Medicare advantage & tv healthcare
 

Since receiving letter from tv health in july 2016 regarding medicare advantage policy i have been very upset by the situation. I have been looking for a pcp. No success yet. Just wondering how the other villagers who don't want to give up their current insurance for medicare advantage are doing. What are your feelings at this point?

I'm annoyed but not upset. I have found a new PCP (recommended by neighbors) and have had my first appointment.

Life goes on. Good luck to you!

I'm just curious as to why you haven't found a new doctor. Are they not taking new patients? You don't like the location? I'm asking because I would think it will be wild and crazy when the snowbirds arrive! I will begin the process in April, so I'm thinking/hoping things will be calm again by then.

At the beginning they wouldn't take our insurance so we just found a PCP. We didn't like him and switched to one we did like.

Non-United Physician
 

I'm new to the villages and don't know where to find a PCP not requiring United coverage. I have BC/BS as a retiree from the State of Michigan. Thanks for your help

We have Anthem BC/BS. While I am sure it is different from yours, I would think their website is very similar in that you can find a list of in-network, non UHC physicians. Have you tried that?

This is all very confusing, if you are under 65 call Villages Health, and you MAY be able to be seen. However, you will need to change insurance or get out when you turn 65.
As for surrounding PCPs, we asked other people we met for recommendations. Found a very nice one in Leesburg, a longer drive, but he appears to be a very good doctor.

Many physician groups and individuals are running ads in the Daily Sun. Some ads specifically target those patients that were "booted" by TVH.

Talk to friends and neighbors.

Go to the website of BC/BS Michigan (or call them) and search for providers in this ZIP Code.

Good Luck - it CAN be done successfully!

I totally agree. We have been ripped off. I know of a person who is 87 who gave up her original medicare. Now she can't relocate to live near her daughter without a financial penalty because she will need to new a medicare account and it will be more expensive than it would have been had she never left it to join UMAP. No one will want to move here if this is allowed to be implemented. I am shocked that The Villages developers have allowed this to happen. I am very worried. I am from Alaska and may return there when I deem it is necessary so I want to keep my original medicare. How sad. Our wonderful Villages has just turned into a bad deal for seniors.

I'm pretty sure you get a one time move from an advantage plan back to original Medicare.

I have been here 10 years ago. I have made four attempts to find a primary care doc none of those choices worked either because of the doc or the his staff. So I asked my cardio guy to fill in and he has, in fact i was having problems with another specialist and he intervened and found me a specialist this is really good.

Be careful with enrolling in and out of plans it can create a nightmare for some. When ACA instituted insurability it made it possible for corp to no longer includ retirees in their enrollment plans. My company continued to pay us a stipend but we were forced to buy our own plans. We stayed with the medical & dental plans the compay worked with and had to decide on a RX company. We are please with both

As of this moment in time, the villages health specialists will continue to see original Medicare patients so you are really looking for a PCP. We are from Orlando so my husband went back to the Florida Hospital associated doctors. We drive less than 45 minutes from Brownwood to FH Waterman. The doctor indicated she will refer my husband to TV specialists whenever possible. She has privileges at Waterman. Unless there is a problem, we see the PCP twice a year. We are very pleased. More importantly, It's halfway to Costco, trader joes and altamonte mall LOL. I'll change to her when I go on Medicare next year.

I have decided to move to a university city in Florida to get excellent health care. I've always lived in cities where the academic practices were resources for the community practices and peer review "lifts all the boats".

You would be surprised how many people buy after a 3 day lifestyle visit. Few do the appropriate research. They find out later about the health care. They see all these beautiful heathcare facilities for "villagers". They assume that they will take medicare. I mean, come on. It's a retirement community. Most villagers are on medicare. And they DO take medicare,...just not part b. But that doesn't seem to come up in discussions during their 3 day visit. Off to the town centers in our golf cart; "now isn't that fun?"

Under the heading of been there and done that, there is an option to switch back to traditional Medicare during the first year (before the 52nd week), after that, you may be subjected to additional Medicare costs, health questions, and underwriting for the supplemental plans. We changed at week 50, and avoided the surcharges and possible underwriting.

Any idea to the logic behind the pay more if you go back rule ?

One of the internet articles on the subject of switching back to Medicare from an Advantage Plan note numbers of older sicker seniors are doing so as the Advantage Plans employ limitations designed to cut costs making it economically unviable to remain with the Advantage Plan insurer. It cited a Brown University study discussed in the 10/2015 issue of Health Affairs. When seniors elect to do so, buying a Medicare Supplement policy as noted previously becomes extremely problematic. While it has been said it in another post, it bears repeating; the red white and blue Medicare Card and guaranteed right to buy a Medicare Supplement policy are " gold " when you become seriously ill. Give a lot of thought to " parking" that card in a drawer instead of your wallet.

It is on the CMS website, and I was told this by the UHC rep.

