The Villages Health will no longer accept new or existing patients who have Original Medicare with supplemental insurance starting Jan. 1.
That means patients with Medicare supplemental plans, also known as Medigap policies, will have to find new doctors or switch to The Villages Medicare Advantage plans through United Healthcare.
“Because our superior care best aligns with Medicare Advantage, we have decided to no longer accept Original Medicare with a traditional Medicare Supplemental policy for all new and existing patients,” stated a July 12 letter to patients from the health system’s chief executive officer Tom Menichino and chief medical officer Dr. Jeffrey Lowenkron. “If you decide this is not the right choice for you, we will provide your care through Dec. 31, 2016, while you search for a new physician.”
The health system apparently will continue to accept commercial insurance plans and Tricare for Life, which covers many retired military veterans.
Patients can change their coverage during the annual fall enrollment period, Oct. 15 to Dec. 7.
Patients with Medicare supplemental policies pay monthly premiums, but their care is at low or no cost. They also are not required to stay within a provider network. Medicare pays 80 percent of approved rates and supplemental polices cover the rest.
United Healthcare offers two Medicare Advantage plans for The Villages Health. Medicare Advantage patients receive care from a network of providers and pay no or low monthly premiums.
To the health system, however, treating patients with The Villages United Healthcare Medicare Advantage plans generates more revenue than treating those with Original Medicare and supplemental policies. That’s because the health system is paid by the number of Medicare Advantage patients they serve whether they see a doctor or not. Original Medicare pays the health system on a fee-for-service basis, often below the cost of providing those services.
For its primary care, The Villages Health is ranked in the top 1 percent of health systems nationally and the top physician group in north central Florida based on HEDIS, a quality rating system. Doctors have smaller caseloads than those at other clinics and spend more time with patients.
“We are committed more than ever to keep our innovative model and maintain the level of excellence we’ve established,” the letter stated.
But The Villages Health apparently has a limited number of specialists and specialty hospitals and clinics in the network, which has caused complaints of delays.
The health system also has been losing money and the Developer reportedly has kicked in a substantial amount to help balance the books.
