Does Mayo Clinic take Medicare?

Posted by Helen, Volunteer Mentor @naturegirl5, Jun 3, 2022

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

Interested in more discussions like this? Go to the Visiting Mayo Clinic Support Group.

@kayak461

I was a patient at the Mayo a year ago for Prostate Surgery. I am 71 years old, on Medicare, with an AARP Supplemental Plan F. This insurance combination is accepted at the Mayo. They do not accept patients with Medicare Advantage Plans. Advantage Plans have lower premiums for you, but your out of pocket expenses (deductibles) are greater. I received a letter from Mayo Clinic last year explaining that they would no longer except Advantage Plan insured patients.

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I am going to call back as our plan is not an advantage plan and cost us $300 a month extra through my husband’s 32 year teaching career retirement plan. The woman I spoke to didn’t ask any questions other than my name, age, and our insurance company. It’s worth a try because my health is rapidly declining to the point that my daughter, a 32 year RN, says my TSH level at 24.13 is now critical. I don’t know if connected as my TSH level in December was 9.85 - high but not critical then.

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@lfhamc

I think your insurance is only part of the issue with Mayo. I heard about their consultative Internal Medicine program thru my primary care provider at Johns Hopkins, who said some of his patients went to this program at Mayo. I am a physician myself and over the last 3 years have been struggling with finding a unifying diagnosis for the multiple symptoms I have been experiencing so naturally I was interested. I contacted Mayo and was told that their program would do the evaluation within 7-10 days and render a opinion. My current workup, and remember that is for a physician who has fairly clear idea of what specialties may be helpful, still was very disjointed and time-consuming. One specialty clinic told me I have to wait 9 months to be seen. Naturally I applied to the Mayo Consultative program to try to expedite this process. Sadly, after long hours on the phone first to sort our my insurance coverage, then taking the time to fill our a cursory survey, despite the fact that clearly I had already had an extensive evaluation by multiple Johns Hopkins specialists that could not come up with a diagnosis, I was turned down for evaluation by Mayo. No explanation given. The lesson learned here is don't think this program is the end-all for your problems. It is unclear to me what criteria they use to select for patients, maybe just the low-hanging fruits? Better to seek a good primary care internist who can coordinate your workup locally if at all possible. I realize this is a tall order in the state of Medicine today unfortunately, especially given a lot of experienced physicians have left the work force due to the pandemic. God help us all..

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does any doctor or system have a procedure to eliminate anosmia?

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nerdwallet.com
I don't work for them and I don't benefit in any way from mentioning them.
I found their explanations and charts to be really clear and helpful. I did not buy through them.

Under age 65
Medicare eligibility for people under 65 depends on the laws of the STATE that you live in.

Impartial medicare advisors
The federal government has mandated that every state provide the public with trained medicare counselors for FREE. So check your STATE level information, too.

Medicare RATES
Can vary by the COUNTY that you live in. So, if you're planning a move, don't forget to consider that.

For people who already have gone through the process of choosing medicare:
We really should try to educate our family and friends about the process/ warn them how long it takes. Three months of hard work was not enough time for me to find information and to understand it and to make a decision that I felt good about.

It's almost like there are TOO many options now.
And you have to be careful not to get ripped off, or to succumb to advertising and "counselors" who do NOT have your best interest first.
And federal- and state-level considerations. [My state Pennsylvania has a lot of protections for seniors and disabled under 65. Some states don't.]

I had to do a lot of reading. The information on the federal government's website is useful. My state has a good website, too.

All these websites are useful but reading on the computer really tires out my eyes and so the rest of my body, too. You may want to budget in time for fatigue, too.

That's my 2 cents. Hope it helps somebody. Have a good day!

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Does anyone have a suggestion for a good comprehensive drug plan? I have Original Medicare + Part G with Mutual of Omaha. I live in Illinois and have an appointment in Rochester next week.

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You can go on Medicare web site and do a drug plan comparison that allows you to enter the meds you are currently taking and compare plans. I use Aetna Silver Script which works best for me for price and their formulary. I also frequently review Good Rx if I get a new drug prescribed that is high priced using my plan. They usually have much lower prices than any of the drug plans.

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@annewoodmayo

nerdwallet.com
I don't work for them and I don't benefit in any way from mentioning them.
I found their explanations and charts to be really clear and helpful. I did not buy through them.

Under age 65
Medicare eligibility for people under 65 depends on the laws of the STATE that you live in.

Impartial medicare advisors
The federal government has mandated that every state provide the public with trained medicare counselors for FREE. So check your STATE level information, too.

Medicare RATES
Can vary by the COUNTY that you live in. So, if you're planning a move, don't forget to consider that.

For people who already have gone through the process of choosing medicare:
We really should try to educate our family and friends about the process/ warn them how long it takes. Three months of hard work was not enough time for me to find information and to understand it and to make a decision that I felt good about.

It's almost like there are TOO many options now.
And you have to be careful not to get ripped off, or to succumb to advertising and "counselors" who do NOT have your best interest first.
And federal- and state-level considerations. [My state Pennsylvania has a lot of protections for seniors and disabled under 65. Some states don't.]

I had to do a lot of reading. The information on the federal government's website is useful. My state has a good website, too.

All these websites are useful but reading on the computer really tires out my eyes and so the rest of my body, too. You may want to budget in time for fatigue, too.

That's my 2 cents. Hope it helps somebody. Have a good day!

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Correction. Medicare rates do not vary by state. Part B supplement or gap policy rates vary by state and location as do part D drug plans. Part A varies only by income and is usually $0 for most of the senior population.

