Medicare Advantage Plans in Florida and The Villages?
 

We just moved to The Villages from another state, and I just started in Medicare in December. All was set up for the other state as original Medicare, as I had researched Medicare extensively and heard lots of negatives about Advantage plans.

We are now working with a local Medicare insurance broker in The Villages, who is telling us that Advantage plans are totally different in Florida than the rest of the country, and that Villages Health is a different and amazing care system than normal care providers.

Sounds too good to be true as we would save a significant amount of money on a Florida Advantage plan, but I don’t want to fall for a sales pitch and regret it later.

Is this a different animal in Florida? Any challenges finding providers around The Villages for Advantage Plans? Any challenges finding providers accepting new patients? Does the UHC Advantage Plan travel provision really work? I’m hesitant to voluntarily join an HMO, but maybe the PPO version would be a better fit for a skeptic.

Looking for real-world experiences with it, especially from those who have been on it awhile.

Thanks for any feedback!

Advantage plans are regulated by the government, just like every health care plan. They're the same all over the USA.

There are 1000's of posts on the subject, here on TOTV. Use the Search Tool and the keyword "Advantage" .... you'll be reading posts until early 2027.

The advantage plans do different, just listen to the TV adv.
Look at this site and you can get free help in learning about the plans. SHINE - Home

I recommend chatting with SHINE.
We have been here 5 years and had Medicare Advantage with absolutely no issues.
I have a wonderful PCP at Lake Deaton, get into specialists quickly, have every 8 week infusions at zero cost to me (they are billed at 13,000 dollars to MA). I am quite happy so
far. Interestingly, I have FloridaBlue MA and my husband has United Health MA - we wanted to do real life comparisons of them. His is a bit better for dental and quarterly things like aspirin and bandaids, but his health is luckily good so we havent tested big ticket stuff with them.

Second vote for SHINE, they helped us avoid a very costly mistake, and their information is UNBIASED.
One of the big problems we had was that the specialist we wanted to see did NOT accept the advantage plans that The Villages Health System required, now this was several years ago, some there may have been some changes.
Remember, advantage plans are MANAGED care they decide for you, traditional Medicare you have a lot more say in your care.

Just went back to original Medicare
 

I recently left an Aetna advantage plan PPO which was absolutely wonderful. There were no co-pays and It usually cost nothing. I went back to original Medicare because after doing research its not so wonderful - as you get older and you get sicker an advantage plan is gonna be limited as to what they will cover when compared to original Medicare. All the advantage plans are run by medical insurance companies with one objective to be extremely profitable and make more money.

We tried Villages Health the first year. Not impressed. Severe doctor shortage and we needed months of notice to see a real doctor. Then they refused to admit me when their parking lot testing discovered that what I thought was allergies was actually Covid (for the 2nd time, after being vaccinated), and then refused to prescribe an antibiotic for the inevitable sinus infection (after I recovered from Covid a week later but took a month to test negative).

Our original doctor isn't even there anymore, anyway. But if you want to use them, no choice -- you have to get your insurance from United, which I also discovered when I switched to Humana the 2nd year, after both Humana and Villages told me they would be available, and then discovered that the greatly restricted HMO plan they accepted wasn't the PPO I'd chosen.

So the next year, we switched back to United and then couldn't find a real doctor in Villages Health who was taking new patients anywhere within a 45 minute drive from my home (even though there's a Villages Health clinic just outside my "village").

This year, I discovered Humana's "Give back" plans, which return $150/mo per patient of our Social Security check's medicare payments. The specialist copay is higher ($45), but for $300/month, I can afford to see a lot of specialists. However, the real reason I switched was that Moffit Cancer Center in Tampa is in-network, unlike any other advantage plan I looked at. Not that either of us have Cancer, but I had a scare a couple of years ago, and Moffit is one of the best in the country.

Whatever you do, be sure to select a PPO, not an HMO. If something goes wrong and you need to hire the best, you don't want to be stuck paying the whole thing out of your own pocket.

I think the PPO suggestion is good. The question is what coverage do you have when you travel around the US.

Travel much?
 

Watch the travel side of it. What's covered, where, at what percentage. Is international travel covered? Do you snow bird? I found most of my seasonal doctors were not on the plan. I went with a medigap policy. It cost me more a month but I get quality care from anyone excepting medicare. Just saying.

SHINE - Home
SHINE can help you find the plan that will work best for your needs. Unbiased information; they are not insurance agents.

To be precise it's Medicare "Disadvantage" not Advantage.🤑

Advantage plans are not governed by Medicare, far from it. Advantage plans suck, ran by insurance companies, and these companies will do anything they can to save money for themselves rather than give you care your dr prescribed.

