"Traditional Medicare" vs Medicare Advantage
 

What do you think the breakdown is for The Villages on Medicare between the two options? Most I talk with are on the advantage plan; I have spoken to very few on traditional Medicare. I have been surprised by that.

Also, I was shocked that The Villages Health Centers only accept Medicare Advantage and not traditional Medicare. Is that because the reimbursement for physician services is that much different between the two options?

Traditional Medicare here, we ran into too many problems with an advantage plan could not get access to desired specialists and the ones available were several weeks to months for appointments.
No idea on the compensation.

Personally, I think that The Villages health care facilities do not accept original Medicare because they want to make them more accessible to Villagers. If they accepted original Medicare, they would be required by law to accept all original Medicare patients from the surrounding areas, and they would soon become overcrowded with non-Villagers. These facilities were constructed within The Villages to be convenient to Villagers, not non-Villagers. Otherwise, what is the point of using Villages property to operate health care facilities within The Villages? My opinion.

I don't believe that has anything to do with it. It's about the money, IMHO. Long read but worth the information provided.. Tap on "just a moment".

Just a moment...

I understand your opinion. But, if a Villager cannot get an appointment at a Villages health care facility because of overcrowding, what is the point of building health care facilities on Villages property? The developer is trying to create a convenient environment for people who want to buy houses and get convenient health care.

Read the attached information regarding Medicare Advantage please. I believe The Villages is looking out for The Villages and it is not a benefactor for the citizenry's medical care.

I have read it, but I tend to view the developer's plan as primarily to create a good lifestyle for residents and to attract homebuyers, not to sell health care services.

Kind of like building the school. The parents have to work for the villages in order for the kids to go there.

Agreed

Regarding your first question, when I became eligible, I chose original Medicare knowing that is was more expensive. However, I also knew that the Advantage programs have a network of providers and my current providers at the time were not included. Also, at the time several of the Major Cancer treatment centers were not on the list of providers. I was also advised that the Advantage program was required to approve certain actions.

With the Original Medicare you don't have a limited provider network and Medicare determines whether treatment is covered by a code provided by providers giving the reason for required treatment. That code itself is the Approval so there is no wait and no restriction to your source of treatment. Doctor wants MRI, chooses source, provides a referral with proper code and you can get MRI. In my situation, my former employer pays the first $1,000 of my supplement cost (slightly less than half,) I pay about $1,200 for my supplement and it includes yearly cost to Genesis Fitness center.

Everyone has a different need. I am happy with my decision.

If that’s the case then the rapid pace of development isn’t doing Villager's who already own homes a solid. How about limiting the pace of growth so it doesn’t suffocate the available health care infrastructure? Perhaps I’m missing something, but in my opinion it totally doesn’t make sense to not accept original Medicare in the largest 55+ retirement community in the world!

There are plenty of Medicare providers close by who do accept original Medicare. The developer builds, owns, and operates health care facilities on Villages property that are designed to be convenient to Villagers who want to use a Villages operated facility. Restricting these facilities to a few Medicare Advantage plan members makes it easier to use these facilities. If they could limit access to Villagers only, they probably would accept original Medicare. But they cannot because Medicare is a Federal program and they are not allowed to descriminate against non-Villagers. If they had to accept original Medicare, I think the developer would close the facilities. This is just my opinion and you don't need to agree.

Yes, you hit the nail on the head. One has to choose a plan with fewer coverages/options for medical care to use The Villages facilities at this point. It appears they are unable to build the infrastructure or attract top notch care for everyone. Some system, from my point of view.

The developer is building new facilities in the south.

Medicare and snowbirds.
 

I think Medicare advantage would put me in a network of doctors. Since I am a snowbird I need doctors in two locations that Medicare will cover. I don’t think that works for snowbirds.

OMG! A business operating for profit!

Surprised, shocked, why?

Medicare Advantage hands down IMO. Never had a issue, don’t need referrals and access to providers has been great.

In "Newspeak" the term "Advantage" actually means "Disadvantage. :)

Wrong! It is not discrimination for / against The Villages residents. Some time ago, I learned from one of The Villages Health leaders, who was part of the original planning, that it was ALL ABOUT the cost structures of what practitioners are paid for Medicare Advantage patients. That cost structure was a key component of recruiting the professionals needed to make the business successful.

The advantage plans are terrible, ran by insurance companies, and almost 70% of the time will refuse medical procedures that your Dr wants to do. Don’t believe me, call an advantage plan provider and ask them if they can deny service. I have, they all say yes, and then google advantage plans denial rates, why congress has been looking into this. Medicare will never refuse a Dr for doing a procedure, but insurance companies do this 70% of the time because this is how they make money. While you are googling about the advantage plans, query why hospitals are refusing admitting advantage plan clients. Hundreds of hospitals have done this so far and more every month.

Take Medicare and get a supplement plan, a plan g, plan n, plan right when you retire because after this don’t have to accept you. Little known fact: if you go initially with an advantage plan then find out you don’t like it, a supplement plan doesn’t have to accept you, whereas if you initially go with a supplement plan and want to go to advantage plan, no problem.

I’ve been on an advantage and love it! Never been turned down for a procedure and I’ve had the same great service here and up north as I’m a snowbird. I also belong to 2 fitness centers in both locations that they pay for from the silver sneakers.

