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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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Just to recap on Medicare: Medicare part A and Part B is accepted by Mayo Clinics. If you have a supplement to cover what Medicare doesn’t pay, great. Mayo will process that as well. I have an “N” plan which is basically a “G” or “F” plan but $200 per year cheaper however I usually (not always) pay a $20 co-pay per office visit. Do the math if you are relatively healthy.
An “Advantage” plan however is actually an agreement between private healthcare networks and Medicare to take over 100% of Medicare involvement for each patient. The Advantage company handles billing, hospital, you name it and Medicare supplements the Advantage company for it’s services. Win-Win except perhaps for the patient who may need services outside of the Advantage HMO / Network. It is far less costly than part B and a supplement and in some places actually free to the Advantage subscribers. The problems begin when you ask another facility not in the Advantage Network to mind your healthcare. You get what you pay for. Just don’t expect someplace else to accept your Advantage. You have no agreement with anyplace else other than your Advantage company and with whom they have made cost sharing agreements.
If you have an Advantage plan, you don’t have traditional Medicare no matter what the advertisers or insurance brokers tell you.
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1 ReactionLive in Wisconsin. I have traditional Medicare A and B and a supplement with 5 riders. One of those riders covers the extra 15% of cost that Mayo Clinic tacks on for Medicare patients Unless they live in Minnesota.
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1 ReactionI am surprised they do not take your ins. most of those large facilities take all insurances. I know that make sure u take traditional MC when u take others that say they r MC a lot of them have horrible coverage. I know it’s very confusing also try and check the Rx plans closely.
It so sad b/c most people will get on this MC Advantage plan due to cost and most places do not accept it. Get the traditional MC .
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1 ReactionAmen, I hope folks will see this post. Absolutely u pay for what u get. Good luck!! MC is so confusing to folks.
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1 ReactionOur insurance is through my husband’s retirement (32 year teacher) and costs us $300 additional a month. We have had tremendous coverage for doctors and medications. Our doctor visits are all $25 copay and a $25 copay for most prescriptions. In 15 years we’ve had it we’ve been very happy with our coverage.
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1 ReactionGreat I am glad to hear this, so hard to find good coverage😊💚💙
I think your insurance is only part of the issue with Mayo. I heard about their consultative Internal Medicine program thru my primary care provider at Johns Hopkins, who said some of his patients went to this program at Mayo. I am a physician myself and over the last 3 years have been struggling with finding a unifying diagnosis for the multiple symptoms I have been experiencing so naturally I was interested. I contacted Mayo and was told that their program would do the evaluation within 7-10 days and render a opinion. My current workup, and remember that is for a physician who has fairly clear idea of what specialties may be helpful, still was very disjointed and time-consuming. One specialty clinic told me I have to wait 9 months to be seen. Naturally I applied to the Mayo Consultative program to try to expedite this process. Sadly, after long hours on the phone first to sort our my insurance coverage, then taking the time to fill our a cursory survey, despite the fact that clearly I had already had an extensive evaluation by multiple Johns Hopkins specialists that could not come up with a diagnosis, I was turned down for evaluation by Mayo. No explanation given. The lesson learned here is don't think this program is the end-all for your problems. It is unclear to me what criteria they use to select for patients, maybe just the low-hanging fruits? Better to seek a good primary care internist who can coordinate your workup locally if at all possible. I realize this is a tall order in the state of Medicine today unfortunately, especially given a lot of experienced physicians have left the work force due to the pandemic. God help us all..
I am very surprised that doc don’t start that model in other places. They can get tests and results so quickly!
I was a patient at the Mayo a year ago for Prostate Surgery. I am 71 years old, on Medicare, with an AARP Supplemental Plan F. This insurance combination is accepted at the Mayo. They do not accept patients with Medicare Advantage Plans. Advantage Plans have lower premiums for you, but your out of pocket expenses (deductibles) are greater. I received a letter from Mayo Clinic last year explaining that they would no longer except Advantage Plan insured patients.