Villages Health
 

I have been researching different Medicare health plans. I currently have traditional Medicare and a supplement plan. I have looked at the Villages Health plan and United Health Care. The upfront costs of Medicare Advantage plans are lower than my plan. It looks very attractive but I am concerned that at some point Medicare may reign in these Advantage plans as they are costing Medicare more than traditional Medicare. If that were to happen and I had made a switch I couldn’t go back to my former company sponsored plan. I get all drugs for a small co pay in my current plan, a great benefit. My concern is further increased because the Villages sells its assets when they no longer see they are needed, e.g. rec centers, fire departments, water and irrigation systems, etc.. The people making the most money in healthcare are the insurance companies not the medical personnel or hospitals. Now I see the Villages Health is advertising in the Daily Sun and is offering residents bounties for physician referrals. Maybe it is becoming difficult to attract physicians to central Florida? What do you think?

Medicare and supplemental you get to decide what doctor to see, etc., Medicare ADVANTAGE is MANAGED CARE you do not get to decide on which doctor to use, your PCP makes this decision for you as well as your insurance company. This seems to work very well if you are healthy, not so good if you have medical problems. We tried it and were able to get back to original Medicare and are much happier. SHINE (Senior Health Information Network) has a lot of unbiased information on this subject and has local meetings for one on one discussions.

The above comments regarding specialists is from 8 years ago and may not be valid under the current insurance coverages. We had very long waits (3 to 4 months) for specialists, and the ones we had been using would NOT accept the advantage plan. We had no option but to drop Advantage and go back to Medicare and supplemental. NOTE: there is a limitation (50 weeks I think), that if you go over that you may be subjected to underwriting to get back to regular Medicare and supplemental.

Advantage through United Healthcare works for me. The overall grade is an A.

If The Village’s Healthcare can't attract Physicians why would they come on a referral unless they are running away from something.
Our Dr’s used Ocala, Orlando and Davenport very satisfied.
My employer provides a UHC Advantage plan thru retirement for my wife and me not giving it up.

Once again false information. Both the The Villages accepted United Healthcare Medicare Advantage (HMO POS) and AARP Medicare Advantage Choice (PPO) 2023 plans do don't require a specialist referral.

:agree:

To clarify, if you have original Medicare, you can use any provider who accepts Medicare. But, if you have an Advantage plan, you can only use providers that are part of the insurance company's network of providers.

Just transferred my health insurance from Colorado to Florida yesterday. I’m under Medicare age for several years, and receive a very large monthly retirement benefit from my former employer, which basically 90% covers my monthly health insurance premium on the open market. When I went to Villages Health, I was told that majority of primary doctors won’t take new patients under 65 (ugh). They did find me only one I the entire system taking new patients under 65 - no he is way up in Mulberry (I live in Richmond). The earliest appt he had was late April - I’m going with Villages Health for now, but we will see, as many have told me to find better care outside of The Villages. If I end up not satisfied with Villages Health, I’m not opposed to going out to Leesburg or the Clermont/West Orlando area.

I have the AARP Medicare Advantage PPO. For grins I looked up how limited my choices are. For example within 20 miles of Lady Lake the following docs are in network:

Surgeons - 134
Orthopedic Surgeons - 53
Urologists - 24

I hope you were not trying to paint a picture that there are very limited Advantage Plan choices Vs Medicare at least on The Villages Health accepted plans.

Another point - Approx 48% of all Medicare seniors have enrolled in Advantage Plans.

I don't have any issue with Advantage plans. I was just explaining the difference between Original Medicare and Advantage plans. According to Forbes Health, in an article reviewing the AARP Advantage plan:

"What are the downsides of a Medicare Advantage plan?

With many Medicare Advantage plans, you can only see doctors in your plan’s network. Furthermore, insurance companies that manage Medicare Advantage plans can deny claims for some expenses that they deem too expensive or unnecessary, such as imaging tests, even when they fall under Medicare coverage rules."

I buy my own health insurance as I am 63 so I don't get Medicare yet. I used to work at a hospital in Wesley Chapel. I moved to Bradenton and still kept my doctors in Wesley Chapel. It was an hour drive but worth it to keep my doctors and my dentist as well. Just moved to Richmond and based on all the chit chat about the difficulty in finding good doctors in the Villages I will continue to keep my doctors in Wesley Chapel and its still an hour drive but its worth it not to start over. Wesley Chapel might be a place to consider if your looking at Orlando. Much easier drive. Advent health and a new Bay care hospital also!

Advantage Plans are really great until the s*it hits the fan... Keep your traditional Medicare and Supplement.

But to have any procedure done they require approval. A friend's doctor told him he needed a hip replacement the advantage plan required 1 year of pt... after the pt and a year of suffering, he got his hip replaced!

A View of not only VHealth, The Villages "model".

Keep in mind, TV is a DEVELOPER.
They develop land............primary: residential.
Included in their model is to develop "all the amenities".
Very Cool Model.

They develop the amenities because no one else is crazy enough to start-up a water system, golf courses, invest in retail space, build a hospital, on and on and on and on.

