Talk of The Villages Florida
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Talk of The Villages Florida (https://www.talkofthevillages.com/forums/)
-   Medical and Health Discussion (https://www.talkofthevillages.com/forums/medical-health-discussion-94/)
-   -   The Villages Health Care Program (https://www.talkofthevillages.com/forums/medical-health-discussion-94/villages-health-care-program-166313/)

massapequa girl 10-26-2015 01:41 PM
Don't worry, there are many doctors OUSIDE OF THE VILLAGE HEALTH CARE SYSTEM, who accept BC/BS and Medicare. My advice, don't give up what you have, once you do, you can't get back into the BC/BS systems. The doctors outside of the Village Health care are better than what they are "selling" in the Villages.

Boomer 10-26-2015 03:05 PM
Another precinct heard from
 
Quote:
Originally Posted by outlaw (Post 1132891)
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.

There was a guy in a TVH booth at the square so I asked him......

Me: Will TVH take Medicare as the primary and a Plan F Supplement?

Booth Guy: Not for new patients.

Me: But it is a UHC Plan F Supplement.

Booth Guy: Won't take it for new patients.

Me: Really?

Booth Guy: UHC Advantage Plan is the only one accepted for new patients.

(Yeah. I know. I asked the guy the same question 3 different ways. That is because I find this appalling on so many levels and I was hoping I was not hearing him right.)

-- So Plan F supplements are out for new patients. And I guess it is true that any other Medicare plan would be, too, including those plans that many Villagers have in place as a retiree benefit from their careers. But I did not ask about those. I think I know the answer. Hope I am wrong......

wow......Talk about the company store.......

CFrance 10-26-2015 03:16 PM
If they don't take Plan F, then they can't take Medicare. So I guess the way they get around that is by saying no to new patients. I don't know how they can take Medicare for some new patients but not for others. I would love to hear an professional's opinion on this.

outlaw 10-26-2015 03:20 PM
Quote:
Originally Posted by CFrance (Post 1135939)
If they don't take Plan F, then they can't take Medicare. So I guess the way they get around that is by saying no to new patients. I don't know how they can take Medicare for some new patients but not for others. I would love to hear an professional's opinion on this.
Why is that?

What they are saying is that new patients have to sign up for medicare part c, which is a medicare advantage plan.

memason 10-26-2015 03:54 PM
I have a retiree plan from my former employer and it is accepted, but I'm not on Medicare yet... The retiree plan also happens to be a UHC PPO plan

outlaw 10-26-2015 03:56 PM
Quote:
Originally Posted by memason (Post 1135961)
I have a retiree plan from my former employer and it is accepted, but I'm not on Medicare yet... The retiree plan also happens to be a UHC PPO plan
Based on what I was told, I think you will be OK. Nor sure, though.

CFrance 10-26-2015 06:20 PM
Quote:
Originally Posted by outlaw (Post 1135941)
Why is that?

What they are saying is that new patients have to sign up for medicare part c, which is a medicare advantage plan.
Because by law Plan F is accepted anywhere in the country that Medicare is. They are getting around that somehow. I would like to know how.

NYGUY 10-26-2015 07:13 PM
Quote:
Originally Posted by Boomer (Post 1135931)
....I think I know the answer. Hope I am wrong......
You are not wrong!!

NYGUY 10-26-2015 07:23 PM
Quote:
Originally Posted by CFrance (Post 1136061)
Because by law Plan F is accepted anywhere in the country that Medicare is. They are getting around that somehow. I would like to know how.
I thought that was already answered....They will no longer accept Medicare if you are a new patient!!!....which part of that are you having trouble with?? Or are you just not happy about it?

CFrance 10-26-2015 07:38 PM
Quote:
Originally Posted by NYGUY (Post 1136101)
I thought that was already answered....They will no longer accept Medicare if you are a new patient!!!....which part of that are you having trouble with?? Or are you just not happy about it?
See post #9. And stop screaming.

