[Virtual Geezer]

Here is an interesting post that was sent to me regarding health care in TV. It may be old news to some but new to others.

Of golf carts and doctors: A retirement community builds its very own health insurance plan

VG

[2BNTV]

It sounds good, if it works as advertised,

[Mack184]

Note that this plan IS NOT available to ALL Villages residents UNLESS you join that specific plan. What this is, is essentially a modified "Gucci" plan. What's likely to happen is that those who can afford the plan will take it and thus leave TVRH with those who cannot, making the hospital's care even less attractive to residents.

[downeaster]

Originally Posted by Mack184

Note that this plan IS NOT available to ALL Villages residents UNLESS you join that specific plan. What this is, is essentially a modified "Gucci" plan. What's likely to happen is that those who can afford the plan will take it and thus leave TVRH with those who cannot, making the hospital's care even less attractive to residents.

I may be a little thick but I do not understand how the plan will impact negatively on TVRH. It would be helpful if you would explain how it would effect those not electing the plan as it relates to TVRH.

Have we gone from Marcus Welby to Gucci?

[Mack184]

OK..No problem at all. When this story was first presented on another thread, I was under the impression that TVRH & it's parent company Central Florida Health Alliance had merely made a "deal" with United Healthcare to be a "preferred provider". This obviously is not the case. This is an entirely new set-up and everybody needs to read the section in the article VERY CAREFULLY...that states that not all Villagers will be able to access this new health system UNLESS they buy into the United Healthcare plan. You could be next door to the facillty but you won't be able to use it unless you are a member of the Villages/UHC plan. Again..make sure everybody reads that section CAREFULLY.

Now since this a a "member only" operation, UHC is going to control and set up your healthcare options under this plan. There are some insurance companies that are currently doing this. The biggest one that comes to mind is Kaiser Permanente. They are very big on the west coast, although they have some presence in other parts of the US.

Under these groups you can ONLY see THEIR DOCTORS and go to THEIR HOSPITALS. It's the way they control costs. Since there has been no announcement that TVRH & Central Florida Health Alliance have a "deal", you will be sent to a hospital that they have an exclusive deal with. It could be Munroe, It could be U-Florida/Shands or someplace else. If you go to TVRH and they do not have a deal with them, it will require you to go to the hospital or doctor that THEY DESIGNATE to receive care under their plan. Also notice that NOWHERE in the article was there a mention of TVRH or their partner Leesburg General. They did however mention Shands.

So first & foremost, if you join this type of plan, you will no longer be able to go to your current doctor and have the visits covered unless of course your doctor joins Villages/UHC. You must go to their doctors for the coverage to pay.

So those who join the plan will most likely NOT be able to use TVRH, but will need to go to whereever they want to send you. So TVRH and their doctors will be serving those who aren't part of the plan, and thus have a smaller revenue stream, and thus have less staff because they can't afford them and so on. A domino effect.

And..I cannot wait to see this board once people try going to these new centers only to be turned away because they are not members. Again, people need to read this article CAREFULLY and understand this. This is a "members only" plan. Just because you live in TV does not mean you can use this service. You've gotta buy into the plan.

Now once again, the genius of Gary Morse is fully on display here. You come in as a new resident and not only do you buy a nice home & a "lifestyle" you can buy into a health care system as well. It's a brilliant stroke of marketing. I'd like to use about 10% of this guy's brain. He's amazing.

The quality or service of this set-up is at this point fully unknown. But it will be vastly different from the way things currently are working. It will require heavy participation from residents to make it profitable. And don't be misled, this is about profits..NOT your well-being. (BTW..I am not now nor have I ever been a believer in the idea that profits are evil.) Only time will tell how it works out.

[skyking]

Sounds like a group model HMO. Best way to provide healthcare if done right. (But I am prejudice.)

