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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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AND PEOPLE...be sure to run your drugs through the Medicare tool on the Medicare site to see which plans are cheaper. I was not careful last year and ended up paying $700 more then I should have. All because the tier 1 and tier 2 drugs were subject to deductible while other plans do not do that. There is an insane difference in costs between plans for the same drugs at the same pharmacy. I DO NOT UNDERSTAND WHY!
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1 ReactionWhat really drives me nuts, I am a medical doctor myself, and I go to specialists, because they know way more about a specific condition than I do. But yet, the insurance have some mediocre medical people who believe, they have the knowledge to second guess the decisions of those specialists at the Mayo!
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2 ReactionsYes, medicine is a huge subject with constant new developments......that is why one goes to the person who is dedicated to staying on top of all the new developments in a specific area.
And insurance companies are first of all profit driven...they have a bottom line and shareholders they answer to. Medicare is far more cost effective than US insurance companies. I remember my Medigap policy brochure that said they returned 67%premium cost in services to beneficiaries....but Medicare pays back 90% and more. Just look at the financial documents of an insurance company - marketing costs, administrative costs. CEO pay, cost of salespeople, need to negotiate every year with providers and customers, advertising etc. Medicare doesn't have to do all that. All these plans are not choice but confusion.
I have a Medicare advantage plan. I’ve had one for 16 years. I’ve been very happy with it. I had to switch to another advantage plan this year because my original one was no longer servicing this area. We live in MN. My agent found me another one with similar coverage and cost. In 2018 I had a kidney transplant. My copay was $751. All of my meds are covered with a copay for only two of the immunosuppressants, which are a little over $100 for a 90 day supply. My annual checkup this year was covered except for a copay of $151. The only complaint I have is that there is no dentist in my town on this plan. I have to find another, but there is one 14 miles away. I have not heard anything about Mayo no longer accepting advantage plan.
I recently received a letter from the Mayo in Jacksonville, FL that they do no longer accept advantage plans. I get part of my women's health taken care of by them.
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1 ReactionYipes, I don’t know what I’ll do if Mayo Rochester is doing the same. I would hope they’d let me know before the deadline to pick a new plan.
Call them. This may just be Florida and it may also be particular conditions based on other variables. The language of the letter said Mayo is not ‘in network’ for most Advantage plans. The condition being treated may alter your situation. Call them or us their tax ID to confirm with your carrier.
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2 ReactionsActually, last April I had the same insurance that I have now. I was told that it wasn’t in network, which is different than not accepting it. I mentioned earlier that my cost for a two day checkup was only $151, which is actually less than I paid for the previous year, with the network insurance. I did have less tests done this past year, though.
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1 ReactionI teceived a letter from Mayo in AZ that going forward they aren't accepting any Medicare Advantage plans. I've go to Mayo, both in MN and AZ, and in the 5+ years of going, I've been billed a total of $8.00 with Blue Cross Blue Shield insurance.
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1 ReactionWe are in the open enrollment quandary for my adult disabled son and myself. Abbott (my late husband’s employer) is offering an Advantage plan through UHC which has many attractive features, including same payment for in and out of network. So we should be able to continue to use mayo AZ as out of network, right? Wrong. And trying to get this information has taken hours and hours of digging.
Both UHC and Abbott have been reluctant to admit that any provider, especially one such as Mayo, will not accept patients in their plan. To be clear, Rochester will accept their Advantage plan, which UHC brags about, but not Florida nor Arizona, which is hidden info.
In fact, from digging deep (5 contacts) with our Arizona Mayo provider, this answer was finally given…
“changing to a Medicare Advantage Plan will end your care at Mayo Clinic and you will not be able to schedule any further appointments with Dr. *** or any other Mayo Clinic providers.”
The only good news here is that we finally got a straight answer, thus avoiding switching our plan to Advantage and ending 20 years of Mayo specialist care for my disabled son.
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