[Karmanng]

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.

I for one will not do advantage plans glad to hear that you were not happy with them plus I know they can change your Dr on you too without any notice

[Karmanng]

Originally Posted by rsmurano

Advantage plans are terrible when you start looking into them or talk with people that actually have them. I used an insurance broker years ago when deciding which way to go when joining Medicare, the best is a supplement plan (gold standard) and the more hmo type of plan (advantage).
A couple of major differences/important info that you need to know about these plans:
1) you can always get into a supplement plan (I have plan g) when you turn 65 but after that, you can be refused entry. So when people try the advantage plan at 65 and then find out it’s not what they want, the supplement plans can refuse you.
2) you don’t need a “Florida” supplement plan. I kept my plan g from another state and am saving over $50 a month doing this and coverage is the same. I asked my provider and they said they cover all Medicare costs in all 50 states and overseas (with limits).
3) I don’t pay co-pays, have a $200 deductible, no referrals required

Who is your supp plan with?

[Michael 61]

This thread got me thinking about Villages Health - I’m 61, so too young for Medicare - had set up an initial appointment with the only primary care doctor taking patients under 65 - and he is way up in Mulberry, which is about a 35 minute drive for me. Since, I have had several people reach out to me advising me to find a doctor outside of Villages Health for multiple reasons. Also, doctor was booked out until end of April, as there seems to a problem attracting doctors to The Villages, which concerns me long term. I decided to back out of Villages Health, and went with Orlando Health - found a primary doctor at Hwy 27 and the Turnpike (about a 20 minute drive, way closer than Mulberry) - and they can get me in two weeks - was also very impressed with their phone service (they actually pick up right away, not being transferred to a phone tree that leads nowhere) - Hopefully, I’ll be impressed with Orlando Health.

[joelfmi]

Medical care in certain parts of Florida is not very good, so if you buy a home in Florida check the medical care facilities first where you intent to live..

[snbrafford]

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?

I used to work for a BCBS plan (10+) years. An insurance company "bids" on Medicare business. Medicare basically offers insurance companies a cost plus (the plus being administrative costs primarily) for handling Medicare's members' medical costs. The insurance companies generally only cover what Medicare covers. The "advantage" plans ARE NOT Village owned - United Health Care and Blue Cross (to name a few) are national plans and they have been in the Medicare business a long time. The real consideration is what coverage works best for you based upon your health situation. Generally, medicare advantage plans are free but supplement plans cover more - especially if you have any chronic conditions. BEFORE SWITCHING, I would suggest making use of the medicare resources in the villages and fully understand the coverage differences.

[rustyp]

Originally Posted by rustyp

I have the AARP Medicare Advantage PPO. For grins I looked up how limited my choices are. For example within 20 miles of Lady Lake the following docs are in network:

Surgeons - 134
Orthopedic Surgeons - 53
Urologists - 24

I hope you were not trying to paint a picture that there are very limited Advantage Plan choices Vs Medicare at least on The Villages Health accepted plans.

Another point - Approx 48% of all Medicare seniors have enrolled in Advantage Plans.

Originally Posted by kendi

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.

Ref my post above re my PPO plan. The out of state in network coverage is now vast. I looked up PCPs in 5 areas all within a 20 mile radius. Again these are all within network on that plan:

Sumter Landing - 305 PCPs
Albany NY - 865
Cleveland OH - 1871
Denver CO - 1891
Madison WI - 510

[Keninches]

Originally Posted by Joeint

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

My thoughts exactly. Advantage plans are not an advantage when something unforeseen comes up. We left Villages Health for the lack of doctors. Also the turnover is crazy. We both have had cancer in the last 4 years and would choose to pick our own doctors and hospitals. Moffitt Cancer inTampa is the Best.
If in any way you can afford Regular Medicare and a great supplement do so. We have an AARP supplement.
Good luck.

[lindaelane]

1) Bottom line: Anyone who can afford Medicare Supplement should have supplement, not "Advantage" (which is actually disadvantage).
2) The decision should be considered permanent. Once you are 66, you cannot get Medicare Supplement without underwriting, e.g., passing a health exam that something like a heart attack or cancer that happened suddenly would cause you to "fail".
3) Advantage does not let you see any doctor. For instance, when I needed the "Inspire" device for sleep apnea, there was no doctor United would let me see with Advantage. - I had United Advantage for the freebies and Village Primary Care when I was 65, but went Supplement just before turning 66.
4) Advantage chooses your drug plan for you - you may wind up on a plan that makes medicines you need very expensive. It's "one size fit all" whereas with Supplement you choose your Part D drug plan.
5) Advantage can and does turn down treatments that a doctor says you need!!! The United Advantage and Supplement representative in The Villages said this tends to happen more and more after one year of advantage coverage - because you will have trouble leaving advantage after one year, and at the very least, you will have to pay a high premium than you would have for Supplement, because you joined Supplement after age 65.
6) There are many cases of Advantage plans finding loopholes to force people to leave respite care before the full 100 days (that Supplement always covers) are up.
7) Advantage does not cover certain drugs at all, for instance, infusions are not covered.
8) Advantage has "max out of pocket" costs that can tend to be high. If you need plenty of care, say with cancer treatment, you will pay the max out of pocket, which is more than Supplement would have cost.
9) Yes, Supplement will probably cost more than Advantage in the early years of your retirement. But Advantage has all the dangers, such as denial of necessary treatment, listed above, and in the end, can cost more Plus you cannot be sure of ability to switch to Supplement. So - back to the bottom line - if you can afford Supplement, you should get a Medicare Supplement plan, not "Advantage" (disadvantage).