So, as a developer.............they will operate amenities until they are able to stand on their own and a specific investor can project a return.

So...............will TV sell off health assets...............Yep!!
But that's a good thing.
Why good....................well, it's established now and an industry specific investor is willing to joint the party.

:posting:

If you want the insurance company to manage your health care then get an advantage plan. If you don’t believe me then ask the people who work in the doctors office

I came to TV in 2005 and got a full time job with Walmart in Feb. of 2006 and then in March I had to have an Ablation for ventricular tachycardia. The procedure cost $21,000 of which Walmart insurance covered only $1,000 and the rest was covered by my AARP Supplement Plan. I have been with them ever since and don't plan on changing.

DO NOT go with the advantage plan. You will be very sorry. It's fine as long as you are healthy, but get sick? You are looking at very expensive bills. Health care is NOT free, you will pay somewhere down the road. Stay with what you have.

United healthcare advantage aka villages health care has a few plans One of which allows you to see any doctor, any specialist in United Healthcare without a referral
Most of the practices here accept United healthcare
You can see a United healthcare doctor anywhere in the USA that accepts United Healthcare

Advantage plans are terrible when you start looking into them or talk with people that actually have them. I used an insurance broker years ago when deciding which way to go when joining Medicare, the best is a supplement plan (gold standard) and the more hmo type of plan (advantage).
A couple of major differences/important info that you need to know about these plans:
1) you can always get into a supplement plan (I have plan g) when you turn 65 but after that, you can be refused entry. So when people try the advantage plan at 65 and then find out it’s not what they want, the supplement plans can refuse you.
2) you don’t need a “Florida” supplement plan. I kept my plan g from another state and am saving over $50 a month doing this and coverage is the same. I asked my provider and they said they cover all Medicare costs in all 50 states and overseas (with limits).
3) I don’t pay co-pays, have a $200 deductible, no referrals required

Everyone on social media has an opinion. We moved here in 2009, before T.V. had the health-care clinics. It was a crap-shoot to find a doctor quite frankly. Coming to a new area and a new state EVERYTHING was unfamiliar. In 2012 TVH came in so we looked into it and signed up. We started with Medicare Advantage and liked it. I think it was two years ago that FL Blue (BCBS) came and their plan looked (for us) to be more attractive. We both see dr's out of network. We go with a cardiologist whose with Orlando Health---have had no issues. We also see dermatologists out of network---same thing, no issues. Some people here have had "Cadillac" plans from their former employers and keep those. I think it all depends on circumstances etc. Word of mouth is helpful but also speaking with an insurance person (who can offer several options) is probably your best idea. I forgot to mention---we both have health issues that require care. So not sure why people say if you're on an advantage plan and have health issues they aren't good. BUT that's just MY opinion.

Medicare
 

I think you should keep what you have.. with the Advantage plans you can't have a GP through the Villages system, you have deductibles and copays, and you have networks. With traditional Medicare you can go to anyone anywhere and not worry about deductibles and copays. It's a pay me now or pay me later. I can plan for the premiums but would dred the bills that would come later after a major medical event. With me an advantage plan would remove Moffitt cancer center from my network. Also recently I took my wife to Mayo Clinic in Jacksonville because we couldn't find a Dr or Hospital capable of finding the cause of her symptoms. Keep what you have because you're correct, you can never go back. IMHO

Exactly! Plus Advantage was way more expensive for me as the co-pays will be very expensive and more than outweigh any monthly premiums IMO.

Advantage Plans can and do deny services that might be vital to your health. Sure, go to the doctors they pick for you, maybe not an issue. But when they deny imaging needed for diagnosis to determine proper treatment of a possible life-threatening illness, that is a huge problem. I’m not willing to take that chance to save a buck.

In 2022, nearly half of (48%) eligible Medicare beneficiaries – 28.4 million people out of 58.6 million Medicare beneficiaries overall – are enrolled in Medicare Advantage plans. Medicare Advantage enrollment as a share of the eligible Medicare population has more than doubled from 2007 to 2022 (19% to 48%).

The Congressional Budget Office (CBO) projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to 61 percent by 2032

In the state of Florida Medicare beneficiaries enrolled in Medicare Advantage plans this year is between 50 - 60 %.

Apparently 28.4 MILLION seniors must all be either naive or healthy !

Medicare/Advantage comparisons
 

The bottom line here is to know what type of health coverage you need and to find a plan that matches it...or, one that is as close to matching it as possible and that is affordable. You simply can't denounce one plan or another because it doesn't fit your needs. It takes time to find a good plan. There are plenty of resources available to use to compare various health insurance plans.

Yep and we have the BCBS PPO Medicare Advantage plan. We pick our own Drs and don’t need referrals.

The savings has been fantastic with the MA plan. No premium, low co-pays, fantastic vision care, mammograms, colonoscopies etc. fully paid for, good prescription coverage and more. Plus we get paid for getting check ups etc. And an OTC allowance.

The thing to keep in mind is these plans have max out of pocket. Ours is not much more than what you’d pay for a yearly supplement premium and the odds of having to use it are slim because the insurance pays so much.

