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Does Mayo Clinic take Medicare?
For those of us who live in the U.S., this is a complicated issue. Whether or not Mayo Clinic takes Medicare comes up frequently. The short answer is yes, Mayo Clinic, on all campuses, does take Medicare. But here is where it gets sticky. It depends on the Medicare Plan you have.
If you have what is sometimes called "Traditional Medicare" then you have Medicare Part A (for hospitalization) and Part B (for outpatient). You also selected another Plan that covers the gap of what Part B does not cover. I have Transamerica Insurance for my Part G supplemental plan. It's very cumbersome however I chose traditional Medicare because it allows me to go anywhere in the U.S. that accepts Medicare. I don't need any prior authorization.
If you chose a Medicare Advantage Plan then you are in a network of hospitals and medical providers and have a managed care plan. You have Medicare Parts A and B but also C (Medicare Advantage Plan) that includes all of your medical services including prescriptions. However, Medicare Advantage Plans have networks so like the type of health care plan you probably had before you retired you have to get prior authorization for some services from your insurance company and you cannot go outside of your network or it will cost you a lot of additional money. Many people go with these Medicare Advantage Plans because the monthly cost is reasonable, it's easy to sign up, and if you live in a large urban area you'll have lots of choices of where you can go. But, if you want to go outside of your network, like Mayo Clinic then you'll have to check to see if your Medicare Advantage plan lets you go to Mayo Clinic.
Confused? It's mind-boggling. I figured all of this out when I signed up for Medicare shortly before I retired.
If you want to know if Mayo Clinic takes your Medicare Plan, you can call the business office at any campus and explain what kind of insurance coverage you have. They will help. I have experienced THE best service when I've contacted Mayo Clinic for insurance and billing questions.
https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/contact-us
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Hi @dtrails50, I’m in Wisconsin and have Network Health as my Medicare Advantage plan. I have my choice of providers. I also travel quite a bit and it pays for out of state blood work.
I’ve had very little out of pocket costs for my AML cancer treatments and bone marrow transplant (which was out of state). Depending on where you’re locating in WI this might be a choice worth investigating.
https://networkhealth.com/
Welcome to WI. When is the big move?
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1 ReactionHi,
Thank you for the information. I will look into that program.
I am still looking around Wisconsin for an area that meets my wish list. But i have time as it will not be for a year. Doesn't hurt to be proactive especially when it comes to healthcare.
You have had a lot to deal with and i do hope you continue in good health!
Take care,
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2 ReactionsHere's further information from Mayo Clinic
- Insurance Frequently Asked Questions https://www.mayoclinic.org/billing-insurance/insurance/faq
"You may provide your insurance company with Mayo Clinic's Tax ID number to determine your coverage and benefits at Mayo Clinic. Click the link above for ID numbers per Mayo location.
Mayo Clinic is a participating Medicare facility at its locations in Arizona, in Florida, in Rochester, Minn. and at all Mayo Clinic Health System locations (https://www.mayoclinic.org/locations)."
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7 ReactionsJust on the news yesterday (10/5/2024) ......" October 2024, the Mayo Clinic notified fewer than 600 Medicare Advantage patients in Minnesota that they will need to find new health insurance to receive care at the clinic in 2025. The change is due to limited capacity to treat patients. Patients can still receive care at Mayo with original Medicare, but costs may be significantly higher."
Now is the time of year when they really advertise but seniors need to understand the difference between Traditional/original Medicare and the Medicare Advantage plans. One has TWO CHOICES 1) With traditional Medicare yu can self-refer to any doctor in the US that takes Medicare. You can purchase a supplemental/Medigap plan to cover the 20% Medicare does not pay. It often also covers eye exam and screening for hearing. There is no difficulty to go to Mayo Clinic if you have something they think they can help with. 2) With Medicare Advantage - Part C - you LOSE choice of doctor and you cannot self refer. You must stay in their network of providers or pay $$$$. In fact every year you need to check to see if your current doctors are still in their network. Many places are dropping Advantage Plans due to payment and approval problems etc. And you need to check with Mayo if they take your insurance.....also with any other provider!!!!
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2 ReactionsWe have discussed this before. Vic makes excellent points that need careful consideration. BUT, there are Medicare Advantage Plans out there that are nonprofit and a patient can go to ANY facility that uses Medicare in or out network. I have such a plan. People need to do their homework.
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1 ReactionI am a big proponent of doing one's homework in all things .....I always tell people to ask the question to 3 different people. Amazing the difference in answers sometimes. And one should think ahead when making decisions about serious issues.
I think it is important for people to understand that choosing a Medicare solution (traditional vs. Advantage), is not just about finding a good plan for today...but having a good plan in the future when one develops health problems and really needs it.
Being restricted to a network, losing one's provider, and being required to obtain approvals for specialists and tests when one has a serious problem is very stressful . I went from an abnormal chest x-ray locally to lung cancer surgery at Mayo Clinic in only seven weeks (with Christmas and Thanksgiving in-between). That is a record, all because I had original Medicare, could self-refer and did not need approvals for tests/procedures. That would not have been possible with an Advantage Plan.
For Medicare one should also be aware that:
1) Finding a good Advantage plan today with your preferred providers is NO guarantee that the same plan and providers will be available next year - note the recent news about Mayo advising patients it will no longer take their plan . That means you must change providers or change plans!
2) Once enrolled in Medicare Advantage, changing back to original Medicare and finding a Medigap/Supplemental plan to cover the 20% not paid by Medicare will be difficult. Why? Because in the beginning when one signs up for Medicare, all insurance companies have to accept you no matter your pre-existing conditions. After that, if one wants to change, insurance companies are no longer obligated to accept you (they are profit driven, sick people take away from profits)
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2 ReactionsI too can self refer with my Medicare Advantage Plan...and am covered when traveling within the USA. I have an "HMO/POS" type of Advantage plan. And for some services, like PT, copay is the same whether in network or out of network. I pay less than a Medigap plan for premium each month, but I did not choose the least expensive Advantage plan the company offered either. A good broker will help or Minnesota offers the SHIP help line too; I have only experience with them once and it was helpful.
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2 ReactionsI have a PPO plan, need no referrals, either. I actually have 2 choices, the advantage plan is what my former employer has selected for their retirees. Other choice is to take the money and purchase your own. There is no one-size-fits-all, therefore, each of us needs to investigate carefully.
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