[2BNTV]

Originally Posted by NYGUY

It depends on the type of United Healthcare Medicare Advantage plan you have. If it's the HMO, you need a referral. If you have the PPO, you don't need a referral.

I have a Medical Advantage UHC HMO 1 Plan and I can see any specialists I want, without a referral. TVH would like to be a gatekeeper but it is not mandatory. Obviously, if I went to a specialists I would send all info back, to my PCP.

This was the main reason I switch from Florida Blue HMO, as I needed a referral from my PCP. It was a PITA to get the authorization through his staff and it should have been a ten minute process. Nuff said about that............

[Avista]

Originally Posted by 2BNTV

I have a Medical Advantage UHC HMO 1 Plan and I can see any specialists I want, without a referral. TVH would like to be a gatekeeper but it is not mandatory. Obviously, if I went to a specialists I would send all info back, to my PCP.

This was the main reason I switch from Florida Blue HMO, as I needed a referral from my PCP. It was a PITA to get the authorization through his staff and it should have been a ten minute process. Nuff said about that............

You're right. I have Villages HMO and have never needed a referral to see a specialist.

[Steve & Deanna]

What you don't know is that you will pay probably $2,000 for your surgery (if required) and any other thing they do to you while you are in surgery is another $2,000 or $1500 and that adds up. I have heard horror stories about Medicare Advantage. People think oh no premium payment but not so nice when your health fails you. Don't give up a good insurance for an insurance that may not last or decides to charge you a premium after they get you.

[rivaridger1]

I am offering a personal opinion after finding out my Medicare and Plan F insurance was no longer acceptable to the Villages Health organization and also after having had access to it for two years. The VHC model is dedicated to young healthy seniors, e.g., an extended first time appointment, lab draws every six months, access to physician assistants and nurses for the common maladies suffered by healthy seniors. The system does not work very well for specialist referrals since most of the VHC doctors are recent transplants and the internal VHC specialists in house are relatively few. There are many respected primary care physicians outside the VHC model which more then a few of the local specialist physicians consider to be first class. I found four specialists myself prior to selecting VHC as my primary health care provider and other then saying " ok " none of them offered another encouraging word relating to the VHC organization. I have a new primary health care physician and as I visit the specialists and change my records most of them say, " you have a good one. "

[Nucky]

I wonder if I'm missing something? As the new guy in town so far I am very grateful to have the medical care that I have received. Seems like my doctors always make me take an appointment on the 3rd friday of the month in the afternoon....Damn....I pay a reasonable amount towards my Blue Cross insurance, they provide clear instructions how to use my insurance and the doctors I have seen so far are top notch. I will be changing to Medicare in April of 2017 and have learned much from those before me. I don't expect my doctors to be a golf cart ride away and it is nerve wracking setting up all the appointment and the BS that come with getting coverage but once it's done it sure feels great.

[gomsiepop]

I watched the following video and made my decision on the information it provided. Each person needs to make a choice based on their own personal needs. My decision to stay with traditional Medicare and my United Healthcare secondary (not Advantage) was based on several factors. First and foremost was my husband has several health issues that require he see several specialists. In good conscience I could not rely on The Villages for their expertise. They flip-flopped on their decision to deny benefits to anyone other than those with the Advantage plan. Watch this video and you can make an informed decision.
No Premium "FREE" Medicare Plans | You Get What You Pay For - YouTube

[Northwoods]

I currently go to TVH and have been very impressed with the care. I have a very capable primary care physician, which is extremely important to me.
I've been reading all the comments about the downside of a UH Advantage plan... one of them being that you can't pick specialty care (like Shands or other facilities for cancer or heart-related care). Taking the cancer example, my understanding is that TVH is affiliated with some of the top cancer care institutions... MD Anderson (nationally-known as a leading cancer center) being one of them. I am impressed that they are affiliated with top-rated institutions. Also, many people say "with TVH, "you can't go to out of network physicians/facilities..." But - I know of at least one person who has received an exemption and has been referred to an "out of network" physician ... so... don't assume that you can't be referred to an out-of-network physician/facility if you go with UH-Advantage.
I've also heard people say that if you leave The Villages you won't be covered.... but I know that UH-Advantage offers a Passport plan, which allows members to receive covered services outside of TVH service area when traveling (or if you're a snowbird).
I would recommend, to make an informed decision, visit the Medicare Resource Center, meet with your insurance provider, contact a United Health Care Medicare Advantage advisor which are located in the town squares, meet with SHINE volunteers, and I would also recommend you consider signing up for an educational session at a TVH care center by calling (352) 674-8789.
Again... TVH isn't for everyone. But research your options and talk to the experts. Then make the right decision for you.

[paulascorpio]

We were on it and got nickled and dimed to death.......stay with part F. We went back to F.

[zonerboy]

Several years ago I switched to United Health Care Medical Advantage plan. Before signing up, I checked with the sales people at The Villages Medicare Store. They showed me a big fat book of specialists who were participants in the plan. I looked up the specialists I was already seeing and most of them were in the book, so I signed up in October for the coming year. Little did I know but come January a new book of participating specialists came out and many of the specialists I had seen in the past were no longer listed. The next year I went back to my old Medicare plan F supplement.

[llaran]

Just one example - A woman I know was diagnosed with a rare cancer , only one DR in the US specializes in this cancer, he is on the west coast, with the medicare you now have you could make an appt and see him with no problem. That to me is the advantage or Medicare, you don't have to ask anyone or if the DR or facality is in network. I worked for UnitedHealth 20 yyears, I would never tell anyone to go on to an HMO, ppo maybe, but even if you are very well now , what will tomorrow bring? The last thing you need if you have some sort of condition is problems getting to the Best Dr.

[Avista]

Originally Posted by Northwoods

I currently go to TVH and have been very impressed with the care. I have a very capable primary care physician, which is extremely important to me.
I've been reading all the comments about the downside of a UH Advantage plan... one of them being that you can't pick specialty care (like Shands or other facilities for cancer or heart-related care). Taking the cancer example, my understanding is that TVH is affiliated with some of the top cancer care institutions... MD Anderson (nationally-known as a leading cancer center) being one of them. I am impressed that they are affiliated with top-rated institutions. Also, many people say "with TVH, "you can't go to out of network physicians/facilities..." But - I know of at least one person who has received an exemption and has been referred to an "out of network" physician ... so... don't assume that you can't be referred to an out-of-network physician/facility if you go with UH-Advantage.
I've also heard people say that if you leave The Villages you won't be covered.... but I know that UH-Advantage offers a Passport plan, which allows members to receive covered services outside of TVH service area when traveling (or if you're a snowbird).
I would recommend, to make an informed decision, visit the Medicare Resource Center, meet with your insurance provider, contact a United Health Care Medicare Advantage advisor which are located in the town squares, meet with SHINE volunteers, and I would also recommend you consider signing up for an educational session at a TVH care center by calling (352) 674-8789.
Again... TVH isn't for everyone. But research your options and talk to the experts. Then make the right decision for you.

Agree. We've found this to be true.