[LeeM]

Originally Posted by Joeint

Advantage Plans are really great until the s*it hits the fan... Keep your traditional Medicare and Supplement.

That is simply not true. An acquaintance had heart surgery which was several hundred thousand dollars. His out of pocket was $1000 with his Medicare Advantage plan.

There is an out of pocket yearly cap on these plans. And that cap depending on your plan is usually less or not much more then what you’d pay for a supplement. And the odds of meeting that cap may be slim because these plans are required to pay what Medicare does.

It’s a win win for us with dental, vision, OTC allowance, gym membership, bonuses for doing healthy activities, prescription coverage etc.

We get to choose our own Drs. With our PPO plan and don’t need referrals. We really like our Villages Drs. They’re a golf cart away and they don’t take regular Medicare.

[crash]

Originally Posted by Happydaz

I have been researching different Medicare health plans. I currently have traditional Medicare and a supplement plan. I have looked at the Villages Health plan and United Health Care. The upfront costs of Medicare Advantage plans are lower than my plan. It looks very attractive but I am concerned that at some point Medicare may reign in these Advantage plans as they are costing Medicare more than traditional Medicare. If that were to happen and I had made a switch I couldn’t go back to my former company sponsored plan. I get all drugs for a small co pay in my current plan, a great benefit. My concern is further increased because the Villages sells its assets when they no longer see they are needed, e.g. rec centers, fire departments, water and irrigation systems, etc.. The people making the most money in healthcare are the insurance companies not the medical personnel or hospitals. Now I see the Villages Health is advertising in the Daily Sun and is offering residents bounties for physician referrals. Maybe it is becoming difficult to attract physicians to central Florida? What do you think?

The advantage plans actually save Medicare money. It is like reinsurance for Medicare.

[Hardlyworking]

So much BS here and other threads about MA plans.

[LeeM]

Originally Posted by Larchap49

I think you should keep what you have.. with the Advantage plans you can't have a GP through the Villages system, you have deductibles and copays, and you have networks. With traditional Medicare you can go to anyone anywhere and not worry about deductibles and copays. It's a pay me now or pay me later. I can plan for the premiums but would dred the bills that would come later after a major medical event. With me an advantage plan would remove Moffitt cancer center from my network. Also recently I took my wife to Mayo Clinic in Jacksonville because we couldn't find a Dr or Hospital capable of finding the cause of her symptoms. Keep what you have because you're correct, you can never go back. IMHO

Moffitt is included in my BCBS MA plan and I heard that The Villages MA plan includes it now too.

As I mentioned there is a cap on these plans. I believe the cap on The Villages plan is a couple thousand dollars.

So let’s say worse case scenario you cap out - you are out a couple thousand dollars. That is most likely not much more then what you would pay in supplement premiums. And you are paying those for years without the perks of vision, dental, etc.

It made no sense to us to pay hundreds in guaranteed premiums every year for ‘what if’ when if the worst actually happened (and insurance didn’t pay - and they are required to pay what regular Medicare does) our out of pocket cost wouldn’t be much more then the guaranteed premiums. Plus we get prescription, dental, vision and more.

[geobar]

There happens to be only one advantage to an Advantage Plan.
.
It's good if only you do not need extensive medical attention.
.
When you retire and you're healthy save with an Advantage plan. Possible limited access and long waits to see specialists.
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When you get older and start having more medical conditions hopefully you can afford to go back to the original Medicare with a Supplement plan.
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Talk to your friends and neighbors for their thoughts as the Insurance brokers do not tell it all.

Originally Posted by Happydaz

I have been researching different Medicare health plans. I currently have traditional Medicare and a supplement plan. I have looked at the Villages Health plan and United Health Care. The upfront costs of Medicare Advantage plans are lower than my plan. It looks very attractive but I am concerned that at some point Medicare may reign in these Advantage plans as they are costing Medicare more than traditional Medicare. If that were to happen and I had made a switch I couldn’t go back to my former company sponsored plan. I get all drugs for a small co pay in my current plan, a great benefit. My concern is further increased because the Villages sells its assets when they no longer see they are needed, e.g. rec centers, fire departments, water and irrigation systems, etc.. The people making the most money in healthcare are the insurance companies not the medical personnel or hospitals. Now I see the Villages Health is advertising in the Daily Sun and is offering residents bounties for physician referrals. Maybe it is becoming difficult to attract physicians to central Florida? What do you think?

