Villages Health Care-Advantage plans
 

I've been with Villages Health Care (Colony Cottage) since its inception. I have traditional medicare with United Health Care supplemental plan F. Since the very start I could not tell any difference between the care I received with my current plan(s) or if the care would improve if I switched to advantage. Since I view the care from the Villages Health Care well below what I received from my primary care physician in the Midwest, I could not justify making the change to an advantage plane. I have felt for some time that I would move along and find another General Practitioner and now will being doing just that. This has never been about "better health care", it is all about the money. VHC is way over staffed and they have wonderful facilities, very large, bright and clean but you need big profit margins to continue to operate in this manner.
I've heard two different "rumors" that United Advantage pays VHS either $5000 per year and/or $800 per month per patient regardless if they are seen by physician or not (I suspect the truth lies somewhere in between) whereas traditional medicare only pays per visit??? So follow the money folks, that's what its all about. VHS will have to continue to tweek their "model" often to keep up the cost of doing business.

I'm not sure we'll find the care we were used to in other places. I've been looking a couple of days and most of the doctors here appear to have been educated in foreign countries. Not saying that is bad, just don't know! I guess they are the only ones that will see us peons who stoop so low as to be covered by Medicare and Supplement!

You make some interesting observations.

Since you have been with the system for about 4 years and view the care as "well below" what you had before, why have you waited to change?

How do you know it's "just about the money"? Obviously, that matters to any business, but could there be other factors? There has to be a maximum number of patients they can serve with the present infrastructure. Over time, Advantage patients could be denied access if there are insufficient openings due to acceptance of all Medicare plans. Sort of like TV schools- if those in now don't follow guidelines for attendance and are allowed to remain, that penalizes those waiting to get in who would comply.

As for tweaking their business model based on results, that is what all good businesses do. Those that don't often fail.

I guess since you aren't that thrilled with the care, and were planning to move on anyway, you probably are not upset with this decision on the part of VHS.

For all who stay in (and everyone can stay in by participating in the accepted plans, similar to many business models), this should be a good thing for long term stability. I know I am counting on it.

Choice is a good thing, and everyone gets to make their own decision about whether to remain in the system. Just hope folks make their decision on facts and not RUMORS as you mentioned.

No one is being booted out, and that is a great thing.

Have a great day.

You obviously have Medicare Advantage and the disappointment in the system does not affect you personally so I doubt you'd be the one to comment and gloat to those of us who were sold property and promised this EXCELLENT healthcare in Americas FRIENDLIEST hometown. It is understandable that one might not have been happy with our choice of physicians. After two years with the same Doctor I determined he was not the one for me so I asked for and got a new doctor that I liked very much! We understand that the bottom line is what it's all about but that does little to excuse their promises and method of notification. It is a great inconvenience for most of us and it would have made it a bit easier to stomach if only they had made a little effort to tack one little paragraph in their letter saying they were sorry!

Because of my background in health insurance it is my opinion that the Advantage plan is great for the healthy but not so good if you have health problems and your trusted doctors do not participate. Although I have reason to believe that not everyone is getting top care at TVs health centers, there are those of us who value good health care and don't want to settle for second best!

Vhs
 

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.

Those who assume I have the Advantage program today are making a bad assumption. I don't, but I will.

Why?

Because I value the service and care I receive from VHS. I understand how business works. If I want their service / care, I need to comply with the requirements of the business.

There are currently 37 PCP's listed on the various VHS web pages (not counting the Aisenstat's who are still shown but not really there).

Now, using the MAXIMUM number of patients (1,250) that each doctor can accept, that equates to 46,250 available patient slots.

Many folks who have complained about the new requirements state they are concerned about being away from TV for long periods of time, like during summers, and therefore limited in coverage.

There are now about 120,000 residents in TV, so wouldn't it make sense that with limited capacity, the business would make decisions that would positively impact the most residents as well as the business's ability to remain strong?

I get it that this is disappointing to some, but 50 years of having health insurance confirms to me that plans and providers change darn near every year. That's just the way it works.

Best of luck as you choose to stay in the system or withdraw for other choices.

I moved to tv in 2013. The villages accepted original medicare & my nys insurance. Now they are telling me that to stay with tv health i have to join
medicare advantange. My nys insurance says they they will drop me if i do this. This will result in loss of benefits & a $2,500 reimbursement from my former employer. The villages runs ads saying "new" villagers can join tv health & pick a medicare advantage plan. This ad also states royalties will be paid to the villages. Best of all you don't have to reside in the villages to use tv health as long as you have medicare advantage.
The phone number for info rang 30 times with no answer or recording to leave a message. Call administrative ofc. 352-674-1700. They are taking names & have a team looking at the responses to this decision. Please call & voice your opinion. I spoke to barbara oliver she did not want to give me her name but i insisted. Fight for your rights.

