[Kliegls5@gmail.com]

Originally Posted by Tomptomp

I think Medicare advantage would put me in a network of doctors. Since I am a snowbird I need doctors in two locations that Medicare will cover. I don’t think that works for snowbirds.

We are snowbirds and have Medicare Advantage plans. We have a full set of doctors both in Illinois and here. Have also had to have PT in both places after a broken wrist. We've never had to get prior approval for any of our treatments. Easy peasy with great coverage and doctors.

[RUCdaze]

I can tell you from personal experience, I looked into Advantage and rejected it. I have Medicare parts A, B, and D., plus I have Blue Cross/Blue Shield. I have never had a problem; I go to whatever doctor I want without a referral, and I've never had a problem with anything. Advantage doesn't come without restrictions, obligations, and limitations,

[Janie123]

Originally Posted by GreggC69

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?

My wife and I are both using Medicare Part G due to the discontinuing of Advantage by our main cancer hospital… the Mayo Clinic in Jacksonville. The 2nd reason is if you are on Advantage and want to switch to a Part G and have underlying conditions, you could be denied. Here is ChatGPT describing why major hospitals are discontinuing… I hear Villagers say, I’m healthy and don’t need to pay extra for part G… well, today healthy, tomorrow, stroke, cancer, etc… it just happens.,..

Several major hospitals and health systems are opting to discontinue their participation in Medicare Advantage (MA) plans due to a combination of administrative and financial challenges. The primary reasons include: 
1. Delayed and Reduced Reimbursements: Hospitals report that MA plans often result in slower and lower payments compared to traditional Medicare, impacting their financial stability.
2. High Rates of Claim Denials: There is a significant occurrence of patient claim denials under MA plans, which can lead to increased administrative burdens and potential revenue loss for healthcare providers. 
3. Excessive Prior Authorization Requirements: The cumbersome process of obtaining prior authorizations for treatments and procedures under MA plans can delay patient care and add to the administrative workload of hospital staff.

These challenges have led to a notable shift, with nearly 1 in 5 health systems ceasing to accept one or more Medicare Advantage plans in recent years. 

For patients enrolled in MA plans, this trend may limit access to certain hospitals and healthcare providers. It’s crucial for beneficiaries to stay informed about their plan’s network and any changes to ensure continued access to preferred healthcare services.

[Kliegls5@gmail.com]

Originally Posted by sdeikenberry

Medicare Advantage Plans work because they are supposed to keep patients healthy. In reality, the plan receives a certain amount of money for each person in the plan and it's in the plan's best interest to not spend money on patient's if they avoid it...because the less spent the more profit they make. That said, they are still obligated to provide the necessary health care to a patient, but they aren't obligated to go beyond what is strictly necessary. The main problem with Advantage Plans is you CANNOT choose to go to any facility or doctor you wish UNLESS they are inside the plans network.
We have traditional medicare with an AARP supplemental plan that covers all of our expenses the traditional medicare won't pay. We've had this plan for over 10 years now. So beyond our monthly premiums we pay zero dollars for healthcare. This works for us...we can go anwhere we choose and have any doctor we choose and it's completely covered...no issues.
I am a former healthcare provider and I would never recommend anyone get an Advantage Plan unless they simply cannot afford regular medicare with a supplemental plan attached. You lose too much control of your healthcare...and you are your best advocate...not someone else.

Why does everyone say they can go anywhere with a traditional medicare plan when in reality they can only go to doctors who accepts their plan. You can't go to any of the Villages Healthcare doctors, correct?

[Justputt]

Originally Posted by Tomptomp

I think Medicare advantage would put me in a network of doctors. Since I am a snowbird I need doctors in two locations that Medicare will cover. I don’t think that works for snowbirds.

Actually, it does work. We have in-network doctors both here, Upstate NY, and any other state we go to. Like traditional (government) Medicare, we have an Advantage plan that doesn't require pre-authorizations to specialists, tests, x-rays, etc. Unlike traditional Medicare, our Advantage plan gives us an allowance for over-the-counter meds, even food, etc., as well as dental, hearing, fitness, and vision coverage. So, the Advantage plan covers so much more and everywhere I want to go inside the US.

[MX rider]

Originally Posted by Janie123

My wife and I are both using Medicare Part G due to the discontinuing of Advantage by our main cancer hospital… the Mayo Clinic in Jacksonville. The 2nd reason is if you are on Advantage and want to switch to a Part G and have underlying conditions, you could be denied. Here is ChatGPT describing why major hospitals are discontinuing… I hear Villagers say, I’m healthy and don’t need to pay extra for part G… well, today healthy, tomorrow, stroke, cancer, etc… it just happens.,..

