[Carla B]

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[dotti105]

The Medicare Advantage Plan through The Villages, written by United Health Care does offer coverage in most other states. The only state we may have an issue in in Ca. as we have family there. If we need to be seen while there we may not have coverage.

For us, the states in which we would need coverage are all "in Network" except for Ca. The United Health Care offices can show you exactly where you will and will not be covered.

[graciegirl]

Originally Posted by golfing eagles

Latin in Hippocratic oath---"First do no harm"

Got that part Doc, I took Latin. It's the post that you responded to that I didn't get.


All Gaul is divided into three parts.

[outlaw]

Vos may exsisto profundus.

[golfing eagles]

Originally Posted by graciegirl

Got that part Doc, I took Latin. It's the post that you responded to that I didn't get.


All Gaul is divided into three parts.

It may help to re-read posts #34-39. The responder to my post regarding insurance said is was making him sick. But it was a tongue in cheek statement that he actually agreed with me, it was the whole mess that was making him sick. I didn't catch on at first, too subtle for early morning

[FromDC]

Originally Posted by dotti105

The Medicare Advantage Plan through The Villages, written by United Health Care does offer coverage in most other states. The only state we may have an issue in in Ca. as we have family there. If we need to be seen while there we may not have coverage.

For us, the states in which we would need coverage are all "in Network" except for Ca. The United Health Care offices can show you exactly where you will and will not be covered.

Are you saying The United Healthcare The Villages Medicare Complete 1 (HMO) is nationwide where you can visit almost any doctor? It is quite the opposite. An HMO is structured to have a very limited number of in-network providers. If you have an HMO plan and you become sick and need urgent care outside the network area, the plan will probably cover your emergency situation. If you have an HMO and you want an elective procedure done outside the network, you will probably pay the whole amount out of pocket. If you favor some of your doctors “from back home”, you better talk to your plan provider to see if they will or won't cover your elective care. I used the word 'probably' a lot, because using an out-of-network provider gets you into a gray area of who will pay for what. If you read the Plan summary, it is quite vague too.

Enter your zipcode on the Medicare.gov website. You will access the Advantage Plans you are allowed to sign up for. Stay on that website and do a columnar comparison of the original Medicare plan and the Advantage Plans you are interested in. Shop around, compare benefits, check out the providers, and costs.

Go see a SHINE volunteer representative and they will give you non-biased information and will guide you to your best options. Also, there is a great class at the Life Long Learning College that provides great information: Understanding Original Medicare and Medicare Options.

Do some homework and just don't hop in the golf cart and have an insurance agent tell you what is best for you. I guess I should mention that you should do this homework every year. Plans change and your health changes.

[golfing eagles]

Originally Posted by FromDC

Are you saying The United Healthcare The Villages Medicare Complete 1 (HMO) is nationwide where you can visit almost any doctor? It is quite the opposite. An HMO is structured to have a very limited number of in-network providers. If you have an HMO plan and you become sick and need urgent care outside the network area, the plan will probably cover your emergency situation. If you have an HMO and you want an elective procedure done outside the network, you will probably pay the whole amount out of pocket. If you favor some of your doctors “from back home”, you better talk to your plan provider to see if they will or won't cover your elective care. I used the word 'probably' a lot, because using an out-of-network provider gets you into a gray area of who will pay for what. If you read the Plan summary, it is quite vague too.

Enter your zipcode on the Medicare.gov website. You will access the Advantage Plans you are allowed to sign up for. Stay on that website and do a columnar comparison of the original Medicare plan and the Advantage Plans you are interested in. Shop around, compare benefits, check out the providers, and costs.

Go see a SHINE volunteer representative and they will give you non-biased information and will guide you to your best options. Also, there is a great class at the Life Long Learning College that provides great information: Understanding Original Medicare and Medicare Options.

Do some homework and just don't hop in the golf cart and have an insurance agent tell you what is best for you. I guess I should mention that you should do this homework every year. Plans change and your health changes.

I agree. UHC offers 4 MA plans in Florida, the Villages MA 1 & 2 are both HMOs. The other 2 are PPOs. TV health only takes the HMO. So I would double and triple check the coverage network and participating providers. The concept of an HMO written with TV in mind would have nationwide coverage is questionable at best.

[FromDC]

Originally Posted by golfing eagles

I agree. UHC offers 4 MA plans in Florida, the Villages MA 1 & 2 are both HMOs. The other 2 are PPOs. TV health only takes the HMO. So I would double and triple check the coverage network and participating providers. The concept of an HMO written with TV in mind would have nationwide coverage is questionable at best.

I have spent over half an hour looking for the full provider directory for the United Healthcare The Villages Medicare Complete 1 (HMO) plan. I have not been able to locate such a directory. I want to see ALL the in-network providers (doctors, hospitals, specialty care services, etc.) and where they are physically located. On the UHC website, you can only enter an individual doctor name, group, facility, etc. to see if they participate in the Complete 1 plan.