Don’t believe me, then why doesn’t Medicare require authorization for a procedure but an advantage plan does? Because, close to 70% of the time an advantage plan will refuse doing the service your dr prescribed whereas Medicare doesn’t require authorization? Because when the insurance company refuses service they save money. Don’t believe me, google it and you will see Congress has been working on this fraudulent practice for many years. The insurance companies hope that the patient will get tired of fighting the insurance company and give up.

Google why hospitals are refusing patients with advantage plans. More and more hospitals are adding themselves to the list.

Go out and get a good supplement plan and you will get the work your dr requested without any headaches

We have our Advantage plan through my husband’s retirement union in California. It’s Anthem Blue Cross Blue Shield Medicare Advantage. Even though it’s a California based plan it’s nationwide. The Villages Health bills Florida Anthem BCBS and they in turn bill California Anthem BCBS. We love it. We have never been turned down for anything and they have covered everything except very minimal copays ($5 office visit). So you can have Advantage plans from anywhere if they are Nationwide.

I have not heard of any doctor or hospital no longer accepting a supplemental plan, but it seems like every year, hospitals and practices are dropping Advantage plans left and right. Currently the Mayo Clinic in Jax is not accepting any advantage plans and Moffitt in Tampa is not accepting certain advantage plans. We have a pancreatic cancer survivor via the Mayo Clinic. Treatment went from August thru April. I can’t imagine what we would have done when they stopped mid treatment.

The survivor was exceptionally healthy and one day, she got very bad indigestion, two days later, a tumor was found in her pancreas. Two weeks later chemo was started.

I will never roll the dice on healthcare. Today we both have a Cigna Supplemental G plan that is accepted everywhere.

When turning 65 and signing up for Medicare, consider a Medicare SUPPLEMENT Plan G or Plan F rather than an Advantage Plan. Medicare Supplement plans cost more, but they are far more comprehensive. Plus, more Doctors accept Supplement Plans and they can save you money if you're hospitalized. For more information, check out medicare school.com or call them at 833-833-3661.

Plan F has an eligibility requirement date of Jan 1, 2020. Someone turning 65 now, will not be eligible.

Avoid "Advantage" Plans
 

The "freebies" from an Advantage Plan are not worth the hassle and danger of not being able to easily go to a doctor outside the Plan. We have a friend who was diagnosed with an aggressive cancer. The next day she flew to Houston, checked into M D Anderson, and has been there for two months with Medicare and United Health paying the bills. She could never have done that in an Advantage Plan.

Don't fall for it. You can always change later, but stay with original Medicare now. It is too good to be true. Lots of interpretation between the lines.

We've been on UHC Advantage since we retired and are happy with it. We use all the wellness benefits they offer, as well as the vision and dental.
Yes, UHC Advantage plans differ by state and even by county, although not a lot.

We were on it in Indiana but switched to The Villages UHC Advantage when we moved here last year. We like The Villages Health system and had no problem getting a PCP. Appointments are easy to get since they limit how many patients a doctor can have, and only take MA plans. So we never sit in the waiting room more than 15 minutes before we get called back. Take a tour of their facility. They have them all throughout The Villages.

MA plans are a good option, over 50% of new enrollees choose them. But it's not a one size fits all as some like to make you think. For some, regular Medicare is the best way to go.

Not all MA plans are the same, some are better than others. Do your research, check the ratings and as others have said, talk to SHINE.
SHINE told us Medicare Advantage was a very good option for us.

No, not every single hospital or doctor takes UHC MA. But we did our research, and many excellent hospitals do take it, including UF Shands and Advent Health in Orlando.

Thats not true!
With UHC MA we can go to any hospital that takes UHC Advantage anywhere in the country. But there are some that don't take it.

We did our research, and even though we're healthy we checked around and found many highly rated cancer centers in Florida and Indiana (our home state) that take UHC MA.

Hot topic - Go with regular Medicare
 

A lot of discussion on this. And while I cannot speak of any specific Medicare Advantage plan, I can tell you that at MD Anderson they really like it when you have regular Medicare. No prior authorizations, just get started on therapy ASAP. Similarly, I met a woman with a Medicare Advantage plan from Arkansas who was in the middle of chemo and received a notification that her Medicare Advantage plan was dropping MD Anderson and she had no idea what she was going to do. It is probably just a negotiating tactic, but it was causing her real stress. If you travel regularly back and forth across the US you may be out of network from an Advantage plan. The benefit of an Advantage plan they are less expensive up front, the risk of an Advantage plan is that it is an insurance company whose main goal is to make a profit. Also, one important point. If you go with an Advantage plan, it is almost impossible to go back to Regular Medicare.

I have this plan as well and have not had any problems. Just curious, I have mine through MPIP (IATSE). What union was your husband in?

The short version is you can switch during the one year trial period when you first become eligible for Medicare. After that, you can switch but will typically have to go through underwriting for a Supplemental Plan. If you have health issues, you may not be able to obtain a Supplemental Plan.