Rockyside, As we debate our options after receiving the VHS letter, besides the option to go anywhere for health care services, the second major factor for us is that we are guaranteed continuation of the supplement plan and that is not the case with Medicare Advantage.

Thank you for a very well written and balanced post. :thumbup:

It's especially compelling, considering that you were actually involved with the whole process from the beginning.

I am new to TV, 2015, and joined the VHS because I talked to a rep from United and he told me I should keep what I had because it was better than what they would offer.
PLUS, I could keep my heath plan, retiree Medicare and supplemental, BC/BS of MD.
I have never had any problem w/ my current health plan coverage. As a matter of fact, I just had a knee replacement by the top Ortho in the area, and my out-of-pocket expense was <$200 vs. original cost of $ 85K.
Now I am being told change to VHS plans or go find another PCP- damned this is not easy to do, where do you find who is good or not so good???

I received my letter on Saturday telling me that unless my husband and I choose United Healthcare Medicare Advantage we would no longer be seen by The Villages Healthcare at Pinellas where our primary doctor is located. Although I am very happy with my primary doctor I was more concerned with the specialists that we see. I called my cardiologist this morning and was told the only thing affected by the "new rules" of medical coverage was our primary doctor. All of our specialists will still see us with our conventional Medicare and United Healthcare. Well, bye bye Villages Health. Your loss, not mine.

My husband and I are leaving the Villages health care after 3 years. We have good coverage and will not switch to an Advantage plan. We agree with everything you said. We were, in fact, told one of the reps at Colony to keep what we had because it was better than anything they could offer!

Blicata, someone doing their job should not be held responsible for the decision of the group. I seriously doubt that Ms. Oliver means any ill-will toward anyone, especially their patients and I can only imagine how hectic their jobs must be now! This is not the messenger's fault and I certainly hope in "fighting for their rights", nobody would take anything out on an individual.

My wife and I were both in the VHS. We both liked our doctors and really liked how well everything was run. We would have loved to stay but to me it would be taking a chance with our health care. The worst thing about the advantage plan is an insurance company is going to decide if you need treatment..not your doctor. The term is medically necessary. Ask someone at SHINE if my doctor orders an MRI for instance, will I get it or will it have to be cleared by the insurance co?
I would suggest that you, and anyone else considering an advantage plan, talk to a SHINE rep and ask them about who decides what is necessary between the two plans.

Villages health care
 

Many people here have also worked their whole life and have been able to retire with benifits for life. They will all have to leave TVH if they want to keep the insurance they worked for. The entire thing seems shady to force ins down your throat if you wish to remain in TVH . I am not of Medicare age so my letter stated that I'm still allowed to remain but I will be looking for a new dr also .

I am not a fan of TVHCS preferring from the beginning to utilize Munroe. However in fairness to all the health care system and insurance are dealing with the enormous upheaval ACA has had. ACA is reported to be going down in flames. Is it so ?????

It is sad to see The Villages Healthcare System boot residents out because they do not belong to the right health insurance club. Does not have that "Friendliest Home Town" sound to it.

Just remember it's only health care. We still get free nightly live entertainment in the squares. Just exercise, stay in shape, eat healthy, and maybe you won't need health care.

OK, that was funny. :1rotfl:

To solve the big mystery, it is all about CONTROL! The Advantage plan will be telling YOU and your doctors what can be done for you! They do not intend to spend more for your care than they allot for your care! If you are not happy with your Advantage plan, I'm not sure you can return to your old supplement without qualifying questions. I could find no one who would tell me that I could "go back" without penalty! I'm sure it's a business decision for TV and THANKS BUT NO THANKS!

Through several years in an Advantage plan and a couple major medical procedures, I've yet to experience anything like this.

[QUOTE=Polar Bear;1257777]Through several years in an Advantage plan and a couple major medical procedures, I've yet to experience anything like this

That's good to hear! I've had friends that had problems.

Villages Health Care-Advantage plans
 

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.

My wife and I are currently considering purchasing a home in the Villages. We are both on Medicare and have BCBS of Illinois as supplemental. We have had BCBS for 40 years and are not going to change. Is this going to be an issue if we decide to buy a home?

No more so than if you were moving to Dallas or Oshkosh. You would have to find a new doctor, and would probably look for someone who accepted your existing insurance after getting recommendations from your neighbors or friends. No different here.