Reviewing this type of complete directory should be a prerequisite before signing up for the plan. Could UHC let us know where we could find such a directory online?

[NYGUY]

Originally Posted by golfing eagles

....UHC offers 4 MA plans in Florida, the Villages MA 1 & 2 are both HMOs. The other 2 are PPOs. TV health only takes the HMO.

Not quite right Doc. The Villages Health now only accepts United Healthcare Medicare Advantage Plans and UHC's PPO's are Medicare Advantage Plans. I have a HUC Medicare Advantage PPO and have my email from TVH saying my insurance will continue to be accepted by TVH.

I might add, that in my opinion, UHC's PPO's are a much better option than UHC HMO's if a larger network of physicians (both primary and specialists) are important to someone as well as not requiring referrals in all cases.

[golfing eagles]

Originally Posted by NYGUY

Not quite right Doc. The Villages Health now only accepts United Healthcare Medicare Advantage Plans and UHC's PPO's are Medicare Advantage Plans. I have a HUC Medicare Advantage PPO and have my email from TVH saying my insurance will continue to be accepted by TVH.

I might add, that in my opinion, UHC's PPO's are a much better option than UHC HMO's if a larger network of physicians (both primary and specialists) are important to someone as well as not requiring referrals in all cases.

Looks like you are correct
From TV website:

If you are eligible for Medicare, we want you to know that the only Medicare Advantage plans The Villages Health participates in are those offered by UnitedHealthcare®.
•UnitedHealthcare® The Villages® MedicareComplete® (HMO)
•AARP® MedicareComplete Choice® (Regional PPO)

my bad, I think I picked it up from other posts--should have checked myself

[outlaw]

Yesterday, I called three different people connected to TVH. My concern is that, although I am a patient with TVH, I am not yet 65 (God that sounds old, doesn't it?). I asked, when I became eligible for medicare, if I would be required to sign up for Med Adv, or would I be allowed to go with medicare plus supplemental. Two people said they didn't know. One person said yes. So, I still am not sure what will happen when I turn 65. And I guess, this whole thing with TVH going to UHC Med Adv is so new that the employees really don't know.

[FromDC]

Originally Posted by outlaw

Yesterday, I called three different people connected to TVH. My concern is that, although I am a patient with TVH, I am not yet 65 (God that sounds old, doesn't it?). I asked, when I became eligible for medicare, if I would be required to sign up for Med Adv, or would I be allowed to go with medicare plus supplemental. Two people said they didn't know. One person said yes. So, I still am not sure what will happen when I turn 65. And I guess, this whole thing with TVH going to UHC Med Adv is so new that the employees really don't know.

I am in the same boat as you. My primary care doctor is with the Villages Health and I am under 65. We can only wait and see what happens.

The doctors, in the front office, strive to make the patients well. The business people, in the back office, strive to make sure the finances are well. As mentioned in my Post #97, the Villages Health business needs to promote selling their Advantage Plan. This is one part of their business model. Sell, sell, sell. Starting immediately, any new patients are required to buy the Advantage Plan. Eventually, the business people will reevaluate to see if they need to bring more people into the Advantage plan. They may target new Medicare eligible folks (like you and me) and/or say that everyone needs to buy the Advantage Plan.

I have a road map of where I want to go with my Medicare sign-up even though I am not 65. Joining Villages Health was easy when I first moved down here, but I don't have any loyalty to them. There are many physicians that take original Medicare and isn't it a better idea to have choices?

[CFrance]

If you have a supplemental plan, anybody who takes Medicare must accept your supplemental (Medigap) plan. Don't see how they can get around that at TVH since it's the law.

Medigap works with the exact same network as Medicare. So you don't have to check the network if they accept Medicare.

https://www.senior65.com/medicare/ar...accept-medigap

[FromDC]

Originally Posted by CFrance

If you have a supplemental plan, anybody who takes Medicare must accept your supplemental (Medigap) plan. Don't see how they can get around that at TVH since it's the law.

Medigap works with the exact same network as Medicare. So you don't have to check the network if they accept Medicare.

https://www.senior65.com/medicare/ar...accept-medigap

I liked the link you referenced. Yes, if a doctor accepts Medicare assignment, he will take your Medicare supplement. Medicare pays 80% and supplement pays 20%. The Villages Health will still process those claims as in the past for existing patients.

The Villages Health has opted to only accept their 2 Advantage Plans for new patients. This is their business decision to do this.

Any doctor can accept Medicare and then drop out of Medicare assignments at any time. This is similar to doctors participating and then not participating as an in-network provider. Also, the Villages Health can drop the Advantage Plan if they wish. It is their decision, but there is no law violation.

I wish someone from Villages Health or UnitedHealthcare would participate in this discussion.

[NYGUY]

Originally Posted by CFrance

If you have a supplemental plan, anybody who takes Medicare must accept your supplemental (Medigap) plan. Don't see how they can get around that at TVH since it's the law.

They get around it by not accepting Medicare for new patients. They can accept Medicare Advantage Plans (in their case, only UHC) and not accept Medicare.