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Mentor

Does Mayo Clinic take Medicare?

Posted by Helen, Volunteer Mentor @naturegirl5, Jun 3, 2022

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

Interested in more discussions like this? Go to the Visiting Mayo Clinic Support Group.

lindes | @lindes | Jun 13, 2023
In reply to @naturegirl5 "For those of us who are seniors (over age 65), we are eligible for Part A..." + (show)
@naturegirl5

For those of us who are seniors (over age 65), we are eligible for Part A which is at no cost to us.

Part A: the original plan that came about in the 1960’s when Medicare started.

Part B: You have to enroll and choose it which we all do for outpatient care. The cost to you is set by the federal government at a standard rate that is deducted monthly from your social security or you pay yourself. The Part B rate that you pay may vary because it is based on your federal income tax return.

Part C: Medicare Advantage Plans.

Part D: Prescriptions plans which we are all required to have.

All of the other “Parts” refer to supplemental plans that are supposed to fill in the “gaps” that Parts A and B do not cover. It’s totally up to you if you want to do that. All of these other parts vary in their coverage and cost.

What I did: I chose Traditional Medicare so I can go anywhere that Medicare is accepted in state or out of state. I have Parts A and B, Part D (a prescription plan that I chose) and Part G (with Transamerica to cover the gaps). I do not have a network of providers and do not need any preauthorizations under Traditional Medicare. I pay more out of pocket during the year for the Part G plan.

I know it is very confusing however if you go to the federal government’s Medicare website, all of this explained.

Example: My relative who is a resident of Santa Clara County in California has Medicare Part A and he chose to sign up for Part B which is required to enroll in a Medicare Advantage Plan. He chose a Medicare Advantage Plan (Part C) (he had many, many choices given where he lives) with Aetna because he figured out that the doctors and practices that he sees are within the Aetna network. His prescriptions are covered by that plan as the Medicare Advantage plans do cover prescriptions as required. If he decides he doesn’t like Aetna for some reason he can change to another Medicare Advantage Plan during the open enrollment period.

Medicare Advantage Plans work very much like the insurance you are probably used to through your workplace.

With Medicare you choose whether you want Traditional Medicare or a Medicare Advantage Plan.

Please,, everyone, feel free to ask me if you have other questions about Medicare.

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I used to have a Medicare advantage plan from Humana, and I nickeld and dimed myself to death with all the fees and copays.
I now have Medicare Plans A, B, D, and a Plan G from Cygna, and I am pretty happy with this setup.

REPLY
1 reply
jdlee22 | @jdlee22 | Jun 25, 2023

I have been a Mayo Rochester patient since I was 30 yrs old. Now retired and living in Nevada. I have Medicare and Aetna Supplemental - Mayo Phoenix Neurology will not schedule me for an appointment but their Urology department will. So I will be traveling to Mayo Rochester.

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vic83 | @vic83 | Jun 25, 2023
In reply to @lindes "I used to have a Medicare advantage plan from Humana, and I nickeld and dimed myself..." + (show)
@lindes

I used to have a Medicare advantage plan from Humana, and I nickeld and dimed myself to death with all the fees and copays.
I now have Medicare Plans A, B, D, and a Plan G from Cygna, and I am pretty happy with this setup.

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And Health Partners (very large network including Park Nicollet, Methodist Hospital in Minnesota) recently announced they will no longer be accepting Humana Advantage Plans next year. 13,000 Minnesotans will have to go elsewhere for care or get a different policy - which may cost them more and they can be refused by insurance company. You did well to get out.

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annewoodmayo | @annewoodmayo | Jun 26, 2023
In reply to @hrhwilliam "First your part D plan. This can be renewed or replaced every year depending upon A)..." + (show)
@hrhwilliam