[Arlington2]

Originally Posted by Keninches

My thoughts exactly. Advantage plans are not an advantage when something unforeseen comes up. We left Villages Health for the lack of doctors. Also the turnover is crazy. We both have had cancer in the last 4 years and would choose to pick our own doctors and hospitals. Moffitt Cancer inTampa is the Best.
If in any way you can afford Regular Medicare and a great supplement do so. We have an AARP supplement.
Good luck.

Good to know there is an opt out if health turns south. We have had been in advantage programs for nearly 15 years and have been very satisified and especially satisfied with TVHS. Our health problems have been less than yours but not insignificant involving a couple of surgeries and hospital stays. Good to know we can change to a supplemental if that turns out to be advantageous.

[Happydaz]

Originally Posted by Arlington2

Good to know there is an opt out if health turns south. We have had been in advantage programs for nearly 15 years and have been very satisified and especially satisfied with TVHS. Our health problems have been less than yours but not insignificant involving a couple of surgeries and hospital stays. Good to know we can change to a supplemental if that turns out to be advantageous.

In most states MediGap supplemental plans can deny coverage if you are switching after a number of years from an Advantage Plan to a MediGap plan. The MediGap plan can deny coverage for preexisting conditions for a certain time period. (Six month+) For example, suppose you got cancer and wanted treatment at Moffitt Cancer Center. If you switched to a MediGap plan you would be responsible for all your cancer treatment costs at Moffitt until you got beyond the six month preexisting exclusionary period. This is just an example but MediGap plans are allowed to exclude preexisting conditions if you are switching from an advantage plan. Your rates may be much higher as well. This was my main concern in going with an Advantage plan and then looking at switching back to a MediGap plan. It might not work out.

[Hardlyworking]

Originally Posted by Happydaz

In most states MediGap supplemental plans can deny coverage if you are switching after a number of years from an Advantage Plan to a MediGap plan. The MediGap plan can deny coverage for preexisting conditions for a certain time period. (Six month+) For example, suppose you got cancer and wanted treatment at Moffitt Cancer Center. If you switched to a MediGap plan you would be responsible for all your cancer treatment costs at Moffitt until you got beyond the six month preexisting exclusionary period. This is just an example but MediGap plans are allowed to exclude preexisting conditions if you are switching from an advantage plan. Your rates may be much higher as well. This was my main concern in going with an Advantage plan and then looking at switching back to a MediGap plan. It might not work out.

They can deny coverage coming from a private plan as well. Ask me how I know.

[PugMom]

Originally Posted by NotGolfer

Everyone on social media has an opinion. We moved here in 2009, before T.V. had the health-care clinics. It was a crap-shoot to find a doctor quite frankly. Coming to a new area and a new state EVERYTHING was unfamiliar. In 2012 TVH came in so we looked into it and signed up. We started with Medicare Advantage and liked it. I think it was two years ago that FL Blue (BCBS) came and their plan looked (for us) to be more attractive. We both see dr's out of network. We go with a cardiologist whose with Orlando Health---have had no issues. We also see dermatologists out of network---same thing, no issues. Some people here have had "Cadillac" plans from their former employers and keep those. I think it all depends on circumstances etc. Word of mouth is helpful but also speaking with an insurance person (who can offer several options) is probably your best idea. I forgot to mention---we both have health issues that require care. So not sure why people say if you're on an advantage plan and have health issues they aren't good. BUT that's just MY opinion.

i had the same experience. the Villages health advantage took care of my spinal fusion, i had it over in orlando. the hosp stay, procedures and fees were included. i paid 1,500 out of pocket total for a fee well over $50,000. i was never denied care, or told i couldnt be treated. if a dr in the Villlages area wasn't available, i was sent to a specialist outside the bubble. i'm staying on the advantage plan

[maistocars]

Originally Posted by LeeM

The co-pays I have with my BCBS MA PPO plan are $0 for my Dr. $35 for a specialist. Prescriptions are included with low copays. We got $250 for eye wear and dental coverage. We also got $300 each in OTC items. And several hundred each for doing healthy activities.

And the coverage has been excellent. $0 for mammogram. $15 for a sonogram etc.

I’m not sure what plan you had but we paid a fraction of what we would have paid in premiums.

I had Aetna. As others have said, they can and will deny you MRIs as happened to me. Thanks but no thanks. Co-pay on an MRI if they allow it was $350 - in Plan G it would be $0. If surgery is needed, then the co-pay goes up even more till you hit your max OOP. $124/mo for Plan G and I'm saving a bundle over the Advantage plan in more ways than one.

[Hardlyworking]

Originally Posted by maistocars

I had Aetna. As others have said, they can and will deny you MRIs as happened to me. Thanks but no thanks. Co-pay on an MRI if they allow it was $350 - in Plan G it would be $0. If surgery is needed, then the co-pay goes up even more till you hit your max OOP. $124/mo for Plan G and I'm saving a bundle over the Advantage plan in more ways than one.

There are lots of MA plans out there. Some are better than others. The ones that VH takes are the best. I’ve had MRIs, sonograms and other imaging all with very low copays. All of my lab work is no fee as are all of my prescriptions. I’m in my third year and so far have put out less than $200 in copays with zero premiums.

[LeeM]

Originally Posted by maistocars

I had Aetna. As others have said, they can and will deny you MRIs as happened to me. Thanks but no thanks. Co-pay on an MRI if they allow it was $350 - in Plan G it would be $0. If surgery is needed, then the co-pay goes up even more till you hit your max OOP. $124/mo for Plan G and I'm saving a bundle over the Advantage plan in more ways than one.

You definitely have to do due diligence on plans. But our Advantage plan saves us thousands each year. We are very happy with it.