Recomendations for PCPs who accept Original Medicare
 

We need recommendations for PCPs who accept Original Medicare in or close to The Villages and are accepting new patients. Also if there are multi-specialty groups that would be a plus. Back in NY we had Crystal Run Healthcare which had a full complement of specialties from Primary to Surgery. Thank you...

Do The Villages Health clinics not accept original Medicare?

No. They only accept certain Medicare Advantage plans for their primary care doctors. They may accept original Medicare for some specialists.

Wow! I am very surprised by that. I would think there are A LOT of Villagers with original Medicare. I am curious why they don’t accept.

My theory is that The Villages wants to make the PCP facilities that they own to be accessible to Villagers. If they accepted original Medicare, they would need to provide service to everyone who has original Medicare, including many people outside of The Villages. This could cause the Villages owned facilties to become overcrowded, and defeat the purpose of building healthcare facilities inside The Villages. This is just my opinion.

That is a good theory. One that I have heard before.

I have medicare along with Blue Cross/Blue Shield through the federal government health plan and The Villages health would NOT accept it.

I also have the BC/BS Standard Federal plan, but, when I did the math, the Medicare Part B premium was a waste of money. You may want to do the math to see if you really need Medicare Part B, which is mostly redundant with BC/BS. The Medicare premium is optional.

I do not think this holds water as the VHS could just require to see the villagers ID card. We were able to use this service in 2013 to 2014 with original Medicare and then the VHS said no sorry, Medicare Advantage only. At the time I left, my wife went on a Medicare Advantage plan, BIG MISTAKE, she lost access to all of her specialists and had long wait times for the new specialists, we got lucky and in discussions with SHINE found out she could get back to original Medicare and we made it just under the deadline. We miss the local PCP doctors, I could walk to the office, but we do not regret the decision to go back to Medicare.

From the website, Medicare.gov:

If you have original Medicare:

"You can:
See any doctor or specialist (including women's health specialists), or go to any Medicare-certified hospital, that participates in Medicare."

I think it would be illegal to require a patient to live in The Villages to use a provider who accepts original Medicare. If a provider accepts original Medicare, they must accept any patient who has original Medicare. They cannot discriminate based on where they live.

they want to manage your care for the insurer

They don’t accept it because with regular Medicare the doctor only gets paid when he sees the patient. With an advantage plan the doctor gets paid a certain amount every year for every patient he has whether he sees you or not.

Greg....the used to accept original Medicare, but the villages put a squash on that about 8 years ago. This is for primary care only. The villages health SPECIALISTS DO accept regular Medicare. Sinai Internal Medicine in Lake Sumter is a primary care office that does accept traditional Medicare.

I called some which listed only Medicare Advantage plans they accepted, including the hospital, and all said they took original Medicare as well. I don't know why they list on their website they take Medicare Advantage but omit they take original Medicare. So, call to be certain, I think almost all will take original Medicare though not listed on their website. UF-affiliated physician offices would have to accept original Medicare if UF Health is accepting original Medicare in Gainsville.

The Villages Health clinics do not accept original Medicare for their primary care doctor visits. You must have one of their specified Medicare Advantage plans.

This is from their website:

"If you are Medicare Eligible, you have an important choice to make about Medicare and the primary care services you receive in this community. The Villages Health is a health care system specifically designed for your lifestyle, but when it comes to Medicare we only partner with a few Medicare Advantage plans.

We only accept Medicare Advantage because we care about the physical, emotional and financial needs of our patients. With Medicare Advantage, our patients stay healthier, experience less stress and save money on health care."

I'm just guessing, but the developer probably made some sort of a deal with Medicare "Disadvantage" operatives.

Dr Emmitt Thompson 352-350-6241 took over Dr. Tafur ‘s office.

I attended a VHA mtg last year where the CEO of Villages Health explained why only Medicare Advantage was accepted.

Their model was to be sure the PCP and associated staff could be available for 30-60 minute appointments for their members, and to be available for appointments in a reasonable timeframe.

We've been a member for 5 years, and are very satisfied with our experiences. When specialists were needed, referrals came quickly, and we discovered that most were considered some of the best in the area.

Medicare Advantage (MA) provides a sizeable stipend for each member. This permits Villages Health to plan around a known funding budget for each patient. It allows them to build a team that is easily accessible to it's members.

Not all Medicare Advantage companies are accepted. Why?

Not all MA insurance companies pass on the federal funding that is provided for each member. Aetna MA is one that is not accepted by Villages Health, and there are many others.

Today Florida Blue, United Healthcare, and Humana are the only MA insurers are accepted. That could change in the future.

We are very happy with our experiences. Quite similar to our Kaiser Permanente HMO and Medicare Advantage experience before we retired, and our first year of retirement before moving here

There are many who don't care for MA for a variety of reasons, preferring instead for Medicare and an extra cost supplemental coverage. The main problem being finding a good PCP and specialists who are accepting new patients.

