Choosing best insurance and insurance at Mayo

Yes I watch developments - I have degree in economics and work experience in corporate America so I understand their business models.
Medicare is cost effective andpays out 90cents/on dollar in services. Insurance companies do not. they have all their administrative, sales and marketing expenses and bonuses. Healthcare is poorly served with profit driven model. They increase profits by limiting services to you.
Everyone needs affordable quality healthcare. We must look at solutions. Seniors would never get healthcare without Medicare.
The whole debt ceiling discussion is irresponsible. No other country does it. the budget should be addressed in Congress not as a threat and now Moody's has again lowered the credit rating of the US because of it.
Wehave a growing national debt because they keep cutting taxes. That is not good business planning. First you decide what the country needs, then you tax to pay for it. Look at history tax rates, they were once much higher. Paying taxes is an investment in your future. Education produces the jobs of tomorrow not tax breaks. You enable the government to hire experienced people to solve problems - like more IRS people to go after big entities who do not pay taxes - google number of US multinational companies who paid zero tax - because they have fancy accountants who know how to use the finance laws to avoid paying taxes. And remember, it is the little people who go to fight for this country and put their lives and limbs in danger. The elite wealthy do not have to go to war but have more to lose. It makes sense to me that we have a progressive tax rate and rich pay more.

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.

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, ???

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'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?

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?

Mayo Clinic Jacksonville puts out an official letter to it's patients regarding open season for Medicare enrollment. I think it helps explain the differences and why so important to know exactly that Medicare Original/Traditional is Federal Medicare and when you go to Medicare Advantage you are moving to a private company coverage not federal Medicare.
Below is official letter put out by Mayo Clinic Jacksonville yearly on this insurance subject.
_______________________________________________________________________________
At Mayo Clinic, our patients are at the center of everything we do, and your trust is very important to us. Sharing information is one way to help ensure we continue to be trusted partners for your health care needs.

As you may be aware, beginning in mid-October, it will be time to select health care coverage for 2024. Mayo Clinic in Florida is not in-network with most Medicare Advantage Plans. We want to be sure that you are aware that Mayo Clinic in Florida will not schedule appointments for patients with out-of-network Medicare Advantage Plans.

Many patients are making elections for their coverage in 2024, including Medicare. Marketing for Medicare Advantage Plans may indicate that you can be seen at any facility that accepts Medicare, however Mayo Clinic in Florida is out of network on these plans.

Medicare Advantage Plans are managed by commercial insurance companies on behalf of Medicare and offer a specific network of contracted medical providers and hospitals, which may not include Mayo Clinic in Florida. These plans are required to have a substantial network of qualified providers to accommodate their members' medical needs.

As you consider your options for health coverage, you can confirm Mayo Clinic's participation by providing the insurance plan under consideration the Tax ID information below:
Mayo Clinic Florida Hospital 59-0714831
Mayo Clinic Florida Outpatient Clinic Services 59-3337028

We do accept Original Medicare (Parts A and B), and supplement plans, sometimes referred to as Traditional Medicare. If you choose to enroll in a Medicare Advantage Plan, we can provide your medical records to the next in-network facility you select for your care.

Learn more about your Medicare options online, or by calling Medicare (1-800-MEDICARE), or a State Health Insurance Assistance Program (locate a local resource by calling 877-839-2675). Mayo Clinic is not authorized to assist with Medicare enrollment decisions.

Please continue to update Mayo Clinic on any changes to your health care coverage.

Sincerely,

Mayo Clinic in Florida Leadership

Thank you for sharing this!!!!

We receive many health care and medical publications that are business oriented. Lately there have been growing lists of health systems, especially orthopedic groups, that no longer accept any Medicate Advantage plan patients. It is difficult for physicians to get permission for surgeries. One said that traditional Medicare denied 1 percent whereas Medicare Advantage denies over 20 percent.
An article co authored by the head of Mayo hematology and Kantarjiian, leading leukemia expert at MD Anderson plus others, (I just know these two) listed all the headaches associated with Medicare Advantage plans. Mayo Jacksonville and Scottsdale do not accept patients with these plans. I think Mayo in Minnesota may accept some but not others; same with MDAnderson.

Thanks for added info. I live in MN and recall on TV last year the comment that a MN insurance company has a hard sell if they do not offer Mayo Clinic as a provider. So there were some agreements made with Mayo. But even for those exceptions, Medicare Advantage plans change every year (they even tell you to call because of that in their advertsing!) so one never knows where one will end up.
Having worked in Corporate America I understand business models. Advantage Plans must create a network of providers who agree to take less than the balance of 20% from Medicare established cost for a procedure. And why do doctors do that? To get guaranteed patients and they have the interest to see as many as possible in any given time frame. And the insurance company has the interest to discourage patients from utilizing benefits. Medicare does not need to advertise, and it utilizes a set of codes across the country while these independent insurance companies must set prices each year with all their providers, and they must advertise and advertise so right off the bat they have much higher operating costs which have no benefit to you and me! And look at the extra costs providers have because they must hire people to administer so many different insurance plans.
We need quality affordable healthcare. That requires clear objectives and competent people to design and administer. That should not be hard to do. Medicare is actually quite cost effective