[Rgstarnes]

I have chosen to not have any association with The VHS, as a result of the level of service received at the hospital for both me and my wife. Without getting into specifics, let me just say the diagnosis from the Villages Hospital were far from accurate for us.
I do agree one hospital stay on an advantage plan will help you understand why the supplemental plan is far better for seniors. That is why we have chosen the supplemental plan.

[Happydaz]

Originally Posted by Johnd

And yet, right from the Medicare.gov website it says:

"Follow these steps if you're already in a Medicare Advantage Plan and want to switch:

To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. You'll be disenrolled automatically from your old plan when your new plan's coverage begins.

To switch to Original Medicare, contact your current plan, or call 1-800-MEDICARE.

Unless you have other drug coverage, you should carefully consider Medicare prescription drug coverage (Part D). You may also want to consider a Medicare Supplement Insurance (Medigap) policy. Remember, you may only be able to switch at certain times of the year."

The information you refer to here concerns switching from a Medicare Advantage Plan back to traditional Medicare insurance. When a person originally switches to a Medicare Advantage plan they no longer are in traditional Medicare, that is why they need to renew their application when they switch back. Medicare Part A covers hospitals and comes with deductibles, etc..The Medicare B part pays 80% of your outpatient care, you are responsible for the other 20%. That can be a lot of money! That is why people who have traditional Medicare usually purchase a MediGap policy from a private insurance company. OK, here comes the problem, when you want to apply for private MediGap insurance after coming off a Medicare Advantage plan they will require you to fill out a health questionnaire. If you have any serious pre existing health problems they can refuse to cover you. This shows that choosing a Medicare Advantage plan when you are relatively healthy and enjoying the low premiums may not turn out so good if you get a serious disease. (Which most of us get sooner or later.) You may think you could switch to the traditional Medicare and then go out and get a MediGap policy, but you may find out that the insurance companies won't sell you a policy. So the choices left to you are to stay with the Medicare Advantage plan or go with just Medicare and get stuck paying high deductibles, etc..

[Carla B]

You're right, Happydaz. If you don't follow strict guidelines, it's not automatic that you'll be able to buy a Medigap supplement. I know, 'cause I've done it and had to qualify health-wise. A person may also be subject to a higher monthly premium based on age at time of enrollment.

[golfing eagles]

Originally Posted by Happydaz

It is one thing to have one or possibly two insurances not accepted in a medical practice but this is a rejection of all insurance plans except United Healthcare Advantage plans. As far as Medicare patients go, TVH has turned their medical practice into an HMO. As a physician yourself could you imagine your former medical practice dropping all insurances except one? You would lose so many patients that it wouldn't be a smart decision.

Well, it's not quite as monolithic as you stated it. TVH has only been around for about 4 years, therefore the population of TV prior to 2012 had doctors not in TVH. I doubt huge numbers of these people dumped their physician of 5, 10, 15 or even 20 years just because a new option opened up---there were plenty of options before TVH. So a large part of TVH patient base is made up of those that came here in the last 4 years, and there are a large number of those people who are under age 65. TVH's decision does not affect the insurances of those under 65.

In growing, non-retirement areas, such as Research Triangle, practices are about 15-20% Medicare. Our NY practice was 41% Medicare. I would guess TVH is about 70% Medicare, maybe higher. With the exception of Tricare, almost all these people either have traditional Medicare with a supplement or already have a MA policy. So essentially they are dropping one Medicare insurance plan in favor of the other, and the people will choose what's best for them.

To use our NY practice as an example, we only dropped one insurance completely in the last 30 years, because it became absolutely ridiculous to accept it. This was an insurance that was offered by several large employers, and most patients picked it because it deducted the least amount from their paycheck (which is generally how most employees choose). We lost about 70% of those patients, but over the ensuing years about half returned due to changing their insurance for whatever reason. Any other insurance we dropped we only stopped accepting NEW patients with that insurance and "grandfathered" the rest---we thought that was the higher moral ground, but many practices will just drop all that have a given insurance.

I doubt the remaining partners would introduce a drastic change to 41% of the practice. But for argument's sake lets say that such a decision would cost the practice 2 million/year. So it wouldn't even be a consideration. Now for the wild card---say UHC came along and said they wanted to use the name of our practice on their MA plans, and for that right they would pay $20 million in royalties. Now the whole decision process changes dramatically, doesn't it? It would be a financial no-brainer, the only consideration would be ethical. But they would probably rationalize that they aren't dumping anyone, the patients have the option of changing Medicare plans. This is essentially the same situation that TVH was in.

[Dan9871]

golfing eagles: I’m trying to figure out what conclusion to draw from the numbers you present here.

