Medicare Advantage has gone off the rails
 

We were one of many people that had our Preferred Care Partners plan terminated. This only applies to people in our three counties. Preferred Care Partners still offers the plan we had outside of our area. As you are probably aware, PCP was purchased by United Health Care.

So, after much research, we found an acceptable Medicare Advantage plan with PUP that lets us keep our doctors. The replacement that United Health Care is offering drops several of our doctors.

My wife signed up with PUP over the phone, got all the way to the end of the application processes, and learned that our current primary care physician's "quota" had already been filled, and we would have to select another primary care doctor.

WTF?

what is happening with the so called medicare "advantage" plans was forecasted last year. The advantage providers, in my opinion, handed out snow jobs to keep their clientelle from leaving...then.

Not a surprise at all. The surprises will continue as the naieve try to maintain the coverage the used to have with who ever, company.

What was not forecast, at least for public consumption, was the new health care law was going to so distort the system that nothing would work like it used to and costs would increase astronomically such that the providers would be scrambling to hedge the increases....including insurance companies and the example set by IBM.....dumping millions more than anticipated into the system.

AND THIS IS ONLY THE BEGINNING.....WAIT TIL NEXT YEAR.

the best and cheapest health care coverage you will ever have is what you have right now. To retain parity for the coverages we all enjoy....WE WILL ALL BE PAYING MORE!!!!!!!!!!!!!!!

btk

We've decided to become guinea pigs for The Villages Health System. We think what they are trying to accomplish is a good thing. Whether they will succeed, we don't know but we are willing to try. I heard good things about the experience with the doctors' interviews from people who joined. As for the back office they don't seem to be moving smoothly. Selection of doctors are very limited for the newer location and having actual interviews with the doctors, if we are lucky, will be in December. Since we travel both inside and outside of the U.S., we can't do HMOs like Medicare Advantage. Our company dropped direct Retirement Benefits as of end of this year and switched to reimbursement plan, we had to find other insurance. The worst is loss of good dental plan for now a pittance plan. Company retiree benefit plan which was promised for life time is going out of the window.

I'm not sure I understand. Are you saying that PUP limits the number of patients they will insure per primary care physician?

That is what we were told at the end of the enrollment process by the PUP representative.

We can probably beat this system by selecting a primary care doctor that we have no intention of seeing, get the insurance, then switch primary care doctors after the plan takes effect on January 1st. But who knows if that will be possible.

This is the first I have heard of quotas for primary care doctors. This happened after our primary care doctors office was closed on Friday. So we will check on Monday and see what they know about it.

This has really put us in limbo. We had switched to The Villages Health Care system for our primary care doctors a few months ago and were happy with the decision. However, when we found out that only United Health Care would offer a plan that allowed us to continue in VHC, we found the additional cost unacceptable and switched back to our previous primary care doctors.

Now we are wasting a whole lot of time just trying to find a plan that keeps costs reasonable (compared to what we had in 2013), and still lets us keep the doctors we like.

Yorio: Paraphrasing your comment----"Company benefits (especially health insurance) promised Retirees is going out the window.". Actually this process started several years ago. Private Companies and Governments across America could not sustain over the long haul the benefits they promised their employees. It was just too costly.

Unfortunately, many in our age group are affected by the loss of these benefits. Like, in the past, those of our generation must just "suck it up". And we will.

justjim: You are essentially correct but keep in mind many corporations were reacting to changes the fed gov't made and forced on employers.

secondly have you noticed that public unions and federal employees continue to full benefits and annual increases even though their liability reserves are under funded. Be ready for a huge tax increase to accommodate them.

Actually, you are wrong about the feds. Both the Civil Service Retirement System (the old retirement system) and the Federal Employees Retirement System are actually funded with a surplus. That is partly because (unlike many of the state and local civil service funds), they were never raided by greedy politicians (like Illinois) and were never taken captive by private fund managers promising 50% return per year (and delivering -50% returns).

All of the talk about the federal system is just the usual BS by politicians trying to convince you to vote for them so they can protect us from themselves... And feds hired since 1982 have been under FERS which pays a pension less than 1/3 of the old pensions - it was designed so that 1/3 of total retirement is pension, 1/3 is social security and 1/3 is savings via a 401k like plan. And (trust me) the "1/3" that is pension is not even close to 1/3 of what you need a month to live.

It's this postal service deficit, largely due to congressionally required pre-funding of health benefits for future postal retirees, that most people associate with federal employees' benefits (wrongly):

"The U.S. Postal Service announced a record loss of $15.9 billion for the fiscal year 2012, which it blamed primarily on a mandate to set aside billions of dollars for a retirement heath fund.

The Postal Service said that its loss includes $11.1 billion in defaulted payments it owes to "prefund" health benefits for future retirees. Postal officials have complained for years about these prepayments, which are required by Congress, to pay for future retirees. The Postal Service also points out that other federal agencies don't have similar mandates for prefunding."

Postal Service posts record $16 billion loss for 2012 - Nov. 15, 2012

Health insurance premiums for non-postal employees are shown here:
http://www.opm.gov/healthcare-insura...postal-ffs.pdf

If your Medicare Advantage plan is ending you then have a 'guaranteed issue right' to go back to Original Medicare and pick up a Medigap policy ie., supplement. The rate the insurance company can charge you will only be based on your age and not on any existing medical condition. Medigap Plan F (most coverage) can be under $200/month and you will never see a co-pay. You will also need a Plan D which can be as low as $12/month with no co-pays for tier 1 and tier 2 generics by mail order. See a SHINE counselor at The Villages rec centers during the open enrollment season. 1-800-963 5337.

Thanks, you made an excellent point. Because of the Affordable Care Act, there is going to be a shortage of doctors. Now, and in the past, HMOs where able to get good deals (offering low compensation to doctors) by signing up doctors who needed more patients to care for. But as time goes on, they won't be able to get the same good deals as doctors will demand higher compensation. It's a simple case of supply and demand.

And this makes me realize that I had better not waste any more time. I will sign up for PUP tomorrow morning before their doctors in TV are all booked up.

Great info. Would you know by chance if the Doc's who were "not invited back" by United Health HMO and PPO, will be in the medigap plan such as plan F? Or...are they "out" of UHC altogether. All of my Dr's were sent packing by UHC on my PPO plan. Plan F sounds like a possible plan for me because of some potential health concerns.

Any doctor who accepts Medicare will accept ANY Medigap plan such as Plan F supplement. You can buy a Medigap policy from UHC and many others in FL. It is a private insurance policy that is a supplement to your Medicare. Note a "supplement" plan is not the same as a "supplementary" plan. Legal definitions are work here. Note that you will be back in 'original' Medicare and no longer in a Medicare Advantage plan. You will have to pay a premium for a Medigap plan but you will have no copays - depending on the plan you select. You will also be covered anywhere in the USA and foreign travel may be included.