Looking for Medicare clarity
 

While seeking to establish myself as a patient with a general practitioner or internal medicine doctor I have found that most of those in TV do not accept Medicare (including Medicare supplement plans), only Medicare Advantage Plans. Why is that when all of the hospitals and specialists take Medicare readily?

The Villages Health doesn't take Medicare but their specialists do. I never really understood why in the biggest retirement community in the country that TV Health doesn't take Medicare.

The Villages Health system employs primary care doctors, and they do not original accept original Medicare. They only accept a few select Medicare advantage plans. But, there are a lot of primary care doctors outside The Villages who do accept original Medicare patients. I think one reason for this rule is that The Villages Health system wants to make the Health facilities, constructed on Villages property, accessible to Villages residents. If they accepted original Medicare patients, they would be overloaded with non-Villages residents, and they would not be able accommodate Villages residents. That is because they could not legally give any priority to Villages residents over non-Villages residents. It would defeat the purpose of building health care facilities on Villages property.

There are a lot of practitioners IN The Villages that take Medicare and a supplement. Only The Villages Health system restricts medicare patients to the Villages United Health Care Advantage Plans. I believe all specialists accept straight Medicare.

The Villages Health System's internal specialists do accept Medicare supplement plans, while their primary care system is limited to Medicare Advantage. I don't know the reason but, after approx. three years of opening their first centers, they stopped accepting supplement plans in 2016. I wonder if it had something to do with a predictable cash flow, in that the government pays a lump sum yearly to an insurance co. for each Advantage patient.

If The Villages health system accepted original Medicare for their primary care doctors, they would be inundated with patients from the surrounding areas, and the health centers would no longer be convenient for Villages residents to use. If you accept original Medicare, you must accommodate all patients who have it.

That's ridiculous.

It's a strictly financial decision. Medicare Advantage Plans are more profitable for providers, under most circumstances. The Provider gets to determine what is necessary & not necessary for a given patient. Advantage Plans promote shoddy medical care, for the sake of profits. Why do you think they all advertise financial incentives to sign onto their plans?

Advantage plans are for folks who can't afford real insurance and are willing to sacrifice their health to save a few bucks.

United healthcare advantage has been wonderful here. Ignore the haters nonsense

My point was that The Villages has constructed 7 health care centers in The Villages that are located to be convenient for Villages residents to use. By limiting the primary care insurance acceptance to a few select advantage plans, they will not be overloaded with patients from outside of The Villages. If that were to occur, it would defeat the purpose of providing convenient facilities for Villagers to use. It doesn't sound ridiculous to me.

Thanks for your insights. We have an advantage plan and very happy with the collection of physicians we have and can see our PCP within a day.

52% of Americans have Medicare Supplemental Insurance. Assuming The Villages falls reasonably close to the "average" ... 1/2 the folks living in The Villages, can't use the medial facilities The Villages supposedly "built to be convenient for Villages residents"

They can if they sign up for one of the accepted Medicare advantage plans. It's their choice.

My employer allows me to take my group BC/BS into retirement so I'll have private insurance as well as Medicare. Will I face the same issues outlined in OP's post? I'm told that even though I'll have BC/BS, Medicare will be my "primary" insurance.

I am a retired Federal employee with the Federal BC/BS standard plan. My employer doesn't require me to have Medicare Part B, so I don't have it. I have saved thousands of dollars by not paying the Medicare premiums. I have no problem finding providers to accept my insurance. So, if you are not required to buy Medicare, you may want to do the math and see if it is worth buying.

You mean television pitchmen such as Joe Namath and Jimmie JJ Walker are not telling the whole story?:)

TV is not what it used to be. You can only rely on the Internet to get honest & complete information.

Bait right!!!!
:1rotfl::1rotfl:

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_:censored:

That will depend on which BC/BS plan you have. BC/BS offers a Medicare Advantage Plan in most states. I believe Florida Blue offers an Advantage plan.

The issue has nothing to do with Medicare being your primary insurer. It has to do with who picks up the difference. Your choice is Medicare Supplemental or Medicare Advantage. Think of it as an HMO vs PPO.

If you want to use The Villages health care system, you generally can't do it, unless you have one of their preferred Advantage Plans. I wouldn't concern yourself with being denied medical care by The Villages healthcare system ... it's atrocious. Look up reviews on the hospital or the other providers. I wouldn't go to them with a hangnail.

