[Snakster66]

Originally Posted by scubawva

You’re mistaken, TVH does not accept Medicare. I don’t know about age situation you mention.
They accept Advantage plans, which is NOT Medicare. They do not accept Medicare or Supplement plans.

The specialist in TVH do accept Medicare & supplements. Not all are taking new px, and most require the px have a PCP in TVH.

Advantage, right. I'm not well versed in nomenclature so I've been fusing the two. But the bottom line is they won't see us with our commercial Aetna Health plan, regardless of what they state on their site. Whether that's because it's not Advantage or because of our age (or a little of both), it's just a fact.

[OrangeBlossomBaby]

Originally Posted by Snakster66

Advantage, right. I'm not well versed in nomenclature so I've been fusing the two. But the bottom line is they won't see us with our commercial Aetna Health plan, regardless of what they state on their site. Whether that's because it's not Advantage or because of our age (or a little of both), it's just a fact.

Their reasoning is NEITHER of what you state.

I'm not on medicare at all, AND I'm not old enough for it yet. They take my commercial Florida Blue plan just fine.

On their website under the list of insurances they accept (including Aetna) it says "Some restrictions may apply." So your plan might just not be one of the ones they accept. But they /do/ accept plans from Aetna. Just not yours. Aetna has a LOT of plans. Villages Health is probably just - not in your plan's network.

[Snakster66]

Originally Posted by OrangeBlossomBaby

Their reasoning is NEITHER of what you state.

I'm not on medicare at all, AND I'm not old enough for it yet. They take my commercial Florida Blue plan just fine.

On their website under the list of insurances they accept (including Aetna) it says "Some restrictions may apply." So your plan might just not be one of the ones they accept. But they /do/ accept plans from Aetna. Just not yours. Aetna has a LOT of plans. Villages Health is probably just - not in your plan's network.

According to Aetna website, they ARE in Network. It is not my plan that is the issue.

Because I've been playing whisper down the lane trying to interpret what my wife heard in her phone call, I called them myself to get the actual story of the current status for The Villages Health. This is what I was told:

For anyone with commercial insurance, they are "at capacity" and are not taking new patients, UNLESS you work for The Villages. If you have commercial insurance and are employed by The Villages, you can get in as a new patient. If you are 65 or older (i.e., medicare [or Advantage, I dunno]) then they have spaces for you. She indicated when new capacity under construction comes online, that MAY change and that I (or anyone) should check back at that time.

Apologies for adding to confusion before. This hopefully clarifies it a bit better.

[Bogie Shooter]

Oh well, it was only 30 posts of opinions, guesses and theories of what the real answer was…………………clarified by one phone call.🤷🏼

[OrangeBlossomBaby]

Originally Posted by Snakster66

According to Aetna website, they ARE in Network. It is not my plan that is the issue.

Because I've been playing whisper down the lane trying to interpret what my wife heard in her phone call, I called them myself to get the actual story of the current status for The Villages Health. This is what I was told:

For anyone with commercial insurance, they are "at capacity" and are not taking new patients, UNLESS you work for The Villages. If you have commercial insurance and are employed by The Villages, you can get in as a new patient. If you are 65 or older (i.e., medicare [or Advantage, I dunno]) then they have spaces for you. She indicated when new capacity under construction comes online, that MAY change and that I (or anyone) should check back at that time.

Apologies for adding to confusion before. This hopefully clarifies it a bit better.

That's what I figured. They do accept your insurance, however - their doctors are already at their maximum patient load and have to cut back on accepting new patients. This was a problem last year as well, and I'm pretty sure it's been a problem since the COVID pandemic in 2020.

[OrangeBlossomBaby]

Originally Posted by OrangeBlossomBaby

The problem with The Villages Health is that many of their doctors are not accepting NEW patients. The group accepts most insurance. But trying to find a doctor available to establish yourself as a patient is next to impossible. What you need to do is call their offices and let them know you'd like to become a patient of the group, and other than "x/y/z" criteria, you'll be happy with whatever doctor can see you. For me, x/y/z is "they can be from anywhere in the world but their accent can't be too thick because I have word differentiation problems with my hearing and I need to be able to understand them." Other than that I'm not too picky.