First your part D plan. This can be renewed or replaced every year depending upon A) your normal prescriptions you take for maintenance and B) which pharmacy you use or will give you the best deals. My wife and I change our part D plan as time goes by.
Your Part B gap plan most likely will renew you at age 65 and for some the rates may increase or in some cases decrease. You certainly can shop for other plans prior to the month you turn 65 and they may or may not ask you about pre existing conditions. I would recommend at least trying for a better rate plan.
Now, consider this: a high deductible plan may be your best choice. If you look upon insurance as something to cover you in a disaster or major out of the normal health issue, then most people are willing to buck up say $1500 to cover this unusual circumstance. Consider that the $1500 represents the 20% that Medicare may not (may being the operative word) cover. That’s $7500 worth of covered Medicare in one year if all of that requires the 20% to be payed. Anything above that then is covered by the gap policy. For people like me, my gap policy hasn’t paid a dime in the last three years and I have the standard deductible policy. It’s something to consider and we should all know exactly what our gap plan has actually paid.
As for expensive medicines, some are covered by Medicare but they may not be the same medicine you are taking. MS medicines for example, Gylenia is not covered which is a daily oral but (name escapes me maybe Ocravis) taken by injection two times per year is covered. Both have relatively the same efficacy. The Medicare folks can answer which drugs are covered.
Hope this information helps a little.

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To William Olsen, re June 12, 2023, post about Part D

Dear William,

It looks like I never thanked you for your informative post. I'm so sorry! Let me say "thank you" now.

THANKS!
Anne

REPLY
flrvingbob | @flrvingbob | Aug 2, 2023

Incorrect "terminology" by the OP about Advantage Plans! Beware!!!.. An advantage plan is NOT Medicare and does not provide for Part A and Part B services as Medicare does. They provided "managed care" services that take the place of (and not the same as) Medicare Parts A, B, and D if you chose D. Advantage PLans are private insurance coverage in lieu of Government provided Medicare. Advantage Plans are managed care plans run by private insurers. By selecting an advantage plan, the government pays the private insurance company to manage and provide services that are totally void of CMS interactions or obligations. You will notice I have not called an advantage plan a "Medicare" advantage plan as it is NOT Medicare.

If you do your research, you will find virtually every advantage plan has different services levels as well as premiums and out of pocket cost......virtually none of them conform to the Medicare model or payment plans. True "Medicare" is accepted anywhere Medicare is accepted....about 90% of all providers in the US. Advantage plans operate networks that are typically geographically and provider restricted.

If you travel, "good luck" getting non-emergency care away from home without jumping through hoops.

Many APs require preauthorization for services beyond your "primary care" provider. Most "centers of excellence" like MAYO, Cleveland, John-Hopkins, and alike accept true, government Medicare and an approved suppliment (Medigap) but virtually no advantage plans (ask yourself why).

Most advantage plans control thier costs by "controlling" (can you say rationing) services available without review and authorization as well as paying providers at lower rates or incentivizing providers to "limit costs" for any given patient.

While there may be some good and fair advantage plans out there, there is no "free lunch". All the hype about no premiums, "extra junk", Joe Neimeth driving you to bingo and so on has to be paid for somehow.....i.e. reduced services.

Also realize that decision that looks so good at 65 may not look so good at 85 when you really need quality, unmanaged healthcare....like at "Mayo". Regardless of the technicalities that say "you can switch back to Medicare", fact is yes you can, but you will be hard pressed to purchase a supplement at a reasonable rate, if at all if your health is poor.

Any as opposed to the OPs statement about "complicated".....Medicare is NOT complicated. Most providers "know the rules" and will be clear on what is and what is not covered. Advantage plans are actually more complicated if you are truly in need of services just by the nature of the "approval/pre-authorization" process. In Some cases it may take them days or weeks to "approve" treatment....and heaven help you if you need to go through the "peer review process". Advantage plans have another "gotch ya"..... They can make substantial changes to their plans every year as well as change the availability of providers based on their agreements with each provider...

Anyway...."CHOSE WISELY". There is no free lunch and it's a situation of pay me now, or possibly pay me mutli-fold latter..... I continue to hope our elected officials finally take action on advantage plan providers using the term "Medicare" and stop "misrepresentation" of what advantage plans are and how they truly work....

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nvan22 | @nvan22 | Aug 3, 2023

I just went through all of this and was ready to sign up for the supplement and then decided on a blue cross advantage plan. I checked Mayo Rochester and they take my plan and it pays for my scans and blood work quarterly. I was told Mayo Florida and Mayo Arizona do not. But that was never substantiated. I wanted a supplement to begin with them switched when I was signing up. My worry was that Medicare does NOT pay for chemo or radiation. So the advantage plan I have Blue Cross has a $5000 out of pocket once that is paid it pays for 100% of everything. I am worried about the pre- authorization.

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1 reply
Mentor
Laurie, Volunteer Mentor | @roch | Aug 4, 2023

@nvan22

I think you were mis-informed about medicare not covering chemo or radiation. See following article:
https://www.medicare.gov/Pubs/pdf/11931-Cancer-Treatment-Services.pdf
Maybe they were talking about perscription chemo druges (not the IV version). Depending on drug / drug plan your on, there may be some drugs not covered.