Villages Health-Advantage plans
 

Amazed to see the disparity of opinions on the topic of 'Villages Health' and 'advantage' plans. I agree to not believe the obvious 'hater's' who form opinions prematurely, without any real exposure, and then become rigid in proving themselves correct. All I got is my personal experience- 1)Have never had a more responsive or accomodating health care situation as I have with the Villages Health. I feel like a person, and not a social security #. 2)Advantage plans have incentives to KEEP you healthy, so will work harder to prevent issues, rather than just reacting to them. It's true-they are paid a fixed fee per patient, so the healthier you are, the better off they are. That's a win/win to me, not to you? 3) The extras-free gym memberships, OTC $$ given, eye exam and glass allowances, discounted hearing aids and even dental benefits, sometimes in the thousands of $$ make it a tremendous value.
My perspective might be skewed by the fact that I am relatively healthy right now, but my hope and belief is that the 'Villages Health' will be keeping me that way for years to come. Again- no hater's please-this is MY experience here.

Dr. Kathy Greene over in the Lake Deaton facility accepts regular Medicare and plans to continue to do so. We switched to her last year when our previous physician over at the Colony facility retired and no one else would take a regular Medicare patient there at that time. Give her a try.

I would agree with your comments with one caveat. If you plan to travel a lot, or have multiple residences in other states like we do, the Medicare Advantage Plan can be inconvenient since you need to have a primary physician referral for specialty care and you may be out of your network coverage area other places. The ability to pick any physician where ever you are is a plus for regular Medicare. If you have some serious health problems, which we have experience with, and have extended stays in multiple cities regularly, you may be better off with regular Medicare. Do your homework and then make the determination based on your lifestyle. It can be tricky.

totally off base, This is about money only. The advantage plan provides a revenue stream for these organizations far better than what they were getting. There are several companies making a pretty penny off the advantage plan. They have quotas, check offs, etc. As for demographics there really isn't a lot of people (in comparison) on the original Medicare.

A serious question: How do you know you’re getting all the services you need? Doctors who accept advantage plans are paid more for providing fewer services. So how do you know if your doctor is doing all he can to help you?

I was told that’s the reason by a care professional at one of the centers, it was a financial decision.

Not exactly correct when you say that “it has to do with who picks up the difference”. If you select a MA plan, Medicare is no longer involved in your healthcare. Your MA plan, and you, are responsible for all the costs. Medicare, with the exception of you still having to pay the Part B premium, is out of the picture.

Medicare advantage plans are the plans of choice for low income seniors by virtue of low cost (and the seniors in our surrounding area tend to be lower income than Villagers), so this statement doesn’t make sense to me.

If you wanted to limit healthcare within The Villages, the doctors would only accept the more costly Medicare Supplement plans. Unless There is some type of Medicare advantage plan that only lets you use The Villages health care system? Which is a scary thought based on what we have seen and heard these past few years from our neighbors.

The Medicare supplement plans are more costly and have much better coverage, and a far greater selection of specialists and top notch health care facilities in the unlikely event you wind up with some unpleasant disease. You pick your doctor and your care. You are not stuck with a primary care doctor playing God with your health. Advantage plans are all well and good til you actually need serious medical care.

I am now very curious how many Villagers choose advantage vs supplements. Having listened to the health care adventures of so many of our friends and neighbors here, we will absolutely be getting a great supplement when we start Medicare next year.

I'm not a Medicare expert. But, about half of the people on Medicare have original Medicare, not an advantage plan. And, The Villages Health system only accepts about 2 or 3 advantage plans for primary care, even though there are many other advantage plans available to Medicare recipients. I am sure they are making a financial decision, but it seems to me that they are also trying to limit the number of patients that they serve, and that they would prefer to serve as many Villagers as they can. Otherwise, what would be the point of building so many primary care centers on Villages property? That is just my opinion.

Does IRMMA surcharges also effect advantage plans?

My wife and I had health insurance from our employers for our working years until we retired in 2019. We both had HMO plans from Kaiser Permanente, and would have continued with them if they had facilities here in Florida.

We view the Medicare Advantage plans here in The Villages to be quite similar.

Back when we were under Kaiser, we had to go out of network, and Kaiser took care of everything. Just a small copay.

Same is true here under Medicare Advantage via United Healthcare at Villages Health.

We've had very good experiences. Only big expense we've had is to pay for medical procedures that Medicare did not cover; we both recently had cataract surgery. Rather than get the normal replacement lenses that Medicare would have covered, we got the deluxe lenses which take care of vision at all distances. Yes $$$.

We've also been referred to other specialists for other procedures, and all was paid by our plan except for small copays.