[Happy Villager 1]

According to an article in 4-traders it states "Under an agreement between UnitedHealthcare and The Villages Health, people who reside at The Villages and other
nearby communities and who are enrolled in a Medicare Advantage plan offered by UnitedHealthcare or its affiliate Preferred Care Partners will have exculsive access to care at the network of primary care clinics in development at The Villages. UnitedHealthcare and Preferred Care will be the only Medicare Advantage plans that will be accepted at The Villages Health clinics." But what is confusing is in another part of this article it states "In addition to UnitedHealthcare Medicare Advantage members, Villagers and others in surrounding communities enrolled in Original Medicare and/or Medicare supplement plans will have access to care at The Villages Health." There also is mention of an electronic medical record system to help coordinate care received at the health care centers and The Villages Regional Hospital.

You can read the article for yourselves by going to the Washington Post link provided in Virtual Geezer's posting. In the first paragraph in the Washington Post click on the
underlined "A New Offering in the works" and it opens the 4-traders article.

[Mack184]

After your post I have re-read the article 4 times. Nowhere does it say that "other communities" will be included. Yes..You will NOT be forced to join the plan to live in TV...BUT..You will NOT have access to The Villages Health/UHC system UNLESS you are a member. Just living in TV does NOT qualify you. You MUST be enrolled in their plan to use their system. Otherwise you will pick your own doctors and go anywhere that you like, but you will NOT be able to be seen and/or treated in the Villages/UHC system unless you are a member.

We will have to wait and see what develops as UHC comes to town and starts hawking their plan.

[Happy Villager 1]

I would like to add that until The Village Health program is in full operation no one not in the loop knows how it will operate. This is being advertised as a system for villagers and a golf-car-ride away for their care. Please note in the 4-traders article in talks about others in surrounding communities too having access.

I need to update my own posting! I just went on www.TheVillagesHealth.com and it does state The care centers will be accepting new patients who are residents of The Villages until such time as all residents have been invited to become members (subject, of course, to any requirements of our managed care plans or law). So I am guessing that means once all residents have been invited and choose to join or not the plan will then be opened up to other communites just as the article states.

[Happy Villager 1]

Originally Posted by Mack184

After your post I have re-read the article 4 times. Nowhere does it say that "other communities" will be included. Yes..You will NOT be forced to join the plan to live in TV...BUT..You will NOT have access to The Villages Health/UHC system UNLESS you are a member. Just living in TV does NOT qualify you. You MUST be enrolled in their plan to use their system. Otherwise you will pick your own doctors and go anywhere that you like, but you will NOT be able to be seen and/or treated in the Villages/UHC system unless you are a member.

We will have to wait and see what develops as UHC comes to town and starts hawking their plan.

Mack have you read the 4-traders article? This information is not included
in the Washington Post article.

[2BNTV]

I am a UHC Medial Advantage Plan member in CT and will use the UHC plan when I get to TV. I have been with them for 3+ years and they are a wonderful provider of services. I look forward to be able to go to their stores in a golf cart, to take care of whatever my medical needs may be.

Personally, I think Medical Advantage Plans are great for those who are healthy and don't require regular visits to the doctor, As always, everyone needs to decide for themselves what plan suits their needs.

IMHO -This have medical stores staffed by eight physicians sounds like a great way to have more access to a medcal system to keep one healthy.

[gomoho]

My understanding is UHC/PCP is the only "medicare advantage" plan they will accept, not the only insurance plan. And I would also like to add that both my husband and I have now both been there for physicals and were sorely disappointed.
First meeting was 45 minutes of the doctor making notes in the computer about your previous and current health - charge billed to insurance company $457.
Next appointment a week later is a routine physical and going over test results. Not once was asked if we had any concerns or questions and was basically told if there were any issues we wanted to discuss that would require yet another appointement. Haven't seen the charge yet for this visit.
The worst part of the experience was I came away with more questions then I went in there with based on what we were told by the doctor. When attempting to ask a question was told she had to get through the lab results 'cause she had other patients waiting. So much for Marcus Welby.
Perhaps they won't order unnecessary tests, but it seems like they want to schedule follow-up appointments to discuss anything. Always thought the pupose of a physical was to assess your current health condition and address any concerns you currently have.