Laurie

REPLY
flrvingbob | @flrvingbob | Aug 5, 2023
In reply to @nvan22 "I just went through all of this and was ready to sign up for the supplement..." + (show)
@nvan22

I just went through all of this and was ready to sign up for the supplement and then decided on a blue cross advantage plan. I checked Mayo Rochester and they take my plan and it pays for my scans and blood work quarterly. I was told Mayo Florida and Mayo Arizona do not. But that was never substantiated. I wanted a supplement to begin with them switched when I was signing up. My worry was that Medicare does NOT pay for chemo or radiation. So the advantage plan I have Blue Cross has a $5000 out of pocket once that is paid it pays for 100% of everything. I am worried about the pre- authorization.

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Incorrect on true Medicare, chemo and radiation. Drugs are in two classifications. Those administered in a medical environment (ie docs office or other medical facility) and those that are considered prescription drugs. Those administered in a med environment are covered under Part B, those provided by prescription are covered under Part D if you have taken that option. Medicare covers virtually anything that is deemed medically necessary without question…..if your provider knows how to code it properly.

I am a retire business owner who has dealt with medical insurance and other benefits for over 40 years. I spent six months studying the entire Medicare vs advantage plan option, including querying everyone I knew who was past 65 as well as every doctor I knew. Almost everyone was clear about true CMS Medicare being the only choice for best medical care long term. Not the cheapest (and, with Medicare Joe Neimeth won’t drive me to bingo or gIve me “free” Depends), but I can go to any Medicare accepting provider, anywhere without some “for profit” insurance company bureaucrat controlling my care.

There is no free lunch. Pay me now or pay me later. Good Advantage plans may have a place for some, but the ability to have full choice, including centers of excellence like Mayo, Cleveland, John’s-Hopkins, M D Anderson and others is worth the potential added costs of CMS Medicare. Oh, advantage plans typically only allow emergency care outside your immediate service area. If you are a traveler as we are, I can go to any provider anywhere in the US and get care without having to be an emergency.

Again, I stress the need to understand the truth and facts about Medicare and advantage plans…. Advantage plans are very profitable for insurance companies. They pay bigger commissions to insurance brokers as well as incentives to providers…. chose wisely….you only get one chance to get it right. After 6 months you are pretty much locked in for life…

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josgen | @josgen | Sep 12, 2023
In reply to @kayak461 "I was a patient at the Mayo a year ago for Prostate Surgery. I am 71..." + (show)
@kayak461

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.

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I am a new Mayo Phoenix patient as of August and am also a Medicare Advantage enrollee. Recently I learned that Mayo Phoenix will no longer accept Medicare Advantage as of Jan. 1, 2024. I don’t want to switch to original Medicare as I can’t get a supplemental policy due to now having pC.
I wished I knew that before engaging with Mayo; now I must find yet another provider and start from scratch with them.
Where is our “representative democracy” on issues like this and why is it not a widespread priority for policy reform?
Maybe it’s because our “representatives” do not have to deal with our health insurance system; they have their own sweet deal which they set up for themselves and, they get mucho dinero from the disease care industry so that the status quo, and its profits, are maintained.
What a drag.

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2 replies
Mentor
William Olsen, Volunteer Mentor | @hrhwilliam | Sep 13, 2023
In reply to @josgen "I am a new Mayo Phoenix patient as of August and am also a Medicare Advantage..." + (show)
@josgen

I am a new Mayo Phoenix patient as of August and am also a Medicare Advantage enrollee. Recently I learned that Mayo Phoenix will no longer accept Medicare Advantage as of Jan. 1, 2024. I don’t want to switch to original Medicare as I can’t get a supplemental policy due to now having pC.
I wished I knew that before engaging with Mayo; now I must find yet another provider and start from scratch with them.
Where is our “representative democracy” on issues like this and why is it not a widespread priority for policy reform?
Maybe it’s because our “representatives” do not have to deal with our health insurance system; they have their own sweet deal which they set up for themselves and, they get mucho dinero from the disease care industry so that the status quo, and its profits, are maintained.
What a drag.

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Quality, service, low price. Pick any two because you can never have all three. And to repeat what has been stated many many times, Medicare Advantage is not Medicare.

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