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@hrhwilliam

Correction. Medicare rates do not vary by state. Part B supplement or gap policy rates vary by state and location as do part D drug plans. Part A varies only by income and is usually $0 for most of the senior population.

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For those of us who are seniors (over age 65), we are eligible for Part A which is at no cost to us.

Part A: the original plan that came about in the 1960’s when Medicare started.

Part B: You have to enroll and choose it which we all do for outpatient care. The cost to you is set by the federal government at a standard rate that is deducted monthly from your social security or you pay yourself. The Part B rate that you pay may vary because it is based on your federal income tax return.

Part C: Medicare Advantage Plans.

Part D: Prescriptions plans which we are all required to have.

All of the other “Parts” refer to supplemental plans that are supposed to fill in the “gaps” that Parts A and B do not cover. It’s totally up to you if you want to do that. All of these other parts vary in their coverage and cost.

What I did: I chose Traditional Medicare so I can go anywhere that Medicare is accepted in state or out of state. I have Parts A and B, Part D (a prescription plan that I chose) and Part G (with Transamerica to cover the gaps). I do not have a network of providers and do not need any preauthorizations under Traditional Medicare. I pay more out of pocket during the year for the Part G plan.

I know it is very confusing however if you go to the federal government’s Medicare website, all of this explained.

Example: My relative who is a resident of Santa Clara County in California has Medicare Part A and he chose to sign up for Part B which is required to enroll in a Medicare Advantage Plan. He chose a Medicare Advantage Plan (Part C) (he had many, many choices given where he lives) with Aetna because he figured out that the doctors and practices that he sees are within the Aetna network. His prescriptions are covered by that plan as the Medicare Advantage plans do cover prescriptions as required. If he decides he doesn’t like Aetna for some reason he can change to another Medicare Advantage Plan during the open enrollment period.

Medicare Advantage Plans work very much like the insurance you are probably used to through your workplace.

With Medicare you choose whether you want Traditional Medicare or a Medicare Advantage Plan.

Please,, everyone, feel free to ask me if you have other questions about Medicare.

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@hrhwilliam

Correction. Medicare rates do not vary by state. Part B supplement or gap policy rates vary by state and location as do part D drug plans. Part A varies only by income and is usually $0 for most of the senior population.

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William,
Thank you for so quickly making the correction!
Anne

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Hi William and Helen,
Could you clarify something for me?

I have Part A and Part B, traditional medicare. I pay for a Supplement/Gap, and I pay for a Part D drug. So, I don't have/don't need a Part C/Advantage Plan.

I am under 65, disabled (Covid on top of a preexisting autoimmune arthritis pushed me out of the workforce and generally wrecked my health...not happy about it.).
I take some typical medications and one very expensive biologic medication.

What factors do I need to consider if I want to change my Supplement/Gap or my Part D drug?

My medicare counselor told me that the commercial insurers might be able to refuse me coverage when I turn 65 based on my health Or they may be able to charge me a lot more, again, based on my health. He also said that, if I stay with the company I have now, they can't refuse me coverage when I turn 65 but they can charge me more. Does that sound accurate to you?

Currently, I am not happy with my Part D drug plan, and I am thinking about changing it at the next open enrollment this Fall. I will still be under 65 at that time.

Thank you very much!

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@annewoodmayo

Hi William and Helen,
Could you clarify something for me?

I have Part A and Part B, traditional medicare. I pay for a Supplement/Gap, and I pay for a Part D drug. So, I don't have/don't need a Part C/Advantage Plan.

I am under 65, disabled (Covid on top of a preexisting autoimmune arthritis pushed me out of the workforce and generally wrecked my health...not happy about it.).
I take some typical medications and one very expensive biologic medication.

What factors do I need to consider if I want to change my Supplement/Gap or my Part D drug?

My medicare counselor told me that the commercial insurers might be able to refuse me coverage when I turn 65 based on my health Or they may be able to charge me a lot more, again, based on my health. He also said that, if I stay with the company I have now, they can't refuse me coverage when I turn 65 but they can charge me more. Does that sound accurate to you?

Currently, I am not happy with my Part D drug plan, and I am thinking about changing it at the next open enrollment this Fall. I will still be under 65 at that time.

Thank you very much!

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First your part D plan. This can be renewed or replaced every year depending upon A) your normal prescriptions you take for maintenance and B) which pharmacy you use or will give you the best deals. My wife and I change our part D plan as time goes by.
Your Part B gap plan most likely will renew you at age 65 and for some the rates may increase or in some cases decrease. You certainly can shop for other plans prior to the month you turn 65 and they may or may not ask you about pre existing conditions. I would recommend at least trying for a better rate plan.
Now, consider this: a high deductible plan may be your best choice. If you look upon insurance as something to cover you in a disaster or major out of the normal health issue, then most people are willing to buck up say $1500 to cover this unusual circumstance. Consider that the $1500 represents the 20% that Medicare may not (may being the operative word) cover. That’s $7500 worth of covered Medicare in one year if all of that requires the 20% to be payed. Anything above that then is covered by the gap policy. For people like me, my gap policy hasn’t paid a dime in the last three years and I have the standard deductible policy. It’s something to consider and we should all know exactly what our gap plan has actually paid.
As for expensive medicines, some are covered by Medicare but they may not be the same medicine you are taking. MS medicines for example, Gylenia is not covered which is a daily oral but (name escapes me maybe Ocravis) taken by injection two times per year is covered. Both have relatively the same efficacy. The Medicare folks can answer which drugs are covered.
Hope this information helps a little.

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