Are you saying the 20M royalties make it possible lose a large number of patients in the transition to MA only but still run a system with 30 minute appointments, same day appointments, and doc’s that support no more than 1250 patients, and TVH doc’s managing Villages Hospital patients until enough TV residents see the value/quality of this system so that it is viable without the royalties?

I ask because I, as a patient, I see TVH as way, way better than any other medical service, including simple medical events, specialists and hospital stays, than any other I’ve experienced. My only worry is that the transition to MA puts TVH out of business.

BTW your explanation about picking the “best” specialist clarified something I’ve thought for decades. I’m not in the medical field but could never figure out how I could pick the “best” specialist/surgeon.. I’ve run into and had some friends run into some of the points you mentioned. I’ve also run into what seemed to me as doc’s doing a good job of marketing themselves as “best”.

But on the other hand in one case though TVH I feel I did end up with the “best” in field….

Originally Posted by golfing eagles

Well, it's not quite as monolithic as you stated it. TVH has only been around for about 4 years, therefore the population of TV prior to 2012 had doctors not in TVH. I doubt huge numbers of these people dumped their physician of 5, 10, 15 or even 20 years just because a new option opened up---there were plenty of options before TVH. So a large part of TVH patient base is made up of those that came here in the last 4 years, and there are a large number of those people who are under age 65. TVH's decision does not affect the insurances of those under 65.

In growing, non-retirement areas, such as Research Triangle, practices are about 15-20% Medicare. Our NY practice was 41% Medicare. I would guess TVH is about 70% Medicare, maybe higher. With the exception of Tricare, almost all these people either have traditional Medicare with a supplement or already have a MA policy. So essentially they are dropping one Medicare insurance plan in favor of the other, and the people will choose what's best for them.

To use our NY practice as an example, we only dropped one insurance completely in the last 30 years, because it became absolutely ridiculous to accept it. This was an insurance that was offered by several large employers, and most patients picked it because it deducted the least amount from their paycheck (which is generally how most employees choose). We lost about 70% of those patients, but over the ensuing years about half returned due to changing their insurance for whatever reason. Any other insurance we dropped we only stopped accepting NEW patients with that insurance and "grandfathered" the rest---we thought that was the higher moral ground, but many practices will just drop all that have a given insurance.

I doubt the remaining partners would introduce a drastic change to 41% of the practice. But for argument's sake lets say that such a decision would cost the practice 2 million/year. So it wouldn't even be a consideration. Now for the wild card---say UHC came along and said they wanted to use the name of our practice on their MA plans, and for that right they would pay $20 million in royalties. Now the whole decision process changes dramatically, doesn't it? It would be a financial no-brainer, the only consideration would be ethical. But they would probably rationalize that they aren't dumping anyone, the patients have the option of changing Medicare plans. This is essentially the same situation that TVH was in.

[golfing eagles]

Originally Posted by Dan9871

golfing eagles: I’m trying to figure out what conclusion to draw from the numbers you present here.
Are you saying the 20M royalties make it possible lose a large number of patients in the transition to MA only but still run a system with 30 minute appointments, same day appointments, and doc’s that support no more than 1250 patients, and TVH doc’s managing Villages Hospital patients until enough TV residents see the value/quality of this system so that it is viable without the royalties?


BTW your explanation about picking the “best” specialist clarified something I’ve thought for decades. I’m not in the medical field but could never figure out how I could pick the “best” specialist/surgeon.. I’ve run into and had some friends run into some of the points you mentioned. I ask because I, as a patient, I see TVH as way, way better than any other medical service, including simple medical events, specialists and hospital stays, than any other I’ve experienced. My only worry is that the transition to MA puts TVH out of business.

I’ve also run into what seemed to me as doc’s doing a good job of marketing themselves as “best”.

But on the other hand in one case though TVH I feel I did end up with the “best” in field….

The short answer is yes. The number I gave is theoretical, but there will be an amount that offsets the loss while maintaining the premise of TVH. Whether this actually occurred or not is anyone's guess, I just don't think UHC gets to use a trademarked name for free.

[spuds51]

Originally Posted by jpforster

Spuds51 - Thank you SO MUCH for posting! This video (and other videos) by Christopher Westfall address just what we needed to know - and at just the right time. My husbands just turning 65. Thanks again! Very grateful!

No problem ..glad it helped

[villagerjack]

Originally Posted by pbkmaine

My husband and I are most concerned with major medical issues, not day-to-day care. What happens if we develop a rare cancer, need an organ transplant, or have a difficult-to-diagnose problem? We want the freedom to go to the best place to get treatment and not have our options limited. That's why we use Medigap F rather than an Advantage plan.

