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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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Our reps haven't represented anyone but themselves in a very long time.
Confusing...but after a little experience one learns that :
1) If you have traditional/original Medicare (Part A, Part B) you can SELF-REFER TO ANY DOCTOR IN THE US INCLUDING MAYO CLINIC. If you purchased a good Medigap policy to cover what Medicare does not pay (20% of Part B) like me - I NEVER SEE A BILL.
2) If you purchased a Medicare Advantage Plan (Part C), Mayo Clinic will most likely NOT take you. In fact, a lot of places will not take you. I heard that in Minnesota some insurance plans made an arrangement with Mayo because Mayo is in Minnesota, and they can't sell policies in MN that don't offer Mayo!
Advantage Plans are for people who have no medical issues and never will. Because if you have medical issues, realize that you will have many copays and need approvals for tests and even cancer treatment. And you must stay in their network and there is no guarantee they will have best treatment options.
And later if you decide you want to return to Original Medicare and seek a good Medigap policy, they no longer have to accept you.
See this is how it works. Doctors agree to accept the price that Medicare will pay for any service. Medicare pays 80% of that. You or a Medigap insurance pays the remaining 20% that Medicare established. But the Advantage plan establishes a network of doctors who agree to take a lot less than that 20% balance of what Medicare has already established as the price. So what doctors want to accept the lower price? And they have the interest to see as many patients in a day as possible. And the insurance company has the interest to make it harder for you to go to doctor because they are paid on head count by Medicare not by service.
These Advantage plans were a great event for insurance companies but not for senior citizens. They seem cheaper but are not because you are giving up much. Healthcare is not well served by profit driven business models
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5 ReactionsHere follows my understanding of Mayo+Medicare:
In 2015, Mayo AZ, did not "accept Medicare assignment". This meant that Mayo was able to charge patients 15% more than the Medicare Part B approved charges. However, this meant Mayo billed the patient and the patient submitted a claim to an insurer. If the patient had a medigap supplement F or G, the entire bill was paid after deductible. If the patient had, eg, medigap N, the patient had to kick in the 15%. If the patient had an 'advantage plan' (Part C), the bill may not have been covered - the patient was potentially responsible for the entire bill.
Now, Mayo is sending out this notice about Advantage plans which states that it "accepts" traditional Medicare. This is a bit ambiguous, unfortunately. The phrase "accept Medicare assignment" is the term of art that means: the provider will bill Medicare directly and accept the Medicare approved reimbursement as payment in full (ie, will not charge the 15% Part B excess). Of course the patient is responsible for any part of the Medicare approved reimbursement not covered by Medicare+medigap supplement, eg, deductibles, copays, etc.
The government site medicareDOTgov (as a newly joined poster, this site prevents my including links)
indicates that Mayo AZ does indeed "accept Medicare assignment". This is good to know because it means cheaper medigap supplements like N cover all Mayo charges: eg, in my location medigap G is about 35% more than N.
It would be great if Mayo would confirm my understanding. Unfortunately, a call to the customer service line rings & rings after wading through the menu.
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1 Reaction@atmarkj I have been to Mayo Phoenix several times. My Medicare and Plan G covered the bills.
Mayo does not accept Medicare Advantage. That’s what the letter says, and they send it out every year.
Yes, I've been a patient for 13 years. I know what the letter says. The issue is what the letter does not explicitly say, ie, whether Mayo accepts Medicare assignment. If it does, then you would be fully covered by medigap N, just like you currently are fully covered by G. And, your insurer is likely to permit you to change to the cheaper N (without underwriting), because N does not cover the 15% Part B excess charges that G covers.
Will someone with a medigap N chime in please.
Sorry in advance-- this post turned into a vent about the so-called "Advantage" plans.
The "Advantage" plans come with many disadvantages. The biggest one is that you have to commit to using the doctors and facilities in their network.
It is not Mayo Clinic's fault that you have chosen a network that does not include them. That's why your Advantage plan is less expensive-- it doesn't include all of the best facilities in the USA or even all of the ones in your area.
The "Advantage" plans are good only IF you are not sick now and IF you never, ever get really sick. Most of us at some point before we die will get really sick.
Personally, I think the "Advantage" plans should be outlawed.
Their marketing is slick. They don't tell outright lies, but they lie by omission, by not telling you that you can't go out of network, for example.
And the "certified insurance consultants" that you can call for advice are NOT impartial. They only represent certain companies in your area. They don't have to tell you all of your options. They lure you in with bells and whistles (free gym membership!), and then can deny payment for the tests that your doctor says you need.
You give the insurance company a lot of control over your health care when you sign up for an "Advantage" plan.
By federal law, every state government must provide free Medicare counseling. In my state, the county government is responsible. I called my local library, and they gave me the contact information. The county medicare counselors were very, very helpful, and they are completely impartial since they are not paid by the insurance companies.
Good luck and health to us all.
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4 ReactionsHas anyone been fortunate to get into Mayo Family practice/ Internal Medicine if you have traditional Medicare? I would love to transition all my care to an integrated system like Mayo with one complete medical record. Thoughts?
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1 Reaction@pmenor, which Mayo Clinic location?
Yes if you are talking Mayo Rochester. I have had Mayo for PCP since cancer diagnosis in 2016. Very nice to see the team. Much faster to get to see specialist with PCP taking control. Original Medicare and BCBS. Easy to get appointment .
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1 ReactionScottsdale, Az