Medicare Advantage

Yes, I know that Mayo Rochester does take some Medicare Advantage plans, I believe there were some special negotiations for that...I recall the discussion on TV and hearing that in Minnesota it is hard to sell a Medicare Advantage plan if Mayo not included.
Your happy friends are merely lucky and the exception because they live close to Mayo. And as I mentioned, many other providers are dropping Advantage plans. Including in the Twin Cities. Once dropped, or if one then wants to go to traditional Medicare, finding a new plan is a problem. Because plans are no longer required to take you like in the beginning. So if you have preexisting problems, they can refuse you.
It is a disservice to not explain the negative reality of the Advantage Plans.

My comments were based on financial analysis. Medicare Advantage plans are not to the advantage of enrollees. They are insurance companies and are profit driven. To make a profit (and pay extra sales and marketing costs, CEO bonus etc.) yet offer a cheaper premium. something must give. Just read their financial statements! Those sales and marketing costs and required profit margin easily add 30% cost to medical care. Yet Advantage plans promise more benefits and lower premiums. And that is why they require approval for tests and procedures, set up their own network of doctors who take less and require copays. That is why there are so many complaints and Congress is investigating Advantage plans. I recall when I went on Medicare reading that Medicare pays out 90 cents on the dollar in services, while my Medigap plan brochure said it pays out 67 cents on the dollar in services. Guess why the difference???? I did a comparison and if I had had an Advantage plan with my medical problems, apart from not being able to self-refer to Mayo, the actual costs of copays etc. in an Advantage plan would have cost me far more than my expensive Medigap plan.
I have seen some heart-breaking stories on Connect of people waiting to get a PET approved by their plan and not getting treated! Pigs cannot fly.

My Medicare Advantage plan, rated tops in NY, specifies that I may go to ANY medical facility that accepts Medicare. It's a PPO rather than a HMO. My plan paid all bills after HCM surgery in Rochester. Big surprise was that I expected to pay an out of network hospital copay and happily I was charged the in network amount. Customer service is superb, worked well with Mayo. There are excellent Medicare Advantage plans and there are some not so great. So, it all depends on the one you have.

Yes, some States are strict about things...but how much did it all cost you? Advantage plans are cheap if you don't use them, but otherwise you pay premium plus copays. What is your max out of pocket? How long do you wait for approval for a procedure? With Advantage plans you need to check each year to see if your doctor is still in network. I have several doctors at Mayo who have told me flat out they don't like Advantage plans. And Mayo Oncology warns to check benefits, and even has brochure on what to do if your insurance company first says it will pay and then refuses to pay for your cancer treatment. That speaks volumes! And later if you want to change you need to find an insurance company that will accept you and at what price?

I have the best Medigap plan - granted the most expensive. I pay a premium of about $3600/year, and I never see a bill. I research the doctor I want to see and just make an appointment. For many years they made money off of me, but now it is my turn. In 2.5 years I have had two lung surgeries (VAT procedures), a cardiac stent, two additional angiograms, 4 PET scans, 12 CT scans, 6 series of pulmonary function tests, Radiation SBRT treatment, several biopsies, many blood tests, countless doctor's appointments including 7 different specialists and eye exams, and a couple of emergency room visits. I never saw a bill or needed any approval before scheduling something. In fact, I went from an abnormal chest x-ray to lung surgery in 7 weeks with Thanksgiving and Christmas in-between.
To make a profit the insurance company has to limit your benefits! They have higher costs than Medicare. That is a fact of life. Just read their financial statements. There is no way that they are so efficient that they can deliver the same care for less. I worked in Corporate America. I know that they are not any better than the government at doing things. It is all about having the right objectives and skill sets. Call Medicare and then call Delta airlines or Comcast. Who answers the phone right away? Medicare! Medicare should be adding benefits and insurance companies should be out of this market. Healthcare is a "captive" market and that means it is not suitable for competition like when one buys a car.
Providers have additional costs to process the different types of policies. US private health care system costs twice what it does in Europe without having better outcome. I had a job where I had to research these things.

Yes, some States are strict about things...but how much did it all cost you? Advantage plans are cheap if you don't use them, but otherwise you pay premium plus copays. What is your max out of pocket? How long do you wait for approval for a procedure? With Advantage plans you need to check each year to see if your doctor is still in network. I have several doctors at Mayo who have told me flat out they don't like Advantage plans. And Mayo Oncology warns to check benefits, and even has brochure on what to do if your insurance company first says it will pay and then refuses to pay for your cancer treatment. That speaks volumes! And later if you want to change you need to find an insurance company that will accept you and at what price?