The controversy is rooted in the concept that some people feel that they were "promised" they could stay in TVH system "forever", regardless of any changes in insurances or national health care policy. They feel they were "lied" to, although no one has submitted proof of any such promise, and probably never will, since it would be a rather unique position. Therefore there are a large number of TVH patients that will either have to change their doctor, or change their insurance. The complainers don't want to do either. They feel they are taking a risk by changing insurance, although after reviewing the plans, the risk is, in my opinion, minimal. It's sort of like stating you don't want to get shot by a terrorist in France. So don't go to France. But they want to go to France anyway, but get a guarantee they won't get shot. Not an option that is offered.

Excellent post!!!! :bigapplause:

When emotions rule the mind, the intellect goes out the window.

Oshkosh, interesting choice of location...lol.

B'gosh, I guess it was:1rotfl::1rotfl::1rotfl:

Oskosh is in Wisconsin, USA :D

BTW - Isn't Google great?

Medicare Advantage video




No Premium "FREE" Medicare Plans | You Get What You Pay For - YouTube

Anyone have a copy of the 2016 UHC plan F and plan N enrollment guides that I could borrow for 1-2 days? My wife and I have these plans, and I have the "accepted" plan books for this year. I want to do a detailed comparison to see what we might be giving up if we stay. I know the new books will be out in October, but I am trying to plan ahead (assuming there will not be significant changes except for costs).

Thank you in advance.

PS I called UHC to get copies, the minion said oh we can send you those electronically, guess what I got LINKS to the website, and NO documents. I could not find the documents on the site, and a google search turned up nothing useful. We tossed ours out after we signed up, who knew???

One thing I haven't seen mentioned in any of these posts is concern over how easily TVHS has changed the rules that people thought they were operating under, and how easily they might change again in the future. My wife and I are going to leave TVHS because of this new ruling, not because we think it is the better way for us to go now, but because we are concerned about what new adverse decisions TVHS might put forth in the future.

A critical element of health care is confidence. If you have lost confidence in the system (as we have because of the way this recent decision was made and communicated), it's time to go. Who's to say The Villages won't close the entire system three or four years from now because it's not making enough money for them then (and with the number of people walking because of this recent decision, that's not such a far-fetched scenario). Where will be people who stick with the system now be then?

Advantage vs Supplement
 

When I signed up for Medicare 3 years ago, I was told that if I initially signed up with Advantage and then later on wanted to change to Supplemental that my medical history would be considered and I could be denied. Not sure if this is true or not but it made an impact on my choice. Anyone from SHINE that can verify whether this is true or not?

Are you informed before buy a home in TV
 

:welcome:I hope everyone that is going to buy a home in The Villages is well informed of this health insurance clinch before buying ......some how I doubt that will happen.

I'm not with SHINE but it is true. I know this because we chose to drop an unsatisfactory employer-sponsored PPO plan for a supplement a few years ago. Approval by the insurance co. that provided the supplement required answering several health questions satisfactorily.

Health care
 

From what I heard from my doctor up north all is going to change for Medicare anyway when the new MACRA laws go into effect.

I moved here primarily for the healthcare system that was so loudly touted as a model system. I have only been in the system for two years. I changed my primary care physician after a couple of months as I felt like just a number with my initial physician. I really like my current physician but the change to their accepted insurance 'only' has really forced me to make a decision that I need to make for myself. The out of pocket cost in higher premiums, plus a co-pay which I do not have with my current carrier, is a no-brainer for me. The fact that hospitals and facilities receive a payment from plans for their acceptance of preferred plans has been going on for years. After many years working in the healthcare field I am very aware that 'kick back' is a common practice. The care I received here has been adequate but not up to the standard I received in rural Tennessee. I have an appointment with my new physician out of TV Healthcare system this week. The location of the practice is not convenient but I need to move on. I'm sure there are many who will make the same decision but, for everyone of us who choose to leave there will be another person to fill our place.

Sadly, you might find the same situation when you change to another individual doctor or another group. You never know ... it's a jungle out there.

One thing I haven't seen mentioned in any of these posts is concern over how easily ANY MEDICAL PRACTICE IN THE US has changed the rules that people thought they were operating under, and how easily they might change again in the future (and probably will).

1) What premium???? Someone with supp. plan F and a part D plan is paying $238/mo. in premiums, there is no premium with UHC MA plan 1. Saving $2856/yr. will cover a lot of co-pays. If someone has very high utilization of medical services, they could theoretically lose on the copays. On the other hand, MA plans are based on average utilization. Maybe rightfully so. I'm not so sure I should pay the same at the all-you-can-eat buffet as the 600 lb. customer, nor the same for an airline seat, especially since they charge me extra for a 25 lb. checked bag but not for his 400 lb. of excess weight.

2) Kickbacks????? Please explain what planet you spent years working in healthcare on.

This possibly may have changed due to "the affordable care act" or "Obama care" . Maybe pre-existing is not allowed? Don't know....just asking.