[photo1902]

Originally Posted by birdawg

Very sad that we got them started when they first opened, and now after we have a relationship with our doctors they will be dumping us for a better profit margin. Makes you wonder if this is how we will be treated with the rest of the Morse promises.

what "Morse promises" you are worried about losing?

[birdawg]

Originally Posted by photo1902

what "Morse promises" you are worried about losing?

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

[Bonny]

Originally Posted by outlaw

Wait until you are eligible for medicare. That's the issue here.

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

[Bonny]

Originally Posted by NECHFalcon68

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.

I meant to say I'm on Medicare.

[outlaw]

Originally Posted by goodtimesintv

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

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.

[outlaw]

Originally Posted by golfing eagles

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.

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?

[trichard]

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.

[NYGUY]

Originally Posted by trichard

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.

[dbussone]

Originally Posted by NYGUY

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.

[Bonny]

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.

[golfing eagles]

Originally Posted by dbussone

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.

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.

[Average Guy]

Originally Posted by Bonny

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.

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.

[outlaw]

Originally Posted by Bonny

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.

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.

[outlaw]

Originally Posted by Average Guy

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.

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.

[birdawg]

Originally Posted by outlaw

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 in 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.

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.