Several major hospitals and health systems are opting to discontinue their participation in Medicare Advantage (MA) plans due to a combination of administrative and financial challenges. The primary reasons include: 
1. Delayed and Reduced Reimbursements: Hospitals report that MA plans often result in slower and lower payments compared to traditional Medicare, impacting their financial stability.
2. High Rates of Claim Denials: There is a significant occurrence of patient claim denials under MA plans, which can lead to increased administrative burdens and potential revenue loss for healthcare providers. 
3. Excessive Prior Authorization Requirements: The cumbersome process of obtaining prior authorizations for treatments and procedures under MA plans can delay patient care and add to the administrative workload of hospital staff.

These challenges have led to a notable shift, with nearly 1 in 5 health systems ceasing to accept one or more Medicare Advantage plans in recent years. 

For patients enrolled in MA plans, this trend may limit access to certain hospitals and healthcare providers. It’s crucial for beneficiaries to stay informed about their plan’s network and any changes to ensure continued access to preferred healthcare services.

Like others here, you're painting with a broad brush. Not all MA plans are the same. Some are better than others.

After much research, and talking to SHINE, we chose UHC MA. We're happy with our choice. And no, not every doctor or hospital takes UHC. But many top rated hospitals and specialists do.

[goneil2024]

It’s all about the money on all sides of the transaction (seller, service provider and buyer). For most of us if we are honest few truly understand the system and differences until services are delivered, at that point our ability to make change has passed.

According to published reports in 2010 25% of eligible beneficiaries were enrolled in Medicare Advantage Plans, while in 2024 the number is over 54% and growing. It is expected that in the next ten years the number will be 64%.

Like all insurance products the devil is in the details, and if you are so inclined there is a wealth of information discussing the pros and cons of traditional Medicare vs. Medicare Advantage Plans on line and from the US Government.

I elected traditional Medicare and then purchased a supplement, and yes the cost was more however after a detailed analysis it was the best fit for me.

The comments above are my personal opinion and not a recommendation. You should consult medical, insurance and finance subject matter experts when making important decisions.

[dlebuis]

Make sure you thoroughly read what and where plan allows you to go. Friend recently had to go to rehab and had to go to one of their approved facilities. It was horrible. Smelly, lack of getting her meds on time and sometimes forgotten meals. Tried to get released because rehab said she was good to go but facility doctor wouldn’t sign her out. Her own doctor didn’t have the power to do so. After 3 weeks she signed herself out and has been flourishing ever since. Lady from Orlando who was next door to my friend was sent there because of her insurance plan. This was in Wildwood and she lived in Orlando. Her family finally just took her out.

[tombpot]

If you want the insurance company to manage your healthcare then get an advantage plan.

[rustyp]

Originally Posted by tombpot

If you want the insurance company to manage your healthcare then get an advantage plan.

Who manages Medicare ? Hint DHHS - they have a new org chart.

[kingofbeer]

Originally Posted by retiredguy123

There are plenty of Medicare providers close by who do accept original Medicare. The developer builds, owns, and operates health care facilities on Villages property that are designed to be convenient to Villagers who want to use a Villages operated facility. Restricting these facilities to a few Medicare Advantage plan members makes it easier to use these facilities. If they could limit access to Villagers only, they probably would accept original Medicare. But they cannot because Medicare is a Federal program and they are not allowed to descriminate against non-Villagers. If they had to accept original Medicare, I think the developer would close the facilities. This is just my opinion and you don't need to agree.

I am not sure why a local non-Villages health doctor would not accept original Medicare. The patient needs to pay the difference.

[Aces4]

Originally Posted by Indydealmaker

OMG! A business operating for profit!

Exactly and I have no problem with that premise, the family is here for the money. The premise that makes me chuckle is thinking that allowing only the Medicare Advantage Plan participants care at certain Village medical facilities and providers is doing all Villagers a favor.

[Aces4]

Originally Posted by Rwirish

Surprised, shocked, why?

Medicare Advantage hands down IMO. Never had a issue, don’t need referrals and access to providers has been great.

Hang in there.. the show isn't over yet.

[maistocars]

Originally Posted by villagetinker

Traditional Medicare here, we ran into too many problems with an advantage plan could not get access to desired specialists and the ones available were several weeks to months for appointments.
No idea on the compensation.

Totally agree. Traditional Medicare - best coverage and costs are small and limited.

[kingofbeer]

Originally Posted by retiredguy123

Personally, I think that The Villages health care facilities do not accept original Medicare because they want to make them more accessible to Villagers. If they accepted original Medicare, they would be required by law to accept all original Medicare patients from the surrounding areas, and they would soon become overcrowded with non-Villagers. These facilities were constructed within The Villages to be convenient to Villagers, not non-Villagers. Otherwise, what is the point of using Villages property to operate health care facilities within The Villages? My opinion.

Only accepting selected Medicare advantage plans keeps the volume of patients lower. Plus, the selected plans are 4 and 5 star plans not the inferior plans that you see advertised on TV'S. "Who wants coffee?". The Medicare Advantage plans pay Villages Health after you are enrolled even if you never use their services.

"Medical groups can get paid from Medicare Advantage plans, as these plans contract with healthcare providers, including medical groups, to provide the Medicare-covered benefits to their enrollees, and are paid a per-person amount to provide the care. "