Choosing best insurance and insurance at Mayo

Hi Skip,

I know a couple of things:
* Every state in the US is supposed to provide free, impartial medicare counselors. I called my local library, and the ladies there gave me the phone number. I had to wait a week for a phone call appointment, but the person was really helpful. That person is NOT paid by any company, so they didn't push any particular companies. We were on the phone for over an hour for my Part D medication plan. Bless her! She found me a new plan that was about half the price of what I have now. And it seems to cover what I need.
I live in Pennsylvania.
* The official medicare website is helpful. It has a LOT of information to read through, but it's written pretty clearly.
* I have heard that, if you have health problems, you should go with the Supplement/Gap plans and NOT go with the Advantage Plans. The Supplement/Gap plans don't offer a lot of the free stuff that the Advantage Plans advertise, but I have heard that they pay for more real medical tests and procedures, etc., and that you have a wider choice of doctors.

*I'm not 100% sure about this part coming up--
I think that if you have an Advantage plan and you have a lot of expenses one year, then your Advantage plan can refuse to take you the next year!
The Supplement/Gap plans, once they have agreed to give you a policy, canNOT refuse to cover you, even if you have a lot of health problems.
Say you have an Advantage plan and you want to switch to a Supplement plan. The Supplement plan companies can charge you more at this point than they would have charged you if you had gone with them in the first place.

*Some of the TV commercials call their Advantage plans by the name Part C.

I hope this makes sense! Your best bet is to call your library to find out how to get the impartial, noncommercial counselor. Good luck!

@skipinjb Skip, If you are looking to have insurance that is accepted at Mayo, it would be best to call the billing department there and ask what they recommend. Mayo in Rochester does accept the real Medicare insurance and not necessarily the "advantage" plans. Those are limited in where you can get care and often it doesn't work in another state, and I have heard that they don't cover as much as Medicare does. Medicare is portable and can be used anywhere in the county at a facility or with a doctor who accepts it. I chose a Mutual of Omaha supplement plan to go with Medicare because I want the option to have care at Mayo if I need something in the future and it works for all states. I have heard of many patients with the "advantage" plans who want to go to Mayo, but their insurance doesn't cover it which is unfortunate. If you need an expensive procedure, you need to be in network at Mayo. I have been a patient there with an employer based insurance plan, and I wanted to have the option to be a patient there in the future. FYI, insurance acceptance isn't the same at all Mayo campuses, so inquire specifically for a particular location.

Hi Skip, I have Medicare A & B with Tricare for life as a secondary which works great with Mayo. But to get Tricare you need to be a retired Veteran. I did receive a notice from Mayo that they don't take a lot of the supplement plans. I'm in Arizona and use the Mayo there. When I was deciding to leave BCBS when I became eligible for Medicare, I called my Social Worker at Mayo and she helped me a lot in finding a plan that worked for my situation. Hope that helps. Good Luck and if I can answer a further questions, please feel free. Have a great Day
Blessings

Advantage plans are horrible. If you can stick with regular Medicare.
All advantage plans are private insurance plans and most have high premiums, high deductibles, and co-pays

Medicare will cover you anywhere in the country. One con is that they only cover 80% of the bill. My State has a very good Medicaid program. They pick up the 20% and drug coverage part D. You need to qualify for Medicaid through.
Some states, especially down south, either has a junk insurance program or none at all.

I pay zero dollars for my health care except $160.00 a month taken out of my social security for a card that has a contract with Medicare and Medicaid. Advantage plans have a bad reputation. You either pay astronomical premiums for a full plan down to zero premium but you pay a lot of pocket. Young healthy people can get a fairly low premium because there healthy.
Us old disabled folks would probably have to pay high premiums because we tend to be sickly. Make sure whoever you go into they will probably still have high copays and deductibles. That’s been my experience anyway and I’m 70.

@skipinjb You have many good answers here. There are SHIP advisors in every state that can help you. https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship#:~:text=State%20Health%20Insurance%20Assistance%20Program%20(SHIP),-State%20Health%20Insurance
This website should help you find yours. As far as getting a Medicaid related program to cover your Medicare part B premium or possibly co-pays and deductibles depending on income, there are Medicare Savings Programs (MSP) through your state. These have income and resource (asset) limits. If your income is extremely low, sometime full Medicaid is available. If you can continue your previous insurance as a Supplement you would likely have the best coverage. Make sure a supplement covers the things Medicare doesn’t unless you can afford to pay these things yourself. I am talking about cataract surgery, hearing aids, dental, etc. It is also an excellent idea to contact Mayo in Florida for help in knowing what they accept. I determine eligibility for Medicaid in my state, and have seen some seniors that pay premiums for vision and dental on top of Medicare, a Medicare Supplement and Prescription insurance. A person could be insurance poor, but these areas can add up if you need care! Good luck in your search.

Mayo Clinic does take Medicare but some like Jacksonville limit the number of patients. I have Medicare part A and B. I have a full BCBS plan "Basic" that covers the Medicare deductible and co-pays Medicare does not cover.

I had Medicare set up automatic crossover to my second insurance policy. So when Medicare pays they automatically sent what they approved and what they paid to BCBS. Mine is a federal sponsored plan as I retired from federal government.

But I think BCBS has high, standard, and basid options that will work with medicare. I would call BCBS and talk to them about it as it sounds like you like your previous BCBS plan.

Just know Advantage Plans are very restricted at Mayo Clinic. At Jacksonville that are not accepted and will not accept you as patient if it is primary payment insurance. There are some exceptions but very limited.

The insurance providers that Mayo accepts are listed on their website.
They do accept some Advantage plans. I have an Advantage plan with a total payout of $4200 for the year. With regular Medicare you pay $1400 ? Or so deductible for every hospital admit. There’s no limit on yearly payout. Guess it depends on how good your health is.

@skipinjb Traditional Medicare vs. Medicare Advantage Plans is very complicated. I did tons of research before going on Medicare in 2019 and I chose Traditional (Original) Medicare, I signed up for Plan B at the Social Security office, and chose Supplement Plan G with Transamerica and Plan D (prescription plan) with WellCare. These supplement plans, sometimes referred to as “Medigap” are exactly the same from one insurance company to the next. The supplement plans are set by federal law (CMS). I chose Transamerica for my Supplement Plan G after comparing the costs among other insurance companies. Transamerica was the most cost effective.

Yes, it’s definitely mind boggling to wade your way through the Medicare mess. However, it’s worth it to figure out what it is that you want. When I was working full-time, my employer chose my plan for me. Now I get to choose my own. So there is some freedom in all of this.

There is no network of providers or hospitals with Original Medicare. Any clinic or hospital that accepts Medicare will accept Original Medicare. All nonprofits are required by law to accept Medicare.

Medicare Advantage Plans typically have networks of providers and hospitals. This is like the plan I had through my employer before I retired.

I suggest you read through this Discussion that explains Medicare and how it works:
https://connect.mayoclinic.org/discussion/does-mayo-clinic-take-medicare/
Are you trying to decide between Original Medicare vs. Medicare Advantage?

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.

I go to Phoenix AZ. Mayo Clinic and have Medicare and AARP Plan F Supplemental. Just received a letter from Mayo stating they don’t bill it take Advantage. I had a friend low income retiree switched to Advantage and it costs her a great deal for breaking her hip from a fall for surgery.