Not every " good" doctor accepts Medicare. They don't have to

[villagerjack]

Originally Posted by jpforster

Spuds51 - Thank you SO MUCH for posting! This video (and other videos) by Christopher Westfall address just what we needed to know - and at just the right time. My husbands just turning 65. Thanks again! Very grateful!

The video is by an insurance salesman selling supplemental plans so read between the lines. After viewing 50% I shut it down since he sounded like a carnival barker to me.

[spuds51]

Originally Posted by villagerjack

The video is by an insurance salesman selling supplemental plans so read between the lines. After viewing 50% I shut it down since he sounded like a carnival barker to me.

He is an independent agent that sales medicare advantage as well as supplemental insurance. The agents also get more money for selling Advantage plans. It's just one of many information videos out there. Go to youtube and type in Medicare Advantage videos and see what comes up. I have watched several and they all seem to be in line with what he says.

Here is another independent agent..Matthew Claassen 1-800-847-9680 ext -2..He also will sell you an Advantage Plan if you want one. He will let you know how they work before doing so tho.

[NYGUY]

Originally Posted by golfing eagles

....It would be a financial no-brainer, the only consideration would be ethical. But they would probably rationalize that they aren't dumping anyone, the patients have the option of changing Medicare plans. This is essentially the same situation that TVH was in.

Doc, are you saying that TVH, in choosing the financial no-brainer, may have been unethical?

[sabinfl]

The one thing I can say is: Marcus Welby has left the building. Maybe I saw that someplace, but it is worth repeating.

[golfing eagles]

Originally Posted by NYGUY

Doc, are you saying that TVH, in choosing the financial no-brainer, may have been unethical?

more like all ethics are created equal only some ethics are more equal than others

[GSchamm]

Sounds like socialism to me. Where have we heard "If you like your Doctor, you can keep your Doctor", before. We were also told by a UHC salesperson to keep our plan because it was better than what UHC had to offer. We all want to make the right choice, the one that is best for us. I never need a 30 minute appointment, usually end up just visiting with my DR about politics or whatever. They don't like this either.

[spiritels]

Originally Posted by rockyisle

Jay Hawk - I'm happy you feel that you've made a good decision on your healthcare plan. Just wish we felt the same way.
We've been with VHS from the start - coming with the doctors at Family Doctors at Belleview. We were very happy that they were bringing a great health care model to TV. And they were the single largest reason we made the decision to purchase a home here vs other larger communities in Florida. Up until we bought our home, finding a good PCP was not easy.

I, personally, participated with the USF focus group in 2011 on what type of medical concerns were keeping couples like us from purchasing a home. It was an interesting and rewarding experience. Not long after, VHS began their program and promotion of the Dr. Welby philosophy. There were able to bring good doctors and support personnel along with them (who by the way have one year, 50 mile radius non-compete clauses in their work contracts.. including the NP's).

We saw the writing on the wall last year when friends who were turning 65 were being told to sign up for Advantage or get out. I began to look at who is who at the top of the VHS system now - none other than Kaiser Permantente followers and practitioners.

I guess that most people have forgotten what happened 20 years ago when HMO's were all the rage - lousy health care, big requirements for referrals and stalling tactics...

So, we will return to FL this fall already signed on with a new PCP... we took care of that before we left for the summer months in NH... By the way, for those of you who travel outside of TV, you need to check to see if your state and county are in the plan.. For us, only 3 counties in NH are considered... we would be SOL should something happen to us while up north.

And, last and most important, you all really need to investigate what your out of pocket expenses are going to look like with the "zero" cost premium. When I looked at it a couple of years ago, you have an out of pocket charge of $$$$ for the first 5 days of hospitalization - and that is not a one time charge.. It's for each incident. It would only take once to eat up the costs of an UH Plan F plan (that's what we have) to get you to realize you've probably made a mistake.

I wish all of you the very best on the new plan. In my parting letter to VHS I reminded them that they were putting thousands of patients at risk should this new venture fail - as it is almost impossible to get supplemental coverage like we have now after going for the low ball program.

My husband spoke today to the "Retirement Benefits Consultant" in the Santa Barbara ofc. He also got the bad news that 1st 5 hospital days will be min $260 ea day, every ofc visit $25 copayment, they will NOT take secondary insurance like BCBS! He left before being told about other out of pocket expenses like tests & lab work, scans, etc. cuz he was so upset. This IS about money people! The Villages Health wants to be paid more money plus do u know that WE help pay them a 13% to 17% govt payment? People, we shouldn't JUST be looking for new doctors! WE need advocates in this issue! What if ALL Drs in the Villages do this? Is this a proper thing to do to long standing elderly patients? What about the news stations? What about our politicians who need us??? What about AARP? Do we have to take this just because The Villages Health Care wants more money? And if this insurance isn't accepted in other locations nearby, what then???