[massapequa girl]

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]

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.

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]

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]

Originally Posted by CFrance

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]

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]

Originally Posted by memason

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]

Originally Posted by outlaw

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]

Originally Posted by Boomer

....I think I know the answer. Hope I am wrong......

You are not wrong!!

[NYGUY]

Originally Posted by CFrance

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]

Originally Posted by NYGUY

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]

Originally Posted by CFrance

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]

Originally Posted by NYGUY

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]

Originally Posted by CFrance

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]

............

[outlaw]

Originally Posted by Boomer

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.