We are super happy with our BCBS MA PPO plan. The UHC MA plans look great too.

I think a lot of them are healthy and have chosen to use an Advantage plan to save money on premiums.

The CBO can only project future Advantage plan enrollments based on the current law. But the Advantage plan rules can be changed during the next 10 years.

The co-pays I have with my BCBS MA PPO plan are $0 for my Dr. $35 for a specialist. Prescriptions are included with low copays. We got $250 for eye wear and dental coverage. We also got $300 each in OTC items. And several hundred each for doing healthy activities.

And the coverage has been excellent. $0 for mammogram. $15 for a sonogram etc.

I’m not sure what plan you had but we paid a fraction of what we would have paid in premiums.

I have a Florida Blue Medicare Advantage PPO. Every doctor I've wanted to see takes this plan. Except for a co-pay all doctors, tests and hospital visits haven't cost me. There is no extra cost beyond medicare for this plan.

Yes - there is talk about in the future this plan may cost me money. I'll deal with that when and if it happens.

If you have retiree health with your employer, do your homework especially if you cannot go back to your employer's retiree health plan. I was a Benefits Manager for my company and we offer the retirees health benefits. Does your employer's plan has an out-of-pocket maximum? Can you go to any doctor or hospital with your employer's plan? You may move to The Villages and at some time in future, decide to move elsewhere. It is important to look at all costs not just the monthly premiums. I suggest that you speak with someone in Benefits at your employer to understand the plan offered by your employer.

That is simply not true. An acquaintance had heart surgery which was several hundred thousand dollars. His out of pocket was $1000 with his Medicare Advantage plan.

There is an out of pocket yearly cap on these plans. And that cap depending on your plan is usually less or not much more then what you’d pay for a supplement. And the odds of meeting that cap may be slim because these plans are required to pay what Medicare does.

It’s a win win for us with dental, vision, OTC allowance, gym membership, bonuses for doing healthy activities, prescription coverage etc.

We get to choose our own Drs. With our PPO plan and don’t need referrals. We really like our Villages Drs. They’re a golf cart away and they don’t take regular Medicare.

The advantage plans actually save Medicare money. It is like reinsurance for Medicare.

So much BS here and other threads about MA plans.

Moffitt is included in my BCBS MA plan and I heard that The Villages MA plan includes it now too.

As I mentioned there is a cap on these plans. I believe the cap on The Villages plan is a couple thousand dollars.

So let’s say worse case scenario you cap out - you are out a couple thousand dollars. That is most likely not much more then what you would pay in supplement premiums. And you are paying those for years without the perks of vision, dental, etc.

It made no sense to us to pay hundreds in guaranteed premiums every year for ‘what if’ when if the worst actually happened (and insurance didn’t pay - and they are required to pay what regular Medicare does) our out of pocket cost wouldn’t be much more then the guaranteed premiums. Plus we get prescription, dental, vision and more.

There happens to be only one advantage to an Advantage Plan.
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It's good if only you do not need extensive medical attention.
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When you retire and you're healthy save with an Advantage plan. Possible limited access and long waits to see specialists.
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When you get older and start having more medical conditions hopefully you can afford to go back to the original Medicare with a Supplement plan.
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Talk to your friends and neighbors for their thoughts as the Insurance brokers do not tell it all.

Again, false information. Your PCP must be accepted by your Advantage plan. Actually, I have found the Villages PCPs are much better than the outside PCPs. Regarding specialists, you can use any specialist that accepts Medicare. With UHC, I found most drs accepted.
Medicare= you pay on the front end
Advantage= you pay at the back end

What's false? Are you saying the UHC doesn't have a provider network? I don't think that is true because I know that some local providers have been removed from the UHC specialist list, at least temporarily.

Yes I did notice paragraph 2 was added 4 hours after paragraph 1

When we lived in The Villages we waited about one year to be able to use The Village Medical facilities. We were impressed with their expertise and were fortunate to have a great doctor from New York.
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After 2 years they kicked us out (with thousands of others) as they would only accept UHC Advantage plans. No way we would limit our medical coverage for their benefit. Why was there an advantage for them to do this? Wouldn't be for financial reasons, would it? Does the Mosre clan need more money?
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So we moved on to other doctors and services in The Villages .and were pleased.
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Do your homework before sacrificing your health service needs and outlay of monies.
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If you talk to an Advantage salesperson ask them how many days will you be covered if you require an extended stay in any hospital.
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Another shameful thing is the hospitals you might need for care near The Villages. In your senior years, you should be treated like seniors with proper medical attention. The reports on The Villages Hospital are sickening.
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As well, if so what other doctor charges will you be responsible for as doctors like to visit you daily for 5 minutes and of course bill the insurance companies regardless of what insurance plan you have?
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Doctors say they are making their rounds, however, they are building their incomes dramatically. Look at their hospital billings on your monthly insurance statements after you are in a hospital compared to an office visit billing.
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Stay healthy and save monies so you can afford to pay for your needed medical insurance coverage if and when you need it.