What city?

seems extreme
 

I can see that if one's general health necessitates it. but it seems extreme. most of us will be treated well by local doctors for what will probably be expected health issues for our age and we always have the option of going north to Gainesville for a teaching facility. However, teaching means much of the treatment will be done by residents not attendings. And a lot of time they are book smart but not clinically exposed. Saw a lot of book smart health care professionals in my career I wouldn't let touch me because they had no capacity to think beyond. It takes an open mind and exposure to different clinical experiences to be an exceptional doctor. Nothing is static in medicine. Look at estrogen....first the studies said it was good and women should take, then bad, then good again, now bad again. Give me a doctor with common sense and experience.

Sorry, you had to make this extreme decision. However, I feel I am getting excellent health care from my PCP and specialist I am seeing.
I did not see the need to leave TV, just because of the health service decision.
Like I have heard there must be more to your story...................

Can someone explain to me,,,,,, I have Medicare and united healthcare supplemental plan. Can I see a doc in the villages system or go outside the system. Thanks for help

You go on medicare advantage while you are healthy. Then, when you start having some health issues that require expensive procedures, etc., you switch back to medicare with supplemental and expect the supplemental to pick up the difference. Of course, you haven't been paying for that supplemental when you were not needing healthcare as much, so the insurance was making money. Now that you have more healthcare expenses, the insurance company needs to charge you a higher premium to offset your increased costs to them.

You will have to go outside the system, or convert to medicare advantage.

we have the same and most doctors accept it. Only exceptions are those who don't take medicare. gives us a lot of flexibility specially when traveling around the us.

So based on the Brown University study referred to earlier the Advantage Plan insurer insures you as a healthy young senior profiting from the government subsidies to do so, and then employing price, access and coverage limitations, forces you back into original Medicare when you are older and sicker. You are then often times at the mercy of the same insurer as to whether they will sell you a Medicare Supplement at all, based on answers to health questions, or, if they will sell it to you, what price you will pay is dependent upon the state of your health at the time. Does it get any better then this ? A decision to stay with original Medicare and the Supplement Plan purchased when signing up in the first place, seems to have been justified. I am not knocking the insurers for " gaming "
the system. It is what it is and the responsibility for reform is elsewhere.

Sounds like a decision a reasonable person might make. Other reasonable people may decide not to. It is good to have choices.

I am trying to understand why a doctor in a university is so much better than one that has graduated. I wouldn't want to fly with a pilot that is just learning.

Many good doctors out there. Do your home work.

This may help you to understand why doctors in an academic setting may be a better choice (we are not talking about treating the sniffles or getting a flu shot)

Why an Academic or Teaching Hospital May Be a Good Choice for You

There are some definite pros and cons to working with doctors who are affiliated with these teaching centers and hospitals. Here are some pros for you to consider:

Salaried Doctors: While most doctors in private practice, and those affiliated with non-teaching hospitals, are reimbursed by insurance based on how many patients they see, or tests or procedures they offer, doctors who work at academic medical centers and teaching hospitals are usually paid on salary. That means the emphasis isn't necessarily on seeing too many patients in too short a time (although in some academic institutions it is.) Since there may be less emphasis on herding large numbers of patients through, or ordering tests or procedures, those doctors may be able to take some extra time with you.
Research and Clinical Trials: The professionals who work in academic medical centers are often interested in research, too. They are the people who run clinical trials, or who are on the lookout for new ideas. In particular when you have a rare disease or undiagnosed symptoms, these extended interests may provide answers that won't be forthcoming from a doctor in private practice.
Centers of Excellence: Academic medical systems and teaching hospitals often build "centers of excellence" which focus on certain diseases or conditions, like stroke centers, heart centers, cancer centers and others. They will group the doctors and support staff needed for these specialty centers into focused teams.
Access to Treatments: Because of the ways licensing works, there are sometimes treatments available through academic medical institutions that may not be available through private practices.
Academic Departments: Academic medical centers often offer services that are related to academics, and are therefore not found in other hospitals. For example, there may be an ethics department that can be called upon to consult with families who may have very difficult decisions to make.

"many good doctors out there" ????? Please fact check. If you can travel up to 100 miles of the villages, maybe.

I think that was the reason that the Morses tried to start The Villages Healthcare. That and they would make money on it of course. Florida has a lot of so-so doctors in my humble opinion.

We were told if we started with Medicare Advantage and then wanted to switch to Medicare and Medigap, we could then be charged extra for certain aches & pains we had, and pre-existing conditions, including some minor things as blood pressure medication, however small, cholesterol, etc. They said that was called underwriting.

If we signed up for Medicare and Medigap from the beginning, they could do no underwriting due to health conditions.

We went with the Medicare/Medicap. IMO, if a truly serious illness befalls us, we will go to whatever medical facility in the US specializes in that condition, and don't want to be hampered by out-of-network problems.

[QUOTE=NYGUY;1298092]This may help you to understand why doctors in an academic setting may be a better choice (we are not talking about treating the sniffles or getting a flu shot)

Why an Academic or Teaching Hospital May Be a Good Choice for You

There are some definite pros and cons to working with doctors who are affiliated with these teaching centers and hospitals. Here are some pros for you to consider:

Sounds logical to me. Now tell us about the cons.

Nailed it!!!!:thumbup::thumbup:

[QUOTE=Shimpy;1298701]It's not golf cart accessible. So, if it is critical, you get to decide, get help or save on gas.