We are both in our late 60s, and both healthy and active. My wife is a cancer survivor. 10+ years ago, when Kaiser could not handle her early stage breast cancer, she was referred to a specialist outside of their network, and they did a great job. When my son had a severe concussion, again we got a specialist outside of the network via referral, and he was taken care of in record time. Similarly for a sports injury.

With Villages Health, we have a great PCP who addresses our questions quickly, and if we need routine care it's taken care of right away.

Last thing:
- for routine care, we go thru Villages Health and our PCP. If special care is necessary, it will be handled within Villages Health or we get a referral to specialists outside of the network if Villages Health does not have someone with the right specialty.
- if we need Urgent Care, we can go to any Urgent Care facility that Villages Health refers to us. Call first, and they will tell us where to go.
- in an emergency, we can go to wherever in the US we are close too, and when able to, let The Villages know for follow-up action.

Medicare Advantage works for us within the US. Outside the US, need to have separate travel insurance. We aren't covered by Medicare outside the US.

Yes, it can be complicated, but best to read up on how coverage works while you are healthy.

Finally, there are other Medicare Advantage plans that are offered in the area that aren't as compressive as the Florida Blue and United Healthcare plans that The Villages accepts.

Yes, it does

Doctors
 

I had the same problem. I found Dr. Joseph Carrasco on That St. In Leesburg. Internal Medicine. Like him just fine so far. Seems very through compared to last GP I had

Medicare
 

It's simple if you want to see any Dr. In the USA or go to any hospital in the USA get original Medicare, if you want to be restricted to a short list of Doctors with high deductibles in a network get an advantage plan. If you are very healthy an advantage plan would work out financially If not the money you save on premiums will be eaten up and then some by deductibles and copays. Remember once you opt for an advantage plan there is no going back to traditional Medicare

I sense bitterness.

I am perfectly happy with my advantage plan and The Villages Healthcare System thank you very much.

We are in the same boat with the federal BCBS (FEP Blue). But, I opted to take Medicare Part B in addition to BCBS. If you don't sign up for Part B when first eligible, there are penalties imposed if you sign up later. Those penalties are severe, and you would pay them for life. Plus, BCBS reimburses each member who has Part B $800 each year to help offset the cost.

For us, this approach has worked well. I have yet to pay a dime out of pocket for medical expenses, including a major surgery last year. We can go to any doctor or specialist we want. And, with the FEP Blue we have worldwide coverage, which can be important when you travel. Everyone's situation is unique, but for us, this works.

No, that is incorrect. You can go back to Medicare from a Medicare Advantage Plan during the open season.

About 6 years ago those of us that had Medicare and part D not advantage the villages made a decision to not accept anything but advantage so we had to find a new doctor. To be honest they did us a favor We found great doctors who are not a part of the health care system in my opinion I’m glad we kept our insurance the way it was and moved on. Best decision we made

Yes you will have a Medicare supplement to back up original Medicare. It depends on your retirement plan as to whether you or your former employer pays the bill, or a portion of it.

Yes you will.

I am a federal retiree with BC/BS and also have Medicare. When I got here in 2016, I was surprised that my insurance was not accepted by The Villages medical system.

I checked with the Villages Hospital and the Hospital in Leesburg and they said our insurance would be accepted there. There are also many other local doctors that accept our insurance.

We have had lots of treatments for skin cancer at Villages Dermatology and one treatment at the Moffitt Cancer Center in Tampa, and all of them have been fully covered by our insurance.

I am also a Federal retiree with the standard Blue Cross plan. I have opted to not purchase Medicare Part B. So, the only health insurance I have is the Federal Blue Cross and Medicare Part A, which has no premium. Since the Blue Cross plan has an annual out-of-pocket catastrophic limit of $5,000, it makes no sense for me to pay Medicare premiums, which would cost me thousands of dollars per year, and almost as much as my BC catastrophic limit. I will note that I am subject to IRMAA, which would make my Medicare premium higher than the minimum premium. I have had no problem finding providers who accept my Federal health insurance. It has never been rejected by any provider who also accepts original Medicare.

Medicare
 

Stop talking about those outside the villages ! There is an extremely large percentage ( 70%) of people on regular Medicare that are barred from getting a primary in the villages. When I came here , I could get a primary . I was suddenly kicked out when I turned old enough to get Medicare because I stuck with my employers Medicare and did not switch to the villages advantage plan which I would have had to pay for. There is the key . I would have had to pay for the advantage plan where my employer pays for the regular plan. This was a decision made by the developers. You figure out why