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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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@jc76 Thank you for your additional information, in particular, about Mayo in Jacksonville where you receive your care.
I'd like to add something. When a person signs up for a Medicare Advantage Plan they are handing over their Medicare health care to a private insurance company. That private insurance company, under a variety of regulations including state regulations, is now managing your care. What that means is that the private insurance company, say Aetna, contracts with Medicare, to offer health insurance to those of us who are Medicare eligible. That is Part C of Medicare.
In addition to calling Mayo Clinic to find out if they take your Medicare Advantage Plan I suggest calling the phone number of the back of your insurance card. Ask the insurance company if Mayo Clinic in whichever state you plan to go (Minnesota, Florida, or Arizona) is "in my network".
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3 ReactionsMedicare Advantage Plans differ greatly! I have a plan through my former employer that is nonprofit and not affiliated with any commercial health insurance providers. It was started and is still overseen by physicians, if care is unavailable for certain procedures (septal myectomy) in the service area, one is sent elsewhere. I chose to go to Mayo in Rochester, there were absolutely no problems, excellent customer service from both my insurance people and Mayo, and my out-of-pocket copays were under $450. It's a PPO. I do not understand why this has not been a model for other people, especially health care providers, who want to practice medicine without one hand tied behind their backs. This is my opinion, but the fact that Medicare Advantage Plans can be unaffiliated and nonprofit is informational.
@naturegirl5 I'm on Traditional Medicare and as a retired Veteran I have Tricare for Life as a secondary for medications and many of the copays of traditional. II am in Arizona so I use that location and every year I get the note that at least at this location its Traditional Medicare and they don't take any of the Advantage plans. Hope that helps
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2 ReactionsHere is the Text I received from Mayo Clinic Arizona
Message from Mayo Clinic Online Services, sent September 26 at 9:35 AM
Mayo Clinic Online Services
Sep 26, 9:35 AM
Reminder: Mayo Clinic in Arizona accepts Original Medicare, is not in network for Medicare Advantage Plans
Beginning in mid-October, it will again be time to select healthcare coverage for a new year. Because you have received care from us, we wanted to remind you that Mayo Clinic in Arizona is not in network for Medicare Advantage Plans.* This means that even if a plan suggests you can receive care at any facility accepting Medicare, it does not include Mayo Clinic.
We continue to accept Original Medicare (Parts A, B and D), and supplemental 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 in-network facility you select for your care.
Learn more about your Medicare options at Medicare.gov, or by calling Medicare (1-800-MEDICARE) or a State Health Insurance Assistance Program (find a local resource by calling 877-839-2675). Mayo Clinic is not authorized to assist with Medicare enrollment decisions.
* Limited Medicare Advantage contracts exist for organ transplantation and transplant-related care only.
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3 ReactionsMedicare from CMS is Medicare. Advantages Plans (while using MEdicare in their names) IS NOT Medicare. As They say there is no free lunch and this is one of those situation. By opting into an "Advantage Plan" (note I did not use the term Medicare), you are essentially allowing a third party, for profit insurance company to "buy" your health coverage responsibilities from CMS.....and thus Medicare rules do not apply. While advantage plans may look attractive (free this, free than, money back, Joe Nemeth driving you to Bingo....etc), all the "non-essential" non-medical "stuff" comes at a cost...and really has no impact on your real health care. Limited provider access, more aggressive cost management, geographic restrictions and more. As I said "no free lunch". If you are healthy (though not guaranteed as you age), require minimal care and are willing to "risk your life" with for-profit coverage, the "Go Advantage"..... you better be banking the "savings" as you will need the money later to cover all the stuff they wont. Advantage plans play on your emotions and not logical, long term assessment. Advantage plans can (and do) change the rules year to year...even up the point of cancelling you. REAL Medicare (while not perfect) is the gold standard for choice of providers, choice of locations, accessibility to care at Centers of Excellence (like Mayo, Cleveland, Johns-Hopkins, etc.). Core reason many providers don't take "advantage plans" is payment and process. Advantage plans are a nightmare for providers....too many burdens placed on the provider to gain approvals and get paid... ALso Advantage plans try to tell providers how to do their job. Do you want some "clerk" behind a screen, reading script telling your provider (think a physician at Mayo) how to do (or not do) their job? I could go on for pages but as a business owner who for decades dealt with the insurance needs of my employees, my months long analysis for my own post retirement needs pointed to conventional CMS Medicare hands down. I commend Mayo and other providers for refusing to lower their ability to provide the best medical care in order to get into the "advantange plan (not Medicare)" business..... End of rant..... YMMV....
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7 Reactions@flrvingbob Everything you wrote is very helpful and unfortunately, true. Yet, there is at least one Medicare Advantage Plan that is not-for-profit and is not managed by insurance companies where the primary mission is to make the stockholders happy. While both younger people and retirees as individuals can choose a plan shown on the website from this company, (CDPHP), many places of employment, including the one that I retired from, choose a PPO group Advantage Plan from CDPHP for their retirees. No insurance problems at Rochester Mayo for a septal myectomy or any other best care there or at home. I wish that physicians in other places would consider starting a not-for-profit insurance company that is overseen by medical people and others who put the patient first.
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2 Reactions@flrvingbob Spot on. I don't know why anyone would sign up for an advantage plan.
I'd second all said above. One irritant for me are the ads attempting to confuse traditional Part C Medicare with "Advantage" plans - "Commonly known as 'Advantage"". They are very different animals...
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1 Reaction@earle Part C Medicare is an Advantage Plan. While the ads are confusing - that's very true - that part is accurate. Below I have copied the website from the .gov website that explains this.
What is Medicare Part C?
-- https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html
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2 ReactionsThat's true. All Advantage plans are not Part C, though. Our Part C cards read "C-Plus," and then down in the corner, is printed "plan G". I've read that before and it could be written more clearly. I just wish more people understood that signing onto an Advantage plan meant largely turning over your coverage decision to a private company, rather than your own doctor. That world of "something for nothing" never has existed, in any context, and particularly not this one. Where do people think all that wonderful money for rides for groceries, etc. is coming from? In my case, MDA wants PET follow-ups every two months for a while. So far, I've not paid a penny out of pocket for any procedure. Just try getting that by an advantage plan's panel of "experts." That's where they make their vast profits...
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