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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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Nicom, Yes my wife and I patients since 2006. We were originally in a special program called Medallion Program with a traditional insurance program. When we voluntary came out of that program we were over 65 and went into Primary Care and under Medicare and my secondary payer plan. Each Mayo Clinic has it's own policies on number of Medicare patients.
Mayo Jacksonville (and the only one I can comment on) did take my wife and I under Medicare. Some of my friends who are on Medicare tried to get into Mayo but could not.
Mayo's like other specialty hospitals are classified under Medicare as specialty providers. Medicare allows them to charge more and thus be paid more as a result. There is a drastic reduction in what a provider has to agree as approved charge under Medicare. And I mean drastic. I can see why Medicare is restricted. I would like to see Medicare pay more as again it is a drastic reduction in what amount a provider has to accept and what they agree to accept under medicare assignment.
I read a post about Medicare Advantage being linked to Medicare Assignment and are very different. When Mayo accepts Medicare (not Medicare advantage) they are agreeing to medicare assignment. Which means they agree to accept the approved amount for the service provided.
Try and if don't make it asked to be put on waiting lists. If you make it I would suggest a secondary Medicare supplement plan to help pay the deductibles and co-pays under medicare.
I received this useful response from Mayo's Katelin T in account services:
"Hello Mark,
Thank you for contacting Mayo Clinic Patient Account Services. We apologize for the delay in responding to your message.
It is true, a few years ago Mayo Clinic Arizona started accepting Medicare B's assignment and no longer charges the additional 15%. This would be true for all 4 specific departments you listed and all of Mayo Clinic Arizona."
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2 ReactionsSorry you feel that way re NP’s. I think that some of best practitioners are NP’s. I won’t bore folks with the examples but will comment that I have been an RN since 1966…am Master’s prepared…taught for 20 years and practiced in NY, Chicago, Michigan and for past decades in Wisconsin. Worked in Psych, Public Heath, Med Surg,Gynecology, private duty, nursing homes, home health, school nursing,occupational health,burn units,doctor’s offices in allergy and industrial settings, and Hospice
was on Wisconsin Nursing Exam Council for 8 years.
Needless to say, I am very critical re who is providing my…and family’s …care.
I …and family…and friends go to NP’s and are getting highest level of care.
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3 Reactionstdrell, I am not familiar with post on NP's.
But want to pass on to you I am a patient at Mayo Jacksonville since 2006. I see a lot of NP and Advanced NP. I have a great dermatologist APN and same for ENT APN. And also at EP.
What I see is any question or concern they get concurrence with MD of that section.
I am very happy with my APCN I am not sure of the correct name but is something like Advanced Practice Care Nurse which means went through an additional training and can also prescribe medications. Mine are fantastic. I know in ENT almost all the MDs are surgeons and thus doing surgeries and very limited patients.
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2 ReactionsYou should be aware of this
info : my husband has NSCLC
I requested info about getting a 2nd opinion from the Mayo Clinic. I have an HMO advantage plan. The representative of the Mayo Clinic that I had the luck of the draw to speak to said, we are not contracted with your HMO. I understand that. I then asked what about if I self pay, her answer was , because we are not contracted with your insurance the federal government does not allow us to offer that.
Hmmm? I cannot find a federal law that says that anywhere! What if I didn't have insurance , is there a federal law that doesn’t allow them to offer self pay to me then either!?
To top all this off, when I requested the procedure of my insurance to request the second opinion with Mayo, my carriers insurance representative told me, I will check for you, but the Mayo Clinic is not accepting any patients from our insurance plan. I asked why would that be? He said, and I am not kidding, I’m not sure, I think they don’t like working with our insurance??!! Oh my goodness! Really!?! Presbyterian senior plan needs to be aware of his response!!!
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1 ReactionI called the Mayo clinic today and still was denied scheduling an appointment, however , the woman said because they are contracted with Medicare we cannot offer self pay to you with an advantage plan. I guess that's the federal law the first woman was trying to tell me. I said what if I was uninsured, or insured and didn't want to use my insurance and wanted to self pay? Her answer to that was, we would know by your age that you would have some kind of coverage and they only accepted Medicare. If they couldn't pull up our information under Medicare they would know we had an advantage plan , and they only have a contract with Medicare. The woman kept talking to me like I was kindergartner! I kept telling her that I understood what she was saying. What I could not understand is why they would turn away a patient, a patient that was willing to pay out of pocket. Why are they turning away money??
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1 Reaction@raygregvic This isn't a problem just at Mayo; you'll run into this anywhere at providers who are not in your insurance network. They have to accept lower payments from Medicare. Medicare has a deductible and once that is met, the patient no longer pays out of pocket when there is a Medigap plan. Medicare determines what the acceptable fees are, and usually these are lower than with private insurance. The Medigap plans cover what Medicare doesn't. Medicare "advantage" plans promise all kind of perks to get people to sign up for them, but they are not as widely accepted as real Medicare. My PT has told me that the "advantage" insurance scrutinizes everything they pay for, even years later, and then can come back to providers and can take the money back. The providers waste excessive administrative time providing records and then are stuck working for free and can't pay their operating costs. I do not blame providers for not wanting to accept these plans. HMO plans dictate that they will only pay for providers in their network and they control your choices. The plan that is portable to every state is real Medicare. It might be worth considering changing to real Medicare next time during the enrollment time. I'm sorry it didn't work out for you. I had a friend who was seen at Mayo and had surgery scheduled, and then the "advantage" plan would not pay for surgery and they picked out a surgeon somewhere else and told the patient that is all they would cover. She had no choice what so ever. She has switched to real medicare now. Before I chose my Medigap plan to go with Medicare, I called Mayo billing to know what plans they accept.
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4 ReactionsI have original Medicare (Part A,B) and I am at Mayo Rochester. For my lung cancer, I was called by the actual Pulmonologist (not scheduling) within hours of receiving my scans and was offered a next day appointment - I have something complex. However, while I live in Minnesota, I live two hours away from Rochester so I am not eligible to have a primary care doctor at Mayo. Mayo explained to me that this was because the people who do live close by would not be able to have primary care doctor if people farther away were given access. This is logical, and for small things or in an emergency I do not want to drive 2 hours especially in the winter!
U my friend absolutely right, I agree 💯 that these Advantages plans should be outlawed. It is so sad that they take ADVANTAGE of folks. no pun intended. It’s so frustrating how the system works especially for TP patients.
Agree with your comments on NP. And Mayo also uses them or PAs.
For my cancer, I have always been seen by my Pulmonologist, and Radiation Oncologist. I had meetings with surgeon also.
Mayo is a teaching and research institution. So, one can expect to see Interns and Resident doctors. Outside my cancer doctors, in other specialty areas I have found that either a resident/Intern or a PA/NP comes in first to collect information. Then the supervising Mayo on staff doctor comes in and goes over things. This happened with my Cardiac stent both for the first time and a new issue 18 months later. (I did my stent at Mayo to assure good communications between specialists since it would impact my cancer treatments. )
For Endocrinologist, I saw first an Intern and then the Mayo staff doctor. However, in Gastroenterology they set up evaluations with Nurse and Intern doctor.