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Choosing best insurance and insurance at Mayo

Visiting Mayo Clinic | Last Active: Jan 18 12:42pm | Replies (36)

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@vic83

Short answer: GO WITH ORIGINAL/TRADITIONAL MEDICARE = Part A, Part B and Part D - then purchase a Medigap policy to cover the 20% Medicare does not pay. Go to the Medicare site to be able to compare Medigap Plans. Medicare has a table giving plan types a LETTER and showing what each type plan covers (deductible, foreign travel etc). This allows you to compare the Medigap plans in your area. In comparing these Medigap plan prices, they should have the same letter type.
In original Medicare YOU CAN SELF REFER TO ANY DOCTOR IN THE US THAT TAKES MEDICARE INCLUDING MAYO CLINIC! YOU DON'T NEED APPROVAL FOR TESTS AND PROCEDURES!
In original Medicare Part A is hospital and has no premium, Part B (tests, drs visits etc) is a monthly premium you pay to Medicare ($174/mo for 2024). Part D is a private insurance drug plan and the Medicare tool is very good to help choose a plan. You put in your drugs and it pulls up all the plans in your area and tells you what total cost will be for each one. That can be very cheap and you can change each year. The Medigap plan is private insurance, and you will find various options.

NOW Medicare Advantage plans are Part C, they are private insurance companies and there are many complaints against them. They advertise incessantly. THE TRUTH IS they seem cheaper BUT 1) YOU CANNOT SELF REFER, YOU NEED APPROVAL FOR PROCEDURES AND TESTS, YOU MUST STAY IN THEIR NETWORK AND THEY MAY NOT HAVE THE SPECIALISTS YOU NEED OR THE CAPACITY TO OFFER BEST TREATMENT OPTIONS - lots of doctors are dropping these plans, 2) You have copays for doctor visits, you need to be referred to specialist with more copays, copays on tests. Costs will quickly add up if you start going to doctors.
WORSE - when you realize that Advantage plan is costing you money and they don't have the doctors you need and you want to go to Original Medicare and get a Medigap plan - GUESS WHAT? The Medigap plan does not have to take you like in the beginning!!!
With age comes health problems. You do not want the aggravation of fighting insurance company when you have cancer - and that is what happens with Medicare Advantage plans. They get paid by Medicare based on head count, so they have a profit interest in signing up as many people as possible and then making it complicated for people to get medical attention, so they don't have to pay out.

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Replies to "Short answer: GO WITH ORIGINAL/TRADITIONAL MEDICARE = Part A, Part B and Part D - then..."

Advanatge plans have often denied treatment plans that physicians have ordered...they also
often have restrictions on expensive medications, especially where there are no generics...require you to try something else first(an older, cheaper, but similiar drug).

Medigap policies are all the same...they cover the 20% of what Medicare does not cover. The difference is the cost of their premiums. I used to have an AARP Medigap plan that was more expensive than my current Transamerica plan. Problem is the premiums often become more expensive, as you age. Also the premium amount is often base on where you live. A friend and I had the same plan, but his in Boston was less than mine in Philadelphia...both cities have many medical centers, ???

I'm hoping you can help me with a medicare ? please. I keep having a problem when calling a Provider that is on the medicare sight, and they will not accept me, unless I have a referral from my primary. At first I thought it was only in my state, But then I tried to make a appointment with a internal med Dr in another state and it happened to me again. I'll tell the secretary I have medicare, don't need a referral then they will say, it's are policy. Does that happen to you also, is there away to get around it?

The problem is that in the State of AZ a Medicare beneficiary under the age of 65 cannot get a supplemental plan! AZ is one of about 7 states that do not require insurance companies to provide medical insurance for under age 65.