I have had UHC since I moved here 10 yrs ago. Wonderful doctor. Always seen by someone same day if medical issue comes up in between 6 month visits. No copay unless specialist. No complaints

You can switch back from and Advantage plan to a Supplement plan you just have to go through underwriting. Yes, if you have an existing health issue they can reject your switch but if fairly healthy and no major issues you can switch to a Supplement plan!

I cant speak as to the advantage plans here but I stuck with regular and a supplement. What I wanted to tell you though is that though is that since you are now in Florida, you have to get a different drug plan or perhaps keep same but it costs more ( at least for me because my previous state was less) BUT you can keep your supplement and that price stays the same as your home state. Again cheaper in my home state than here. If you change supplement plans then yes you have to pay Florida prices . I will probably never change as I paying lots less . Found this out purely by accident but I glad I did!

Most people over 65 have a "pre-existing condition." That's why it's a risk to start with Advantage with the presumption that you can always just switch to regular Medicare. If they decide some day that YOUR pre-existing condition is a disqualifying one, then they'll deny you.

The true test is which plan is best without considering cost. Sure, no problem
with Medicare Advantage if you are healthy. You will save money and it may continue that way.

But, when you some serious care, you may be excluded from some of the best care resources. May never happen, but if need cancer care, does your plan cover Moffit, Shands or Mayo. I understand that UHC Advantage may now cover but several years ago it didn't. What about other Advantage programs?

I am fortunate that my pension pays $1000/year toward my Medicare supplement plan. I am also fortunate enough that I can afford Medicare Supplement Plan. I would rather have the assurance that I can get the best medical care. I will give up my need to have a new Tesla, Geneses, or Lexus every year.

Not exactly. There is no issue with switching back to traditional Medicare. The only issue might be if you also want to add a Supplemental Plan. There is no requirement to have a Supplemental Plan although most people do enroll in one. Exactly which preexisting conditions would cause a rejection during underwriting for a Supplemental Plan will vary. I had asked my broker this and she could only speak in general terms.

Stay away from Advantage Plans. If you have any medical issues or you may never know when an issue will happen.
What sounds too good to be true is Bad. Someone said earlier, “It’s Medicare DisAdvantage, instead of Advantage.

If you take the advice posted on this subject in this thread I have a bridge to sell you. This has got to be a record of how much misinformation has been published per post.

I'll make a bet 75% of the Medicare / Supplement supporters of whom the overwhelming majority never had an advantage plan can not tell you the difference between a HMO and a PPO. Do yourself a huge favor - GO TO SHINE.

If's unfortunate that Florida isn't as flexible as many other states, that give you an almost unlimited right to switch back to a Medicare Supplement. Given the insurance climate in FL, I guess I shouldn't be surprised.

For those of you with supplemental plans, what is the approximate cost of your plan per month?

And does it go up every year?

Well said!
Pretty much what I said too. Most of the people bad mouthing MA plans really know very little about them except "what I heard is".

Not all MA plans are the same and some are better than others. That's why people need to actually research the plans.
SHINE said The Villages UHC MA plan was a very good option for us.

Having a choice is a good thing imo.

Well. I guess is depends on your situation, but a typical supplemental plan costs about $150/mo per person, plus the $185/mo medicare payment. That works out to $8,400/year per married couple, just to be able to see any doctor you want.

Personally, I think it's a better deal to spend $840/yr for PPO insurance that pays everything except the co-pay to stay in-network for routine stuff -- or 80% of any doctor or treatment I want up to $6700 total out of pocket (and then all of it) -- if I have a medical disaster. And Moffit being in-network even saves the $6700 if I get cancer.

So far, neither Humana nor United have ever refused me anything, unless you consider staying in-network for primary care and the typical specialists old folks have to see every year. United covered almost everything a couple of years ago when I had to go to Orlando to have a super-duper specialist make sure a pancreatic cyst wasn't cancer. And Humana covered almost everything when my wife spent a week in the hospital last year from a (thankfully minor) stroke. But I guess its possible some out-of-network doctor or hospital could refuse to take Humana's money for some reason some day.

I guess I'll never know until something really bad happens. Then I guess I'd have to spend our savings or sell the house. Life's a gamble. I guess I'm willing to bet a multi-billion-dollar company isn't lying to me in any serious way that millions of customers haven't have already discovered.

My Plan N runs $170 per month and it does go up each year.

I believe it is only 4 states. I grew up in one and wouldn't consider moving back there or to the other 3. I guess that qualifies as "many" ;-)

We’ve had great service and care through the Villages Health United Advantage plan. No trouble seeing specialists or Marion West Hospital. We tried Premier Medical, but was unhappy with service and facilities.

We have nothing but positive things to say about our Plan. Our United Healthcare plan includes $5,000 for dental. Max out of pocket is $2,400 per person.

Don’t single out Florida. This happens in any other state.