NYGUY 10-26-2015 07:54 PM
Quote:
Originally Posted by CFrance (Post 1136108)
See post #9. And stop screaming.
No....and post #9 doesn't say anything about them accepting "Medicare". CF, Send me a PM so I can try to explain.

outlaw 10-27-2015 06:49 AM
Quote:
Originally Posted by NYGUY (Post 1136101)
I thought that was already answered....They will no longer accept Medicare if you are a new patient!!!....which part of that are you having trouble with?? Or are you just not happy about it?
I think they will still accept medicare. But you will have to enroll in medicare part c (med adv plan), as opposed to using a supplemental insurance.

golfing eagles 10-27-2015 07:42 AM
Quote:
Originally Posted by CFrance (Post 1136061)
Because by law Plan F is accepted anywhere in the country that Medicare is. They are getting around that somehow. I would like to know how.
Very easy---a physicians office does not have to accept any insurance or patient they do not want to. They can apply a different rule to NEW patients. As long as they are consistent with existing patients, they have the prerogative to change the rules for new patients. We do this all the time, usually when an insurer drops reimbursement to a ridiculous low level. We don't like dropping patients we have had for 30 years, although some practices do, so we just don't accept any new patients with that insurance. Medicaid is a prime example. We take no new Medicaid, but have kept existing patients who already have it---if for no other reason than life circumstances can change
Hope that answers your question

Boomer 10-27-2015 08:10 AM
............

outlaw 10-27-2015 08:57 AM
Quote:
Originally Posted by Boomer (Post 1136236)
I have seen Advantage Plans described as "replacements" for Medicare. I also found something that said when you sign up for Plan C (aka an Advantage Plan) you "leave" what they call Original Medicare. -- If that wording is correct, it looks like therein could lie the loophole. (I will try to find that source and cite it later. It was not the .gov site though. It was one of those sites with explanations.)

I do not see how holders of Plan F who have found that those plans have worked for them with hospitalizations, etc -- or snowbirds -- or those who have good Medicare supplement coverage as a retiree benefit -- or those who will pay for choice -- will switch to this Advantage Plan. But I guess the pool is so big here that TV figures they eventually can hold all the cards.

I do realize that premium cost is often the main consideration. And I think there may be other coverages available within an Advantage Plan. But what are they saying about out-of-pocket limits? -- I know people who are going with this plan and, of course, I hope it serves them well. We each must decide what works best for us.

You know......whether a supplement or an advantage plan, the stockholders in a huge insurance company own a piece of every patient. -- and before I get bashed because somebody thinks I am bashing the market, that is so not true. I like to stock-pick, but I do not want to own a piece of patients. Whoops.....I digress....

So anyway, I remain appalled at this move by TV to shut out those new patients who do not buy their insurance plan. -- Appalled but not surprised. What's next? Priority seating in the waiting room?

I think I better just stop typing and go get some coffee.....maybe then this little song I keep singing in my head will stop.......It's all about the profit, 'bout the profit, not medicine.....all about the profit, 'bout the profit, not medicine.......

Boomer
Here's the way it was explained to me by a UHC rep. When you choose medicare c, you also sign up for medicare b. You still send your medicare b premium ($105 for most people) to the government. The government sends the medicare c insurance company about $10,000 per patient per year. It is up to the insurance company to manage the healthcare for each of those patients without anymore money from the government. So the insurance company can adjust coverage, copays, doctors in network, etc. You still are enrolled in medicare.

jojo 10-27-2015 09:37 AM
I just came from the UHC office and was told that indeed the Villages Health System will not accept United Health Care Supplement (or any supplement) for new patients although they will for current patients. When queried about providers having to accept supplements if they accept Medicare they said it was because Medicare Advantage is a replacement for Medicare. ugh.

looneycat 10-27-2015 11:56 AM
Quote:
Originally Posted by Schneil (Post 1128846)
We are so disappointed in the healthcare program and restrictions. The advertising which sold us on TV while house hunting was and continues to be misleading. I particularly love the following advertisement that "health care is just a short golf cart ride away...." There is no disclaimer of: "only if you belong to UHC! Shame on the Morse family!

Copied from the Village Website:

An important part of a great retirement lifestyle is convenient access to wellness facilities and quality health care.

The Villages Health and USF HEALTH, a major academic health resource, are partnering to make The Villages America's Healthiest Hometown.

Staying healthy is easy in The Villages. Neighborhood fitness centers and health care facilities are located throughout The Villages -- just a golf car ride away. The Villages Healthcare Centers, The Villages Regional Hospital, Moffitt Cancer Center, VA outpatient clinic, senior living facilities, and a long term acute care hospital are all located here.
actually it is accurate as there are plenty of doctors in and around TV who are not part of vhc. they were all dropped by UHC if they were not part of the villages health care system. I certainly don't expect the villages health care system to take care of me, I take care of me and my medical choices. personally I have the aarp/uhc supplement. an advantage plan is out of the question as I have occasional hospital visits that would be financially crippling if I were on an advantage plan.

TheVillageChicken 10-29-2015 01:16 PM
Quote:
Originally Posted by Fredwms (Post 1130795)
My fiancé's ex was a Navy captain and she qualified for Tricare under their 20/20 program (20 years in service and 20 years married). I personally have Humana Advantage under Medicare as I am not military and not eligible for Tricare.
Actually the program is 20/20/20 and she will lose the benefit when you marry her.