[MSGirl]

Originally Posted by retiredguy123

To clarify, if you have original Medicare, you can use any provider who accepts Medicare. But, if you have an Advantage plan, you can only use providers that are part of the insurance company's network of providers.

Again, false information. Your PCP must be accepted by your Advantage plan. Actually, I have found the Villages PCPs are much better than the outside PCPs. Regarding specialists, you can use any specialist that accepts Medicare. With UHC, I found most drs accepted.
Medicare= you pay on the front end
Advantage= you pay at the back end

[retiredguy123]

Originally Posted by MSGirl

Again, false information. Your PCP must be accepted by your Advantage plan. Actually, I have found the Villages PCPs are much better than the outside PCPs. Regarding specialists, you can use any specialist that accepts Medicare. With UHC, I found most drs accepted.
Medicare= you pay on the front end
Advantage= you pay at the back end

What's false? Are you saying the UHC doesn't have a provider network? I don't think that is true because I know that some local providers have been removed from the UHC specialist list, at least temporarily.

[rustyp]

Originally Posted by villagetinker

Medicare and supplemental you get to decide what doctor to see, etc., Medicare ADVANTAGE is MANAGED CARE you do not get to decide on which doctor to use, your PCP makes this decision for you as well as your insurance company. This seems to work very well if you are healthy, not so good if you have medical problems. We tried it and were able to get back to original Medicare and are much happier. SHINE (Senior Health Information Network) has a lot of unbiased information on this subject and has local meetings for one on one discussions.

The above comments regarding specialists is from 8 years ago and may not be valid under the current insurance coverages. We had very long waits (3 to 4 months) for specialists, and the ones we had been using would NOT accept the advantage plan. We had no option but to drop Advantage and go back to Medicare and supplemental. NOTE: there is a limitation (50 weeks I think), that if you go over that you may be subjected to underwriting to get back to regular Medicare and supplemental.

Yes I did notice paragraph 2 was added 4 hours after paragraph 1

[chrissy2231]

Stop worrying

[geobar]

When we lived in The Villages we waited about one year to be able to use The Village Medical facilities. We were impressed with their expertise and were fortunate to have a great doctor from New York.
.
After 2 years they kicked us out (with thousands of others) as they would only accept UHC Advantage plans. No way we would limit our medical coverage for their benefit. Why was there an advantage for them to do this? Wouldn't be for financial reasons, would it? Does the Mosre clan need more money?
.
So we moved on to other doctors and services in The Villages .and were pleased.
.
Do your homework before sacrificing your health service needs and outlay of monies.
.
If you talk to an Advantage salesperson ask them how many days will you be covered if you require an extended stay in any hospital.
.
Another shameful thing is the hospitals you might need for care near The Villages. In your senior years, you should be treated like seniors with proper medical attention. The reports on The Villages Hospital are sickening.
.
As well, if so what other doctor charges will you be responsible for as doctors like to visit you daily for 5 minutes and of course bill the insurance companies regardless of what insurance plan you have?
.
Doctors say they are making their rounds, however, they are building their incomes dramatically. Look at their hospital billings on your monthly insurance statements after you are in a hospital compared to an office visit billing.
.
Stay healthy and save monies so you can afford to pay for your needed medical insurance coverage if and when you need it.