I am an agent for Florida Blue and can explain the various options and can explain TBH policy as well. Look me up on Facebook, when you search my name, you'll see I'm an agent in my profile picture.

For the TV veterans who have Parts A and B and TriCare for Life, what are your experiences?

We are sold on “traditional Medicare” because we can select the top rated specialists for whatever medical issue we may have. Do not like being restricted to specialists in a particular network. We want the freedom to choose.

Medicare Advantage Plans work because they are supposed to keep patients healthy. In reality, the plan receives a certain amount of money for each person in the plan and it's in the plan's best interest to not spend money on patient's if they avoid it...because the less spent the more profit they make. That said, they are still obligated to provide the necessary health care to a patient, but they aren't obligated to go beyond what is strictly necessary. The main problem with Advantage Plans is you CANNOT choose to go to any facility or doctor you wish UNLESS they are inside the plans network.
We have traditional medicare with an AARP supplemental plan that covers all of our expenses the traditional medicare won't pay. We've had this plan for over 10 years now. So beyond our monthly premiums we pay zero dollars for healthcare. This works for us...we can go anwhere we choose and have any doctor we choose and it's completely covered...no issues.
I am a former healthcare provider and I would never recommend anyone get an Advantage Plan unless they simply cannot afford regular medicare with a supplemental plan attached. You lose too much control of your healthcare...and you are your best advocate...not someone else.

Villages healthcare does accept traditional Medicare for it's specialists. It does not accept traditional Medicare for Primary Care docs.

The developer is interested in who will pay the rent and in The Villages that is medical. He just rents the buildings.

The new hospital that was planned south of. 44 got cancelled because they have staffing issues not enough doctors. Instead they are building free standing emergency rooms. There will be a day when we have a medical crisis because too many people for the number of medical facilities.

People complain about The Villages Advantage Plan and Advantage Plans in general, but we have had great experiences after switching when we moved to TV! I had heartburn while on my morning walking, went to my PCP at Colony and ended up with a triple bypass. Got an EKG, stress test, heart Catherization then a triple bypass. From initial PCP visit to triple bypass, 17 days! After giving myself 15,000 - 20,000 injections over my life, now down to ONE injection per week, off insulin and A1C is 5.7 - 6.0! My wife has had severe back issues, received back surgery and has NO back issues since! We travel back to Massachusetts every summer and have no issues seeing out former doctors if and when needed. Complain all you want, but you can’t prove it by us!

It’s about attracting top talent. Medicare payments won’t make a doctor enough money to want to live here for very long. Private Medicare insurance (Advanrage) does pay a lot more. I have Anthem and have loved it. I was in the hospital for 5 days and I paid out of pocket $100 for the entire stay. Medicare is known for not paying much.

In 2024, 32.8 million people are enrolled in a Medicare Advantage plan, accounting for more than half, or 54 percent of Medicare eligible participants.

The Villages Health said they could not accept me as a new patient due to not being on Medicare. They accepted my husband who is on an Advantage plan. I am not an expert but sounds like age discrimination in reverse :). I am over 55 so thought I would be accepted.

Awesome
 

It works well. If I remember we were grandfathered in when the villages changed their policy. We have been treated very well.

Only issue I don’t like is that when you are selected to use the villages health you cannot select a location near where you live or doctor.

A must read article!!! Take the time to read, excellent, accurate summary. Thanks for sharing!

The Villages Med Plan doesn't have access to the Moffitt Cancer Center.

Ever wonder why the push and advertise the Advantage plans so much? That should set off red flags. More money for them. Advantage gives less doctor options and very limited across state lines.

Well said.
We're on UHC Advantage and are very happy with it, and The Villages Health. No waiting weeks for an appointment and we never wait more than 15 minutes for our PCP. We also use all the wellness benefits from UHC.
Our best friends are on Humana MA and like it. I hear Florida Blue is very good as well.

Contrary to what some will say, there is no real one size fits all.
Do your research and talk to SHINE. They said MA was a great option for us.

Choice is a good thing!

Your response seems to assume that Medicare Advantage is only for Villagers. Hate to break it to you, but Medicare Advantage is all over and everyone can choose it.

If The Villages wanna treat only villagers then they should probably ask for their resident ID before treatment at sign in. Insurance type shouldn’t even play into it.

I chose Original Medicare because I travel some and want to be able to choose my own specialists when needed. Have not been disappointed. I spend some time in Maryland with my kids and grandchild during the summer and have had to have some medical procedures done. As an example, Johns Hopkins does not accept Medicare advantage.

There are those who will respond to this and say they do have options for specialists, but I did check into this and the options are still limited. I want the best care I can find as quickly as I can get it with no runaround from a company telling me who I can see and when.

As a final note, I loved my Villages Health physician Kathie Greene when I was still working and had a corporate plan, which they accepted. Hated to switch but need to do what is best for me.

I agree that it should set off red flags. But, if you think about it, a "for profit" company can increase their profits by screening out waste and fraud. On the other hand, Traditional Medicare claims are processed by the Federal Government by people who don't need to make a profit, and who don't seem to care much about screening out waste and fraud.