Having several different health care options (ERs, hospitals, specialty clinics and primary care centers) coming into The Villages area such as UF Health, Orlando Health Medical Group, HCA Florida Healthcare, AdventHealth and Premier Medical is positive because it provides critical competition, prevents insurance monopolies and expands in-network access, particularly for major Medicare Advantage plans.
Up until recently, CenterWell (formerly The Villages Health) was the “major player” in The Villages for primary care centers and specialty clinics.
In 2016, The Villages Health forced patients onto the UnitedHealthcare Medicare Advantage plans by telling patients that they must switch to UnitedHealthcare or stop receiving care at The Villages Health. There were limited options at that time, so most patients had no choice but to switch into UnitedHealthcare Medicare Advantage plans.
Then in 2024, the unexpected happened! It was discovered that between 2020 and 2024, The Villages Health had billed Medicare $360 million in overpayments.
Due to a clear lack of compliance oversight, the billing processes utilized for years were inconsistent with Medicare payment policies, resulting in the receipt of more money to The Villages Health than legally due.
Fast forward to this moment. CenterWell now has ownership of the eight primary care centers and two specialty care centers once owned by The Villages Health.
Prior to the purchase of The Villages Health, CenterWell told patients that the transition would be seamless and their care would continue uninterrupted. CenterWell has continued to state this, and its website (under FAQs) explains that nothing has changed with patient care and that patients will “continue seeing the same health care providers at the same locations.” Unfortunately, this is not the case in many situations. As an example, individuals with UnitedHealthcare (UHC) Medicare Advantage Group Plans are now being told that this plan is a “commercial plan” which does not “fit in their healthcare model.” CenterWell is encouraging individuals with that plan to look elsewhere for their health care needs. There are only a few providers in their system that accept this insurance (UHC Medicare Advantage Group Plans), leaving many patients unable to receive the care they need. As a result, these patients (many elderly and vulnerable) are basically being abandoned by their health care provider.
The good news is that more choice options outside of CenterWell are becoming available in The Villages! Research has continued to prove that health care entities are motivated to offer better care, shorter wait times and a higher standard of customer service to retain business.
With The Villages’ rapid population growth and our elderly population, the demand for specialists (like cardiologists, neurologists, urologists and orthopedists) will only continue to increase.
As an example, someone with Alzheimer’s and/or Parkinson’s disease may need to see other specialists besides their primary care doctor, such as a neurologist, psychiatrist, psychologist, urologist, neuro-ophthalmologist and/or geriatrician. Oftentimes, additional services are needed for these patients as well, such as physical therapy, occupational therapy and/or speech therapy. Options and choices are critical for those with serious health care needs!
Hopefully, we will continue to see ongoing growth with various health care entities coming into The Villages area and calling it home, as this will continue to improve the overall health care in this community.
Carol Ann Wolf is a certified dementia practitioner who lives in the Village of Hemingway.