We are both in our early 70s, healthy, and pursuing an active lifestyle. We travel a lot, foreign and domestic. When out of the country, we realize that Medicare wont help us, so take the appropriate steps to make sure we can get local immediate treatment, and get back to the US quickly.

In the US, Villages Health takes care of us when at home. Access to Urgent Care and Emergency Care is easily accessible during our travels within the US.

We e seen specialists as needed, and have small out of pocket expenses for covered procedures.

We are very impressed by our Villages Health experiences, and have no concerns. We have the United Healthcare MA plan that Villages Health accepts. No issues for the 5 years we've been members

No one answered your question -- here are some of the medical groups that accept Medicare -- Rivers Family Medicine
Orlando Health
Advent Health
Premier Medical
Lakeview Medical

All listed have offices in and around The Villages. There are other primary care doctors that accept Medicare -- this list will give you a place to start.

The Villages Health primary care doctors do not accept Medicare.

Typically when a group like the Villages Health only accepts medicare advantage plans they have cut a deal for a higher reimbursement rate than they would get through regular medicare. The Villages Health is not trying to serve Villagers be only accepting advantage plans, because many others living outside The Villages also have advantage plans...that is not exclusive to The Villages.

Post No. 18 states that one reason for only accepting a few advantage plans is "to be available for appointments in a reasonable timeframe". This is consistent with my theory that, by not accepting original Medicare, you make the Villages-owned facilities more available to Villagers. Yes, anyone can join an advantage plan, but The Villages reserves the right to limit the number of advantage plans that they will accept. In my opinion, if you allow too many advantage plans to be used, as well as original Medicare, you could very likely overcrowd the Villages-owned facilities, and defeat the purpose of constructing facilities within The Villages. If the Villages-owned facilities become so crowded that Villagers cannot get a convenient appointment, why bother to construct facilities on Villages property? At least the current system allows some control over the number of patients using the facilities.

Rivers family Medicine accepts Medicare

Yes, we really didn't get any answers on available medical groups/doctors who accept Original Medicare which concerned us and reinforced what we've been hearing about the lack of doctors who accept Original Medicare in the Villages or thereabouts. Though we do appreciate the discussions as it brought forth information we weren't aware of.

That said, thank you for the recommendations ! We will follow up on them.

???? Really?? If the facilities are overcrowded it will discourage new facilities? By that logic, if the current facilities are empty, then health care facilities will be tripping over themselves to build more facilities with not enough patients to utilize the facilities. In my opinion, the reason no Medigap plans, and limited MA plans, are accepted, is purely profit motivated, with little regard to serving the best interests of the general Villages populations health care needs.

The bottom line is that plans are accepted that offer the highest reimbursement rates, or guaranteed fixed annual payments, which yield the highest profit margins that can be earned on the available existing facilities.

Does anyone know of any studies that document this claim?

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Overcrowding at medical facilities would be caused by a shortage of doctors, not a shortage of buildings.

The latter is the model VHS was set up as. The PCPS are paid a salary. Their schedules are limited to X patients per day. Each patient gets plenty of face time with the docs. If I remember correct a minimum of 30 minutes. This was advertised as the Marcus Welby welcare with the emphasis on prevention.

We have regular Medicare plus supplement plan G, and our PCP is Norman Novis, MD, who has his original office up in the northern villages area, and now a new office down on 44 near the Chitty Chatty bridge. We’re very happy with him and his two APRNs (male & female).

There are also two very popular female PCPs down here near Brownwood Square, each in separate practices. Ana Karovska, MD on 44, and Tanya Diaz, MD on Warm Springs near 301. I think Dr. Diaz also has an office in the northern villages. These two physicians are mentioned often in Villages Facebook groups when someone asks for a PCP referral.

Right, let me get right on that for you. It must be tough when your phone doesn't work.

PCP Dr Sara Gitte
 

I was hospitalized briefly and asked five healthcare workers who attended me who their PCP was. This name came up three times. We signed up with her 10 yrs ago and so did several couples we referred. We are all still with her and are impressed with her extensive knowledge and thoughtful care. She accepts regular Medicare. Not advantage plans.

Dr. Sara Gitte, M.D.
Lakeview Heath Care
Office: 352-633-5282
1950 Laurel Manor Drive
Building 150
The Villages FL 32162

No they do not. Had to drop my PCP that I really liked when I retired and went to regular medicare because they only take medicare advantage (because they get a better reimbursement).

Dr. Novis is accepting new patients and I just switched to him after dropping my employer policy when I retired. He seems to be very knowledgeable and takes time (30 minutes for me) with each patient.

Correct. It’s all about money.
They get paid whether they see you or not. What a racket.