Originally Posted by Bogie Shooter

Oh well, it was only 30 posts of opinions, guesses and theories of what the real answer was…………………clarified by one phone call.🤷🏼

That was post #7.

[rustyp]

Originally Posted by OrangeBlossomBaby

Their reasoning is NEITHER of what you state.

I'm not on medicare at all, AND I'm not old enough for it yet. They take my commercial Florida Blue plan just fine.

On their website under the list of insurances they accept (including Aetna) it says "Some restrictions may apply." So your plan might just not be one of the ones they accept. But they /do/ accept plans from Aetna. Just not yours. Aetna has a LOT of plans. Villages Health is probably just - not in your plan's network.

Excellent summation. May I add once one turns 65 (Medicare) TV Health will no longer accept their commercial insurance. The choice will be to go on one of their Advantage plans or leave.

[OrangeBlossomBaby]

Originally Posted by rustyp

Excellent summation. May I add once one turns 65 (Medicare) TV Health will no longer accept their commercial insurance. The choice will be to go on one of their Advantage plans or leave.

That's important information for any of us who are approaching the age when we have to make this decision!

I'll check with the desk at TVH next time I have an appointment to find out if "legacy" patients are grandfathered in or not. If not, then I have a couple more years to transition to a doctor's office that accepts "whatever" health insurance INCLUDING Medicare Advantage (since I don't know what my choices will look like by the time I'm 65 and would like to prepare for all possibilities).

[retiredguy123]

As I understand it, the Villages Health facilities are built and owned by The Villages for the convenience of Villagers. The reason they don't accept original Medicare is because they would need to treat anyone in the area who has original Medicare, and it could be difficult for Villagers to get appointments. If you accept original Medicare, you must be accessible to everyone who wants to use the facilities. At least that is my theory.

[Mrprez]

Originally Posted by retiredguy123

As I understand it, the Villages Health facilities are built and owned by The Villages for the convenience of Villagers. The reason they don't accept original Medicare is because they would need to treat anyone in the area who has original Medicare, and it could be difficult for Villagers to get appointments. If you accept original Medicare, you must be accessible to everyone who wants to use the facilities. At least that is my theory.

There is no requirement to be a resident of TV to be a patient. Scroll down to the FAQ.

Creating Personalized Patient Experiences - The Villages Health

[retiredguy123]

Originally Posted by Mrprez

There is no requirement to be a resident of TV to be a patient. Scroll down to the FAQ.

Creating Personalized Patient Experiences - The Villages Health

I know. They could not legally do that. But you do need to have a specific Medicare advantage plan, which limits the patient list.

[Mrprez]

Originally Posted by retiredguy123

I know. They could not legally do that. But you do need to have a specific Medicare advantage plan, which limits the patient list.

Of course. Non-villagers follow the same rules as us.

[retiredguy123]

Originally Posted by scubawva

You’re mistaken, TVH does not accept Medicare. I don’t know about age situation you mention.
They accept Advantage plans, which is NOT Medicare. They do not accept Medicare or Supplement plans.

The specialist in TVH do accept Medicare & supplements. Not all are taking new px, and most require the px have a PCP in TVH.

I'm not sure what you mean when you say that an advantage plan is not Medicare. The Medicare.gov website refers to advantage plans as "Medicare Part C". These advantage plans are regulated and subsidized by the Federal Government Medicare program and funding. So, it seems to me that it is not accurate to say that advantage plans are not Medicare. It is true that TVH does not accept patients who have Medicare Part B.

[MX rider]

Originally Posted by OrangeBlossomBaby

That's what I figured. They do accept your insurance, however - their doctors are already at their maximum patient load and have to cut back on accepting new patients. This was a problem last year as well, and I'm pretty sure it's been a problem since the COVID pandemic in 2020.

We just signed up for The Villages UHC Advantage 3 weeks ago. We no problems finding a doctor. We had the choice of 4 at Spanish Springs and 5 at Sumpter. Brownwood location had some as well.