TV MAN 10-29-2015 01:46 PM
Loonycat why do you think that you would lose coverage under advantage vs aarp suplemnetal ??

"I have the aarp/uhc supplement. an advantage plan is out of the question as I have occasional hospital visits that would be financially crippling if I were on an advantage plan."

golfing eagles 10-29-2015 01:48 PM
Quote:
Originally Posted by looneycat (Post 1136400)
actually it is accurate as there are plenty of doctors in and around TV who are not part of vhc. they were all dropped by UHC if they were not part of the villages health care system. I certainly don't expect the villages health care system to take care of me, I take care of me and my medical choices. personally I have the aarp/uhc supplement. an advantage plan is out of the question as I have occasional hospital visits that would be financially crippling if I were on an advantage plan.
If I may give some advice----re-read the advantage plans thru UHC and look at the plan details, use the link thru TV Health page.

If I'm reading correctly, plan 1 has an out of pocket max of $4500 with 0 premium, and plan 2 has a max of $1900 with an $85/mo. premium= $1020/year
Assuming you will be paying about $178/ mo. UHC supp. and $51/ mo. part D in 2016, that's $229x12= $2748/yr.
So, with plan 1, your exposure would be $1752/ year.
If you know you will exceed $2748 in out of pocket costs, then with plan 2 you'll have $1020 in premium and a max of $1900, = $2920, or exposure over your current cost of $172/yr. The prescription co-pays look identical in the advantage and supp. plans.

If I'm reading it right......

outlaw 10-30-2015 07:38 AM
Quote:
Originally Posted by golfing eagles (Post 1137544)
If I may give some advice----re-read the advantage plans thru UHC and look at the plan details, use the link thru TV Health page.

If I'm reading correctly, plan 1 has an out of pocket max of $4500 with 0 premium, and plan 2 has a max of $1900 with an $85/mo. premium= $1020/year
Assuming you will be paying about $178/ mo. UHC supp. and $51/ mo. part D in 2016, that's $229x12= $2748/yr.
So, with plan 1, your exposure would be $1752/ year.
If you know you will exceed $2748 in out of pocket costs, then with plan 2 you'll have $1020 in premium and a max of $1900, = $2920, or exposure over your current cost of $172/yr. The prescription co-pays look identical in the advantage and supp. plans.

If I'm reading it right......
Based on discussions with a UHC rep, I believe you still have to pay for your medicare part b, which is $105 per person. So that would add another $1260 per year.

waynegbrown 11-09-2015 04:44 PM
Nov 9, 2015. We are enrolled with The Villages Health, using Medicare and Tricare For Life. The Villages Health sent us a letter telling us they will continue to care for their existing 1700 patients covered by this combination, but will no longer accept new patients so covered. TVH suggested we get an insurance checkup with UHC Medicare Store at Sumter Landing and consider adding UHC Medicare Advantage coverage since there may be no cost additional benefits available such as dental, vision and hearing aids. We have an appointment to hear their pitch.
To clarify one issue, I believe UHC Advantage does not require you get your care from The Villages Health, but the only Medicare Advantage program accepted by
TVH is UHC.

looneycat 12-30-2015 04:51 PM
$4500 out of pocket for COVERED services. As the villages hospital twice sent me elsewhere because of prior health issues I would be outside covered services in Shands and financially impacted beyond $4500. If a UHC Villages rep can tell me differently i would listen, looking for facts not opinions.

PTennismom0202 01-05-2016 04:49 PM
Villages Healthcare and insurance
 
I've started with The Villages Healthcare for primary care a few months prior to my 65th birthday. They (The Villages Healthcare) told me good thing I got in before I was 65, because I'll be grandfathered in without United Healthcare Medicare Advantage when I hit Medicare age. Today I got the call -- 1 month before I am Medicare eligible. They changed their policy. They will not allow me to stay in the practice unless I change from Medicare B + Tricare for Life to a United Healthcare Medical Advantage plan + Tricare for Life. I stand to have a poorer Rx benefit and limit my provider choices if I do as they want. Don't think I'll do it. It's hard to find PCPs around here -- there seems to be a revolving door for them.