I am currently working on a presentation of the errors that occurred during our visit to present to their Chief Medical Officer. Hope I have better luck with him.

[Mack184]

Originally Posted by 2BNTV

I am a UHC Medial Advantage Plan member in CT and will use the UHC plan when I get to TV. I have been with them for 3+ years and they are a wonderful provider of services. I look forward to be able to go to their stores in a golf cart, to take care of whatever my medical needs may be.

Personally, I think Medical Advantage Plans are great for those who are healthy and don't require regular visits to the doctor, As always, everyone needs to decide for themselves what plan suits their needs.

IMHO -This have medical stores staffed by eight physicians sounds like a great way to have more access to a medcal system to keep one healthy.

I'm interested in your opinion on this because at one point I worked for a radio corporation that had UHC for it's health plan. It was absolutely..bar none..the very WORST plan I was ever under anywhere. Now with that said, I don't know if it was UHC that was awful, or the plan that the company had purchased. But it covered almost nothing and required you to go to out of the area doctors & hospitals for care.

[downeaster]

Originally Posted by Happy Villager 1

According to an article in 4-traders it states "Under an agreement between UnitedHealthcare and The Villages Health, people who reside at The Villages and other
nearby communities and who are enrolled in a Medicare Advantage plan offered by UnitedHealthcare or its affiliate Preferred Care Partners will have exculsive access to care at the network of primary care clinics in development at The Villages. UnitedHealthcare and Preferred Care will be the only Medicare Advantage plans that will be accepted at The Villages Health clinics." But what is confusing is in another part of this article it states "In addition to UnitedHealthcare Medicare Advantage members, Villagers and others in surrounding communities enrolled in Original Medicare and/or Medicare supplement plans will have access to care at The Villages Health." There also is mention of an electronic medical record system to help coordinate care received at the health care centers and The Villages Regional Hospital.



You can read the article for yourselves by going to the Washington Post link provided in Virtual Geezer's posting. In the first paragraph in the Washington Post click on the
underlined "A New Offering in the works" and it opens the 4-traders article.

They are talking about two separate methods of insuring.

The only Medicare Advantage Plan they will accept is UHC.

However, they will accept Medicare patients with supplemental insurance. I am one of their patients with Medicare and supplemental insurance.

There is no provision for accepting any other Medicaid Advantage Plan.

I think the negative aspects of the Villages Health Plan are being over blown. The plan, as I see it, is a good solid plan that can benefit a lot of Villagers. It is not for everyone, in fact not for me due to my individual situation, but it certainly doesn't hurt anyone. I would expect it to be well run but I doubt it will please everyone. One size doesn't fit all. If it goes as expected I think you will see a lot of Villagers switching to the plan from their current Medicaid /Supplemental plan. I will be watching it develop and I will be taking a close look at it next fall. It may "fit' me after all.

[2BNTV]

Originally Posted by Mack184

I'm interested in your opinion on this because at one point I worked for a radio corporation that had UHC for it's health plan. It was absolutely..bar none..the very WORST plan I was ever under anywhere. Now with that said, I don't know if it was UHC that was awful, or the plan that the company had purchased. But it covered almost nothing and required you to go to out of the area doctors & hospitals for care.

I see all my doctors that I saw when I was under an employers health plan before I signed-up for Medicare Complete administered by UHC. I never had to go out of network one time in three years.

I think the plan your company purchased left a lot to be desired if you constantly had to go out of network especially if it covered almost nothing.

I can honestly say, I would never select a plan that required large deductibles and large co-pays. With that being said, the UHC Medicare Complete is better coverage than the plan I had at work and I paid less premiums. I recently had a very substantial hospital bill that only required a small co-pay of services that were not covered and even that was reduced by 30% for a prompt payment. Peanuts, compared to the total bill. UHC customer service is really good.

When it comes to medical plans, one size does not fit all so one must choose the plan that best suits their needs. I wish you good health and better coverage going forward.