. I can remember when we got those prescription cards. Ah, yes, there was great happiness in the land, no more saving receipts for rembursement, no more recordkeeping, just go forth clutching that convenient card. Never looking at what was happening to prescription prices. Never even thinking about looking at anything but the co-pay. That prescription card was a Trojan Horse. We rolled that Trojan Horse right in and fell asleep.

I predict this TV demand of Their-Way-or-the-Highway insurance for Medicare coverage will eventually affect not only patients but doctors as they have to put up with more and more intrusion into their decisions.

For those who are happy with their decision to go with this specific advantage plan, I sincerely respect that and wish you the best. The problem I have with this situation is the morphing. There are lots of retired military in TV and others who have worked many years to receive good retiree benefits and those who want the wider coverage of primary Medicare with a Plan F supplement who now are being booted out if their choice is not to accept a narrowly dictated HMO. Many who have been happy with their docs and with their insurance must feel like they have just had the rug pulled out from under them. It just does not seem right to me.......

wow....I do digress.....I could say more.......will I hit submit....oh whatthehell.......

Norma Rae Boomer

PS: I really do want to know the source of that 34% number. I am not being cantankerous. I like cited sources for comments I find interesting. I can listen and then think about stuff.......

My Wife and I just moved here 3 months ago. We have United Health Care with Supplement F. I sent the VHC an email this morning telling them what I had. They just called back-great service that way-and very kindly told me that after Oct you must have UHC Advantage to be accepted as a new patient. So, the search begins!

///

Was at Colony yesterday, no rumors. THIS IS HAPPENING...

I was sincerely interested in understanding and learning something new. I didn't know you could be on medicare until 65. No hidden agenda. Just confusion. I think GE answered it though; ssdi.

My letter from the Villages Health came yesterday informing me that I need to be on Medicare Advantage or find a new Doctor. I called the person whose name was on the letter. This policy change came about January 1, 2016.

Ditto for my wife, today. She received the dreaded letter; their way or the highway". Oh well. The search begins.

How can you enroll if the enrollment period is over?

Here is my take on the situation;
First, if you read the recent article in the Daily Sun, it actually noted there were 12 (yes twelve) specialists in the system. Think about this, anyone who needs more care then the PC, will be referred to a specialist, if they are "limited to 1250 patients", guess what LONG wait times, etc. Unfortunately my wife sees 3 to4 specialists, what a mess.
No add it the news release a few months ago that United Health Care (sound familiar) is LOSING several hundred MILLION dollars on these SUPPLEMENT programs.

Here is my take:
1. If UHC goes out of the SUPPLEMENT programs TVHC will need to scramble to "fix" their system, my guess they will need to open it to all of the ADAVANTAGE plans.
2. TVHC sees the handwriting on the wall, and changes their stance (we can only hope.)
3. UHC, goes from a FREE (aka zero monthly cost) type of program to a monthly charge program. I actually think this is the most likely outcome. UHC and TVHC would be able to keep the original program will all of the goodies, and charge a suitable monthly charge to make up for the losses.

NOW, here are the potential CONTINUING problems:
Due to the lack of specialists, you may end up with an OUT OF NETWORK doctor, guess what, better have a really healthy checkbook.
If you go to a hospital other then TVRH, you may find additional OUT OF NETWORK charges on your bill.
Due to the lack of specialists, you may need to go outside the TVHC network to get a LOCAL specialist, guess what, they will NOT accept the United Health Care insurance card, carry a big check book....

For all of the above reason, we converted from the existing advantage plan to a supplemental plan. Yes, we have a monthly premium, but yes we are covered by ANY DOCTOR that accepts Medicare, yes we are covered at ANY HOSPITAL that accepts Medicare.

Please look over your options carefully, contact SHINE:
SHINE - Home
Florida Department of Elder Affairs' SHINE Program
1-800-963-5337
for an UNBIASED assessment of your situation.

Hope this helps, and please do not shoot the messenger.

I have a different take:
1. I have never read that specialists in the system are limited to 1,250 patients. I can only recall this limit pertaining to primary care physicians.
2. In November 2015 UnitedHealth announced that it is scaling back its marketing of Obamacare exchange plans and may exit the program completely. These are NOT Medicare Supplement plans.