NYGUY 01-05-2016 09:03 PM
Quote:
Originally Posted by PTennismom0202 (Post 1167284)
I've started with The Villages Healthcare for primary care a few months prior to my 65th birthday. They (The Villages Healthcare) told me good thing I got in before I was 65, because I'll be grandfathered in without United Healthcare Medicare Advantage when I hit Medicare age. Today I got the call -- 1 month before I am Medicare eligible. They changed their policy. They will not allow me to stay in the practice unless I change from Medicare B + Tricare for Life to a United Healthcare Medical Advantage plan + Tricare for Life. I stand to have a poorer Rx benefit and limit my provider choices if I do as they want. Don't think I'll do it. It's hard to find PCPs around here -- there seems to be a revolving door for them.
Oh, what a tangled web we weave when first we practice to deceive..:ohdear:

outlaw 01-05-2016 10:32 PM
Quote:
Originally Posted by PTennismom0202 (Post 1167284)
I've started with The Villages Healthcare for primary care a few months prior to my 65th birthday. They (The Villages Healthcare) told me good thing I got in before I was 65, because I'll be grandfathered in without United Healthcare Medicare Advantage when I hit Medicare age. Today I got the call -- 1 month before I am Medicare eligible. They changed their policy. They will not allow me to stay in the practice unless I change from Medicare B + Tricare for Life to a United Healthcare Medical Advantage plan + Tricare for Life. I stand to have a poorer Rx benefit and limit my provider choices if I do as they want. Don't think I'll do it. It's hard to find PCPs around here -- there seems to be a revolving door for them.
Sounds like the hammer just dropped. So much for TV Healthcare. It's HMO or hit the road.

JoMar 01-05-2016 10:47 PM
Quote:
Originally Posted by outlaw (Post 1167416)
Sounds like the hammer just dropped. So much for TV Healthcare. It's HMO or hit the road.
Not only HMO.....also PPO. Both are plans under the AARP United Healthcare plans.

jamougel 04-12-2016 09:03 AM
We are new to the Villages, and went looking for a primary care physician, kept reading about the Villages Health, so we went to make an appointment. We were told the woman that was to interview us was at lunch, so we were told she would get back to us within 24 to 48 hours. She did call, the next morning, only to inform us they accept nothing but Medicare advantage plans. One, they should have told us that when we went for the appointment, two, that should be in all their advertisements and brochures. Seems to me with TV being almost all medicare, doctors should accept all national supplemental plans....just my opinion. Never ever thought finding a doctor in the Villages would be so problamatic

dbussone 04-12-2016 10:27 AM
Quote:
Originally Posted by jamougel (Post 1211566)
We are new to the Villages, and went looking for a primary care physician, kept reading about the Villages Health, so we went to make an appointment. We were told the woman that was to interview us was at lunch, so we were told she would get back to us within 24 to 48 hours. She did call, the next morning, only to inform us they accept nothing but Medicare advantage plans. One, they should have told us that when we went for the appointment, two, that should be in all their advertisements and brochures. Seems to me with TV being almost all medicare, doctors should accept all national supplemental plans....just my opinion. Never ever thought finding a doctor in the Villages would be so problamatic


Call Angel Tafur, MD if you are looking for a highly competent primary care physician. My wife and I both worked in healthcare before retiring, and both are very pleased.

His office number is: (352) 350-6241

PTennismom0202 04-12-2016 11:41 AM
I have Tricare for Life and was invited to leave in January before my 65th birthday. I think this has been in place for quite some time. This is a concierge practice.

skyc6 07-20-2016 07:36 PM
Does anyone know if United Health Care The Villages, which has a Dental part to it, has dental coverage for services other than preventive work? I know it covers exams, xrays, and cleanings, from dentists in the network. What I am asking is what if you need a root canal or a filling? Is there coverage for that?

SKIMAN 07-21-2016 07:24 AM
my neighbor who works for the villages health care system says this deal puts $16 million it the the pockets who ever made this deal..so much for Marcus Welbey heath care... welcome to the real world........

CritterLover 07-21-2016 07:40 AM
Quote:
Originally Posted by SKIMAN (Post 1257345)
my neighbor who works for the villages health care system says this deal puts $16 million it the the pockets who ever made this deal..so much for Marcus Welbey heath care... welcome to the real world........
I so respect and appreciate those who are trying to remain objective and who have something reasonable, rational, or factual to add to this discussion, and anything else is just irresponsible.

Polar Bear 07-21-2016 08:01 AM
Quote:
Originally Posted by SKIMAN (Post 1257345)
my neighbor who works for the villages health care system says this deal puts $16 million it the the pockets who ever made this deal..so much for Marcus Welbey heath care... welcome to the real world........
Oooh...your neighbor said...
Quote:
Originally Posted by CritterLover (Post 1257352)
I so respect and appreciate those who are trying to remain objective and who have something reasonable, rational, or factual to add to this discussion, and anything else is just irresponsible.
Agree.


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