I have the best Medigap plan - granted the most expensive. I pay a premium of about $3600/year, and I never see a bill. I research the doctor I want to see and just make an appointment. For many years they made money off of me, but now it is my turn. In 2.5 years I have had two lung surgeries (VAT procedures), a cardiac stent, two additional angiograms, 4 PET scans, 12 CT scans, 6 series of pulmonary function tests, Radiation SBRT treatment, several biopsies, many blood tests, countless doctor's appointments including 7 different specialists and eye exams, and a couple of emergency room visits. I never saw a bill or needed any approval before scheduling something. In fact, I went from an abnormal chest x-ray to lung surgery in 7 weeks with Thanksgiving and Christmas in-between.
To make a profit the insurance company has to limit your benefits! They have higher costs than Medicare. That is a fact of life. Just read their financial statements. There is no way that they are so efficient that they can deliver the same care for less. I worked in Corporate America. I know that they are not any better than the government at doing things. It is all about having the right objectives and skill sets. Call Medicare and then call Delta airlines or Comcast. Who answers the phone right away? Medicare! Medicare should be adding benefits and insurance companies should be out of this market. Healthcare is a "captive" market and that means it is not suitable for competition like when one buys a car.
Providers have additional costs to process the different types of policies. US private health care system costs twice what it does in Europe without having better outcome. I had a job where I had to research these things.

I have no other practice or hospital dropping Medicare Advantage. Is it isolated to Mayo. I don't think it is an AZ/FL regulation problem.

My PCP is confused as to why Mayo did this.

Vic83, Thank you for pointing out all of the details that people should be looking for in deciding whether or not to sign up for a Medicare Advantage Plan. As I said before, plans vary. My plan is not-for-profit and was started by physicians in 1984. Rated very high by US News and World Report as well as NYS, it is unique and THE ONE selected by my former employer for the retirees. (Other choice is take the money and buy your own.) No copays for screenings, annual check-ups and either of the 2 meds I take. Copays are $10 otherwise. Silver Sneakers included. Costs are low (my share is $196 for the year). Max out of pocket is $3,350 and I have never paid a third of that. I had a septal myectomy at Mayo and 4 other short local hospital stays before and after. I believe that they use a good model, they pay providers within a month (I get verification), and there are thousands of providers. Seriously, I do not know why people at other places do not look at this model - I think for-profit insurance companies lobby against such non-profit licensing/certification.

Other benefits to my Traditional Medicare with BCBS Medigap plan:
If I travel, I am never out of network. If I am in Florida for the winter, I have no problem going to the doctor since I can go to any doctor in the US who accepts Medicare.
And I don't need to check each year to see if my doctors are still in the network, because the network is all doctors that take Medicare in the US.
I self-refer to the appropriate specilaist for most health issues. Why waste time going to a Primary Care doctor who has less knowledge on the subject?

I think the US should go to Medicare for All type healthcare. Insurance companies only drive up the cost of insuring people with their sales & marketing expenses and administrative expenses, etc. That extra cost could go to additional benefits

For sure we want to understand the differences between Medicare plans, because it is key in the abillity to get the healthcare we need at Mayo Clinic amd other institutions.
It is not a big jump to arrive at "Medicare for all" in this discussion since people also discuss their "before Medicare" plans. I look at these discusisons through the lens of my background (degree in Economics, worked in Corporate America, many years of researching business and industries) ...so my "diagnosis" is based on assessment of numbers.
In strategic planning we first set goals/objectives, then study solutions and decide which one provides the most. So if our objective is affordable quality healthcare for all, we have to look at the numbers - outcomes and costs. Even 20+ years ago there were several studies showing how the US healthcare system is twice as high as Switzerland (the second highest) with no better outcomes. I also recall a study that asked nurses if they would go to a not-for-profit or profit hospital and they said "not-for-profit" I suspect the reason being that the NFP hospital does not have to cut corners to meet profit objectives.
Medicare administration is more cost effective than private health insurance because it does not have the sales and marketing expenses, it does not have to renegotiate with many providers each year, etc. And it has a uniform coding system...providers also have more costs because they need to hire people to process all kinds of different insurance claims. Our additional issue in the US is not having enough doctors!!!!