[rustyp]

Originally Posted by geobar

When we lived in The Villages we waited about one year to be able to use The Village Medical facilities. We were impressed with their expertise and were fortunate to have a great doctor from New York.
.
After 2 years they kicked us out (with thousands of others) as they would only accept UHC Advantage plans. No way we would limit our medical coverage for their benefit. Why was there an advantage for them to do this? Wouldn't be for financial reasons, would it? Does the Mosre clan need more money?
.
So we moved on to other doctors and services in The Villages .and were pleased.
.
Do your homework before sacrificing your health service needs and outlay of monies.
.
If you talk to an Advantage salesperson ask them how many days will you be covered if you require an extended stay in any hospital.
.
Another shameful thing is the hospitals you might need for care near The Villages. In your senior years, you should be treated like seniors with proper medical attention. The reports on The Villages Hospital are sickening.
.
As well, if so what other doctor charges will you be responsible for as doctors like to visit you daily for 5 minutes and of course bill the insurance companies regardless of what insurance plan you have?
.
Doctors say they are making their rounds, however, they are building their incomes dramatically. Look at their hospital billings on your monthly insurance statements after you are in a hospital compared to an office visit billing.
.
Stay healthy and save monies so you can afford to pay for your needed medical insurance coverage if and when you need it.

I can only offer you my experience to relate to your experience:

I was under 65 and joined The Villages Health - at that time they would accept (and I believe still do) many insurance plans but for pre 65 year olds. They threw me to the curb at 65 unless I got their approved Advantage Plan. I did and many years hence with some health speed bumps along the way I am still very happy. I asked my PCP why TV Health did not accept Medicare. His answer to me (be it true or not) was getting paid and the paperwork involved dealing with Medicare direct from their end is a nightmare. By offering a very low number of Advantage plans tuned to their practice the paperwork nightmare is much less and allows for their primary focus to be on the patient not the system. Do with that info as you wish but just to add some validity I am a snowbird and have gone to doctors in my summer hometown and was told they do not accept Medicare patients for that same reason. However they accepted my TV Advantage Plan and as in network also.

[sowtime444]

The main three Advantage plans that are accepted by Villages Health:

FloridaBlue BlueMedicare - sometimes need a referral
United Villages Focus - need a referral
United Villages Advantage - don't need a referral

(not sure about AARP or Humana, the other two)

We recently switched my father-in-law from BlueMedicare to United Villages Focus. When he needed a nursing facility, the one near his house wouldn't take BlueMedicare but would take the United plans. They also have a much better system for free over-the-counter stuff and better dental coverage.

[JMintzer]

Originally Posted by rustyp

In 2022, nearly half of (48%) eligible Medicare beneficiaries – 28.4 million people out of 58.6 million Medicare beneficiaries overall – are enrolled in Medicare Advantage plans. Medicare Advantage enrollment as a share of the eligible Medicare population has more than doubled from 2007 to 2022 (19% to 48%).

The Congressional Budget Office (CBO) projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to 61 percent by 2032

In the state of Florida Medicare beneficiaries enrolled in Medicare Advantage plans this year is between 50 - 60 %.

Apparently 28.4 MILLION seniors must all be either naive or healthy !

Or... They cannot afford the more expensive supplemental plans...

[kendi]

Originally Posted by Michael 61

Just transferred my health insurance from Colorado to Florida yesterday. I’m under Medicare age for several years, and receive a very large monthly retirement benefit from my former employer, which basically 90% covers my monthly health insurance premium on the open market. When I went to Villages Health, I was told that majority of primary doctors won’t take new patients under 65 (ugh). They did find me only one I the entire system taking new patients under 65 - no he is way up in Mulberry (I live in Richmond). The earliest appt he had was late April - I’m going with Villages Health for now, but we will see, as many have told me to find better care outside of The Villages. If I end up not satisfied with Villages Health, I’m not opposed to going out to Leesburg or the Clermont/West Orlando area.

I am still on private insurance as well and use The Villages Health. My doctor is at Lake Deaton which is close to my house. She’s very good and I like being in the system. But at 65 I cannot use the advantage plans because most of my doctors are up North. So I’ll be looking elsewhere down here for a new primary. Not looking forward to losing my current doctor but do not want to be limited as to who I can see.

[Burgy]

If you want absolute control of who you can see and where you go, or travel a lot , stay with plain Medicare. In my experience as a provider with the local VA clinic and after with the Villages Health and UHC advantage plan, care and options have been very good, well covered a timely. I think there are good doctors outside the plan but the can be hard to find. There is a 40,000 shortage of primary care in the country, recruiting is difficult everywhere.